Schwartz v. Corcoran

118 A.D.2d 355, 505 N.Y.S.2d 401, 1986 N.Y. App. Div. LEXIS 55161
CourtAppellate Division of the Supreme Court of the State of New York
DecidedJuly 31, 1986
StatusPublished
Cited by5 cases

This text of 118 A.D.2d 355 (Schwartz v. Corcoran) is published on Counsel Stack Legal Research, covering Appellate Division of the Supreme Court of the State of New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Schwartz v. Corcoran, 118 A.D.2d 355, 505 N.Y.S.2d 401, 1986 N.Y. App. Div. LEXIS 55161 (N.Y. Ct. App. 1986).

Opinion

OPINION OF THE COURT

Fein, J.

In this CPLR article 78 proceeding seeking vacatur of an order of the Superintendent of Insurance of the State of New York (Superintendent), the Superintendent appeals from so much of an order and judgment, Supreme Court, New York County (Robert E. White, J.), entered November 1, 1985, as granted the petition by annulling that part of the Superintendent’s January 11, 1985 order which determined that the Medical Malpractice Insurance Association (MMIA) rate is the "lowest appropriate base rate for physicians and surgeons [357]*357professional liability coverage in New York State” and attempted to utilize said rate to fix the rates of other malpractice insurance carriers, and also annulling that part of the directive that each medical malpractice insurer submit a rate filing for the 1984-1985 policy year "actuarially equivalent” to the MMIA rate so fixed.

Respondent Medical Liability Mutual Insurance Company (MLMIC) appeals from so much of the order and judgment as denied its motion to dismiss the petition and denied it leave to answer the petition.

Petitioner Joseph C. Polifrone, M. D. (Polifrone) cross-appeals from so much of the order and judgment as denied that part of the petition which sought to annul so much of the Superintendent’s order as approved an increase in MMIA’s rates for physicians and surgeons professional liability insurance. Polifrone is a physician insured by MMIA.

Petitioner Howard Stanley Schwartz, M. D. (Schwartz), is a physician insured by respondent Physicians Reciprocal Insurers (PRI).

Petitioner William Winner, M. D. (Winner), is a physician insured by MLMIC.

MMIA is a statutorily created, nonprofit, unincorporated association established to provide medical malpractice insurance which is not readily available in the voluntary market. The rates for most insurance carriers are governed by Insurance Law article 23. All insurance companies directly writing personal injury insurance in New York are required to be members of MMIA as a condition of their continued authority to transact business in this State.

MMIA is required by the Insurance Law to provide primary medical malpractice insurance up to $1 million per occurrence, with an annual aggregate limit of $3 million, upon the application of any physician or surgeon licensed to practice in New York (Insurance Law § 5502 [e] [1]; § 5506). MMIA’s rates are developed and filed under the standards of Insurance Law articles 23 and 55.

Insurance Law § 5505 (b) provides, in part: "All rates shall be on an actuarially sound basis, [and] be calculated to be self-supporting * * * The premiums shall be fixed at the lowest possible rates consistent with the maintenance of solvency of the association and of reasonable reserves and surplus therefor.”

Insurance Law § 2303 provides, in part: "Rates shall not be [358]*358excessive, inadequate, unfairly discriminatory, destructive of competition or detrimental to the solvency of insurers.”

In developing MMIA’s rates, Insurance Law § 5505 (a) provides that consideration shall be given to: "past and prospective loss and expense experience for medical malpractice insurance written and to be written in this state, trends in the frequency and severity of losses, the investment income of the association, and such other information as the superintendent may require.” The Superintendent is required to take all appropriate steps to make available to MMIA the loss and expense experience of insurers previously writing medical malpractice insurance in New York. He is empowered to disapprove a rate filing by MMIA which does not meet the requirements of the Insurance Law (§ 2305 [b]; § 2321 [b]). MMIA is entitled to a hearing challenging the disapproval of its rate filing and to a written final determination concerning its rate filing.

MLMIC is the largest writer of medical malpractice insurance in New York. In the early 1980’s, both MLMIC and MMIA filed for a series of substantial increases. The Superintendent approved a different rate increase for each. MMIA demanded an adjudicatory hearing. When the Superintendent declined to hold a hearing, MMIA instituted an article 78 proceeding in the nature of mandamus to compel a hearing. The petition was granted (Matter of Medical Malpractice Ins. Assn. v Lewis, 112 Misc 2d 103, affd 87 AD2d 571, lv denied 56 NY2d 506). A hearing was held and concluded on July 20, 1982.

MMIA filed a request for an increase for the 1983-1984 policy year. There were further proceedings, and finally the Superintendent directed a hearing on MMIA’s 1983 rate filing. The Superintendent invited all insurers potentially affected by a decision on MMIA’s premium rate, including MLMIC, to participate in the hearings. The hearings were held over a period of several months, first before former Chief Judge Stanley H. Fuld, and later, after his recusal, before former Judge Domenick L. Gabrielli (the hearing officer). During the hearings, MMIA filed for a rate increase for 1984-1985. It was decided that the scope of the hearing should be expanded to include a determination of that rate as well as the rate for 1983-1984. Extensive testimony was taken. The hearing officer issued written findings, conclusions and recommendations on December 10, 1984.

[359]*359The hearings demonstrated that MMIA’s rates were based upon the combined State-wide experience of major writers of medical malpractice insurance, not MMIA’s experience alone. MLMIC and other insurers do not rely on their own experience.

In his 25-page report, Judge Gabrielli determined that MMIA was entitled to a 42% rate increase for the 1983-1984 policy year and an additional 8% for the 1984-1985 policy year. Judge Gabrielli noted that the findings were limited to the MMIA rate filings under review and were not "generic” determinations.

On January 11, 1985 the Superintendent adopted Judge Gabrielli’s recommendations. However, the Superintendent concluded that despite Judge Gabrielli’s caveat, the report had broader implications than merely the proper level of MMIA rates. The Superintendent stated that he expected other medical malpractice insurers to submit rate filings that would bring their rates to an actuarially equivalent level unless there was sufficient evidence to justify deviations from the MMIA level. The Superintendent stated that the other insurers could submit evidence to justify different rate levels.

The Superintendent’s order stated in relevant part:

"[Although Judge Gabrielli limits his report to MMIA and does not render a generic determination in this matter, I find the Gabrielli Report to have broader implications * * *
"It is clear from the Gabrielli Report, testimony and other evidence produced at the hearing that the data base used in the analysis of the appropriate rate for MMIA in regard to physicians and surgeons professional liability insurance in New York has great relevance to, and in many respects is, the data base utilized by the other medical malpractice insurance carriers in this State.
"In the absence of observable and measurable factors to the contrary, the rate that is appropriate for MMIA is also the lowest appropriate base rate for physicians and surgeons professional liability coverage in New York State.

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Related

Gramercy North Associates v. Biderman
169 A.D.2d 345 (Appellate Division of the Supreme Court of New York, 1991)
City of New York v. Corcoran
150 Misc. 2d 359 (New York Supreme Court, 1990)
Med. Assn v. Supt of Ins
72 N.Y.2d 753 (New York Court of Appeals, 1988)
Medical Malpractice Insurance Ass'n v. Superintendent of Insurance
533 N.E.2d 1030 (New York Court of Appeals, 1988)
Medical Malpractice Insurance v. Superintendent of Insurance
141 A.D.2d 475 (Appellate Division of the Supreme Court of New York, 1988)

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Bluebook (online)
118 A.D.2d 355, 505 N.Y.S.2d 401, 1986 N.Y. App. Div. LEXIS 55161, Counsel Stack Legal Research, https://law.counselstack.com/opinion/schwartz-v-corcoran-nyappdiv-1986.