S.D. Life & Health Guaranty Assoc. v. S.D. Bankers Benefit Plan Trust

993 N.W.2d 543, 2023 S.D. 31
South Dakota Supreme Court·Decided July 5, 2023·No. 29895·Published

Opinion

#29895-r-JMK 2023 S.D. 31

IN THE SUPREME COURT

OF THE

STATE OF SOUTH DAKOTA

****

SOUTH DAKOTA LIFE & HEALTH GUARANTY ASSOCIATION, Appellee,

v.

SOUTH DAKOTA BANKERS BENEFIT PLAN TRUST, Appellant.

****

APPEAL FROM THE CIRCUIT COURT OF THE SIXTH JUDICIAL CIRCUIT HUGHES COUNTY, SOUTH DAKOTA

****

THE HONORABLE M. BRIDGET MAYER Judge

****

MICHAEL L. SNYDER CHARLES D. GULLICKSON MITCHELL A. PETERSON of Davenport, Evans, Hurwitz & Smith, LLP Sioux Falls, South Dakota Attorneys for appellee.

TERRA M. LARSON MICHAEL F. SHAW of May, Adam, Gerdes & Thompson, LLP Pierre, South Dakota Attorneys for appellant.

****

ARGUED

AUGUST 31, 2022

OPINION FILED 07/05/23

KERN, Justice [¶1.] Until 2019, the South Dakota Bankers Benefit Plan Trust (Trust) was statutorily required to be a member of the South Dakota Life and Health Guaranty Association (Association). The Association covers impaired and insolvent insurers’ obligations to their insureds by assessing Association members. In 2017, the Association assumed liability for an insolvent insurer. The Association established a five-year assessment schedule to cover the insolvent insurer’s obligations. The Trust paid three years but protested having to pay the last two because they were assessed after its membership in the Association ended. The Association denied the Trust’s protests. [¶2.] The Trust appealed to the South Dakota Division of Insurance, which scheduled a hearing in front of the Office of Hearing Examiners (Examiner). The Examiner determined that the Association had no legal authority to assess the Trust for the last two assessments because they were authorized and called after the Trust ended its membership in the Association, and the Employee Retirement Income Security Act of 1974 (ERISA) preempted the State’s laws requiring trusts to make payments for assessments. [¶3.] The Association appealed the Examiner’s decision to the circuit court, arguing that the Association had legal authority to assess the Trust under State law and its plan of operation, and ERISA does not preempt any state insurance law making the Trust liable for the assessments. The circuit court reversed the Examiner’s order and adopted the Association’s arguments. The Trust now appeals

from the circuit court’s order requiring the Trust to pay the two assessments along with prejudgment interest. We reverse.

Facts and Procedural History [¶4.] Both parties have stipulated to the material facts underlying this appeal as first recounted in the Examiner’s findings of fact. The Association is an organization that exists to pay benefits and continue coverages of impaired and insolvent insurers through assessments that it levies upon its member insurers, subject to limitations delineated in SDCL chapter 58-29C. South Dakota Bankers Benefit Plan Trust is a Multiple Employer Welfare Arrangement (MEWA) under ERISA § 3(40). The Trust is also a self-funded Multiple Employer Trust (MET) pursuant to SDCL 58-18-88. The Trust provides and maintains an employee welfare benefit plan for eligible employees of employers that are active members of the South Dakota Bankers Association. It describes its purpose as “assum[ing] the financial risk of providing health care benefits to its members by maintaining stop- loss coverage and adequate reserves to cover any potential losses, as well as making participating employers assessable in the event of insolvency.” [¶5.] Before July 1, 2019, the Trust was required under SDCL 58-18-88(6) to participate in and be a member of the Association. However, on July 1, 2019, a legislative amendment to SDCL 58-18-88 took effect and eliminated the Trust’s mandatory membership in the Association. Consequently, the Trust ended its membership. [¶6.] At issue in this appeal is whether the Trust is obligated to pay assessments issued by the Association after the Trust ceased being a member. The

assessments arose from the insolvency of the insurers Penn Treaty Network American Company and its subsidiary American Network Insurance Company (collectively Penn Treaty). Penn Treaty was declared insolvent pursuant to an order of liquidation entered by the Commonwealth Court of Pennsylvania on March 1, 2017, approximately two years before the Trust ended its membership with the Association. That same day, the Association accepted liability for and reinsured the obligations it incurred as a result of Penn Treaty’s liquidation. The Association decided to spread the obligatory payments, resulting from the liquidation, over five years rather than requiring its members to pay a one-time lump-sum payment. 1 Had it wished to, the Association asserts that it could have legally assessed a one- time lump-sum payment in 2017 pursuant to SDCL 58-29C-51(O) and SDCL 58- 29C-52(A). 2

1. The Association authorized yearly assessments for its total obligation. The first of five yearly assessments was authorized in a resolution passed unanimously by the Association’s Board of Directors on April 5, 2017. In part, this resolution stated:

The Board hereby authorizes and approves a Class B assessment of its member insurers having health premiums in South Dakota for the time periods specified herein in the amount of $8,800,000 less the amount of PTNA and ANIC assets allocable to the Association as reasonably determined by the guaranty associations’ Penn Treaty Task Force, its consulting actuaries, LTC Re, and the Executive Director of the Association. The Board notes that the current estimated amount of estate assets allocable to the Association is $3,176,000 and may be subject to change.

2. During oral arguments, the Trust expressed doubt over whether the Association could have assessed a one-time lump-sum payment for the entire obligation amount. The Trust directed this Court to SDCL 58-29C-

52(E)(1)(a), which provides that “the total of all assessments . . . may not in (continued . . .)

[¶7.] To satisfy its obligations over the five years, as planned, the Association began authorizing yearly assessments to be paid by its members. 3 The Association authorized and called assessments in 2017, 2018, and 2019. The Trust paid all three without objection. 4 However, after the Trust ended its membership in the Association, it protested having to pay the Association’s 2020 assessment, which was authorized on December 20, 2019, and called on January 22, 2020. On January 28, 2020, in response to the called assessment, the Trust sent the Association a letter outlining its objection to paying the assessment. The Association responded in a letter dated February 7, 2020, stating its understanding that the Trust was still

(. . . continued)

one calendar year exceed two percent of that member insurer’s average annual premiums[.]” Although the Trust’s average premiums are not in the record, the Trust asserted that a one-time lump-sum payment would have exceeded the statutory limit by $105,000.

3. Each yearly assessment levied by the Association must go through the statutory process of being “authorized” and “called” by the Association before member insurers must pay the assessment. SDCL 58-29C-48(3) defines an assessment as “authorized” when “a resolution by the board of directors has been passed whereby an assessment will be called immediately or in the future from member insurers for a specified amount. An assessment is authorized when the resolution is passed[.]” (Emphasis added.) Member insurers do not have to pay an authorized assessment until it is “called,”

which occurs when “a notice has been issued by the association to member insurers requiring that an authorized assessment be paid within the time frame set forth within the notice. An authorized assessment becomes a called assessment when notice is mailed by the association to member insurers[.]”

SDCL 58-29C-48(5).

Free access — add to your briefcase to read the full text and ask questions with AI

S.D. Life & Health Guaranty Assoc. v. S.D. Bankers Benefit Plan Trust, 993 N.W.2d 543, 2023 S.D. 31 (S.D. 2023).

993 N.W.2d 543 (S.D. Life & Health Guaranty Assoc. v. S.D. Bankers Benefit Plan Trust) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Related

Goetz v. State
2001 SD 138 (South Dakota Supreme Court, 2001)
Halls v. White
2006 SD 47 (South Dakota Supreme Court, 2006)
In Re the Expungement of Records Related to Oliver
2012 S.D. 9 (South Dakota Supreme Court, 2012)
Muhlenkort v. Union County Land Trust
530 N.W.2d 658 (South Dakota Supreme Court, 1995)
Grievance of Wendell v. South Dakota Department of Transportation
1998 SD 130 (South Dakota Supreme Court, 1998)
US West Communications, Inc. v. Public Utilities Commission
505 N.W.2d 115 (South Dakota Supreme Court, 1993)
Liberty Mutual Insurance v. Superintendent of Insurance
1997 ME 22 (Supreme Judicial Court of Maine, 1997)
Skjonsberg v. Menard, Inc.
2019 SD 6 (South Dakota Supreme Court, 2019)
Butte County v. Vallery
1999 SD 142 (South Dakota Supreme Court, 1999)
Matter of Tax Refund of Hunt Cos.
2019 S.D. 26 (South Dakota Supreme Court, 2019)
Pirmantgen v. Roberts County, South Dakota
954 N.W.2d 718 (South Dakota Supreme Court, 2021)
Endres v. Endres
984 N.W.2d 139 (South Dakota Supreme Court, 2022)