State Ex Rel. Commissioner of Insurance v. Rate Bureau

252 S.E.2d 811, 40 N.C. App. 85, 1979 N.C. App. LEXIS 2620
CourtCourt of Appeals of North Carolina
DecidedMarch 6, 1979
Docket7810INS238
StatusPublished
Cited by10 cases

This text of 252 S.E.2d 811 (State Ex Rel. Commissioner of Insurance v. Rate Bureau) is published on Counsel Stack Legal Research, covering Court of Appeals of North Carolina primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State Ex Rel. Commissioner of Insurance v. Rate Bureau, 252 S.E.2d 811, 40 N.C. App. 85, 1979 N.C. App. LEXIS 2620 (N.C. Ct. App. 1979).

Opinion

CLARK, Judge.

The Rate Bureau has appealed under the provisions of G.S. 58-124.22 and G.S. 58-9.4 from the order of the Commissioner of Insurance disapproving the 9 September 1977 Filing of the Rate Bureau in its entirety. This Court has the authority under G.S. 58-9.6(b) to reverse or modify the order of the Commissioner “if the substantial rights of the appellants have been prejudiced because the Commissioner’s findings, inferences, conclusions or decisions are: . . . [unsupported by material and substantial evidence in view of the entire record as submitted . . . .” The insurers, represented in this case by appellant Rate Bureau, have the right to a premium rate which will assure a fair and reasonable profit and no more. State ex rel. Commissioner of Insurance v. Rating Bureau, 292 N.C. 471, 234 S.E. 2d 720 (1977).

The problem of deciding whether the Commissioner has acted responsibly is a delicate one. In this case brevity must yield to the massive record and the need for construction of 1977 rate-making legislation, codified in Article 12B, Chapter 58, General Statutes of North Carolina. Having given some consideration to the record on appeal, the briefs, relevant statutes and opinions, we approach the decision-making with the desire to avoid the tendency to judicialize administrative rate-making procedures.

I. Workers’ Compensation Rate of 1973

The last rate adjustment for workers’ compensation insurance rates went into effect on 1 December 1973. See State ex rel. Commissioner of Insurance v. Attorney General, 19 N.C. App. 263, 198 S.E. 2d 575, cert. denied 284 N.C. 252, 200 S.E. 2d 659 (1973). Under the statutory scheme at that time the Compensation Rating and Inspection Bureau was required to submit its rate proposals to the Commissioner for approval. G.S. 97-100; G.S. 97-102 to -104. The 1973 rate change was based on the 21 September *93 1972 Filing made by the Bureau. After the 1973 rate became effective, a rate filing was made on 19 March 1974 and was denied by the Commissioner on 14 October 1975. Upon appeal, this Court on 4 August 1976 ordered a remand for appropriate findings. See State ex rel. Commissioner of Insurance v. Rating and Inspection Bureau, 30 N.C. App. 332, 226 S.E. 2d 822 (1976). Thereafter the Commissioner held a series of hearings in 1976 and 1977, issued his “Revised Findings of Fact” on 11 February 1977, and again disapproved the Filing. The Bureau again appealed, and this Court in an opinion filed on 18 April 1978 vacated the order of the Commissioner on the ground that his findings of fact were not supported by material and substantial evidence, but the proceeding was not remanded because of the 9 September 1977 Filing which is the subject of this appeal. State ex rel. Commissioner of Insurance v. Rating and Inspection Bureau, 36 N.C. App. 98, 242 S.E. 2d 887 (1978).

Since the 21 September 1972 Filing, the basis for the 1973 rate, there have been six legislative changes and three Industrial Commission changes which have increased benefit levels and costs for workers’ compensation. These changes constitute substantially the basis for this 9 September 1977 Filing, an overall increase of 28.4% over the 1973 rate. Assuming that the 1973 rate was fair, in view of the nine changes resulting in increased benefit levels and costs, it is reasonable to conclude some increase in the rate is necessary to assure the insurer a fair and reasonable profit.

II. 1977 Legislation

In 1977 the General Assembly modified G.S. 97-100 and repealed G.S. 97-102 to -104 and other statutes making up a patchwork system of rate-making procedures and enacted new and comprehensive legislation for the purpose of regulating workers’ compensation and other types of insurance rate-making. Article 12B, Chapter 58, General Statutes of North Carolina.

The old “prior approval” method of setting workers’ compensation insurance rates was replaced by a new “file and use” procedure which in substance authorized the Rate Bureau to make a rate filing and provided that “[e]ach filing shall become effective immediately on the date specified therein but not earlier than 90 *94 days from the date such filing is received by the Commissioner.” G.S. 58424.20(a).

If the Commissioner contends that the Filing fails to comply with the law he must, within 30 days after the date of the filing, give written notice to the Bureau “specifying in what respect . . . he contends such filing fails to comply . . .” and fix a date for hearing. G.S. 58424.21(a).

At such hearing the Commissioner shall consider the factors specified in G.S. 58424.19 as follows:

“Method of rate making; factors considered.— The following standards shall apply to the making and use of rates:
(1) Rates shall not be excessive, inadequate or unfairly discriminatory.
(2) Due consideration shall be given to past and prospective loss experience, within this State, to the hazards of conflagration and catastrophe, to a reasonable margin for underwriting profit and to contingencies, to dividends, savings or unabsorbed premium deposits allowed or returned by insurers to their policyholders, members or subscribers, to past a.nd prospective expenses specially applicable to this State, and to all other relevant factors including judgment factors, deemed relevant, within this State; provided, however, that countrywide expense and loss experience and other countrywide data shall be considered where credible North Carolina experience or data is not available.”

After hearing, if the Commissioner disapproves the filing, wholly or in part, G.S. 58424.21(a) requires that he include in his order “wherein and to what extent such filing is deemed to be improper . . . .” And to insure proper appellate review upon appeal under G.S. 58-9.4 by the Rate Bureau from all or any part of the order, the Commissioner must make findings of fact which specifically point out the absence of, or deficiencies in, the evidence produced in support of the filing. These findings must be supported by material and substantial evidence in view of the entire record as submitted. G.S. 58-9.6(b)(5); State ex rel. Commissioner of Insurance v. Rating Bureau, 292 N.C. 70, 231 S.E. 2d 882 (1977).

*95 Pending judicial review of the Commissioner’s order of disapproval, the Rate Bureau has the option to continue to use the filing rate, provided that each insurer member of the Bureau shall place in escrow account “the purportedly unfairly discriminatory or excessive portion of the premium collected during such interim period and the court, upon a final determination, shall order the escrowed funds to be distributed appropriately, except that refunds that are de minimus shall not be required.” G.S. 58-124.22(b).

This completes our attempt to present the new statutory scheme for workers’ compensation insurance rate-making. Verbatim quotations from the various relevant statutes have been limited and many statutes have been summarized, hopefully avoiding accusations of voluminosity without sacrificing clarity.

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Related

State ex rel. Commissioner of Insurance v. North Carolina Rate Bureau
284 S.E.2d 339 (Court of Appeals of North Carolina, 1981)
State Ex Rel. Commissioner of Insurance v. North Carolina Rate Bureau
269 S.E.2d 547 (Supreme Court of North Carolina, 1980)
STATE EX REL. COMMISSIONER OF INS. v. North Carolina Rate Bureau
256 S.E.2d 810 (Supreme Court of North Carolina, 1979)

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Bluebook (online)
252 S.E.2d 811, 40 N.C. App. 85, 1979 N.C. App. LEXIS 2620, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-ex-rel-commissioner-of-insurance-v-rate-bureau-ncctapp-1979.