State Ex Rel. Com'r of Ins. v. State Ex Rel. Atty. Gen.

198 S.E.2d 575, 19 N.C. App. 263
CourtCourt of Appeals of North Carolina
DecidedAugust 29, 1973
Docket73101NS493
StatusPublished
Cited by1 cases

This text of 198 S.E.2d 575 (State Ex Rel. Com'r of Ins. v. State Ex Rel. Atty. Gen.) 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. Com'r of Ins. v. State Ex Rel. Atty. Gen., 198 S.E.2d 575, 19 N.C. App. 263 (N.C. Ct. App. 1973).

Opinion

198 S.E.2d 575 (1973)
19 N.C. App. 263

STATE of North Carolina ex rel. COMMISSIONER OF INSURANCE and the North Carolina Compensation Rating and Inspection Bureau
v.
STATE of North Carolina ex rel. ATTORNEY GENERAL.

No. 73101NS493.

Court of Appeals of North Carolina.

August 29, 1973.
Certiorari Denied and November 1, 1973.

*577 Allen, Steed & Pullen, by Arch T. Allen, and Thomas W. Steed, Jr., Raleigh, for plaintiff appellee the North Carolina Compensation Rating and Inspection Bureau.

Atty. Gen., Robert Morgan, by Asst. Atty. Gen., Charles A. Lloyd, Raleigh, for intervenor appellant.

Certiorari Denied and Appeal Dismissed November 1, 1973.

BALEY, Judge.

The statutory method for judicial review of decisions by the Commissioner of Insurance concerning insurance rates is set out in G.S. § 58-9.4 through G.S. § 58-9.6.

G.S. § 58-9.4 provides in part:

". . . Any order or decision of the Commissioner, if supported by substantial evidence, shall be presumed to be correct and proper. . . ."

G.S. § 58-9.6(e) sets out:

"Upon any appeal, the rates fixed or any rule, regulation, finding, determination, or order made by the Commissioner under the provisions of this Chapter shall be prima facie correct."

The position of the Attorney General is that there is no substantial evidence supporting the Commissioner's approval of the rate increase in the present case. In particular, he contends that the Commissioner *578 was not supported by substantial evidence in determining that the insurance company should be allowed a profit figure equal to 2.5% of the total premiums received. In our judgment there is substantial evidence to support the decision of the Commissioner, and it is affirmed.

The standard of "substantial evidence" is widely used in judicial review of administrative decisions. It has been defined by the North Carolina Supreme Court as "more than a scintilla or a permissible inference." Utilities Commission v. Trucking Co., 223 N.C. 687, 690, 28 S. E.2d 201, 203. The United States Supreme Court has interpreted it as "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion," Consolidated Edison Co. v. NLRB, 305 U.S. 197, 229, 59 S.Ct. 206, 217, 83 L.Ed. 126 (1938), and has stated that "it must be enough to justify, if the trial were to a jury, a refusal to direct a verdict when the conclusion sought to be drawn from it is one of fact for the jury." NLRB v. Columbian Enameling & Stamping Co., 306 U.S. 292, 300, 59 S.Ct. 501, 505, 83 L.Ed. 660 (1939). See generally 4 K. Davis, Administrative Law Treatise, §§ 29.01-.06. In the application of the "substantial evidence" standard courts will generally defer to the expertise of the administrator in his specialized field if there is reasonable evidence to support his decision.

Here the expert witness Roy Kallop, a workmen's compensation insurance actuary, testified in detail at the public hearing as to the procedure used by the Bureau in arriving at the increased rate. He stated that this procedure involved determining the total amount of premiums received by the companies over a year-long period and their yearly losses (payments on claims by policyholders) and loss adjustment expense. It involved adjusting these figures to reflect current premium rates and benefit levels and determining the proportion of total premiums received which is paid out by the companies in losses and loss adjustment expense. Detailed charts (based on policies taking effect during the twelve-month periods beginning 1 August 1968 and 1 August 1969) were submitted at the hearing, showing that in North Carolina, at the present premium rates, losses and loss adjustment expense would take up such a large proportion of total premiums (67.9%) that, when other company expenses and taxes (amounting to 31.1% of total premiums) were added, the amount remaining for the companies' profit would be less than 2.5% on premium receipts. Additional charts, based on more recent data involving all policies in effect in the twelve-month period beginning 1 July 1971, likewise indicated that present premium levels were inadequate. Kallop testified that the Bureau's procedure for determining rate levels had been followed for many years, was generally accepted throughout the United States, and was brought up to date by review each year by the National Council on Compensation Insurance. As to the validity of setting the companies' profit at 2.5% of total premiums received, Kallop testified in his opinion as an expert that the 2.5% figure is "a minimum profit allowance," that it "has been adhered to for many years," that it is followed in all states except California, that it is not a guaranteed profit since it also covers contingencies such as unforeseeably high losses, that "the profit allowance is less than what it is in other [types of insurance] because this is a highly regulated line," that it "is a minimum factor that is necessary to attract capital," that "[a]fter taxes the 2.5 is reduced to 1.3," and that the 2.5% allowance is reasonable and "eminently fair."

In In re Filing by Automobile Rate Office, 278 N.C. 302, 180 S.E.2d 155, it was held that hearings before the Commissioner are not within the scope of G.S. §§ 143-317 and 318, requiring administrative agencies to consider only evidence that would be admissible in court. The Commissioner is free to hear "`all evidence of any type having reasonable probative value,'" including "`[a]ny evidence of the type upon which responsible persons are *579 accustomed to rely in the conduct of insurance affairs.'" 278 N.C. at 318, 180 S.E. 2d at 166, quoting Rules and Regulations for Public Hearings, promulgated by the Insurance Advisory Board in 1950.

The testimony of Kallop, along with the charts presented at the Commissioner's hearing, seems clearly to come within the standard of admissibility established in the Automobile Rate case, and to provide more than a scintilla of evidence supporting the validity of the 2.5% profit allowance and of the increased premium rates. If these issues were being submitted to a jury, the judge would not be justified in directing a verdict that the profit allowance or the rate increase was improper. Thus both the Commissioner's determination that 2.5% is an appropriate profit figure, and his ultimate decision that the rate increase was fair and reasonable, are supported by substantial evidence and should be upheld.

However, the Attorney General has raised three additional issues, each of which, he contends, requires reversal of the Commissioner's decision. First, he insists that the Commissioner should have required the presentation of evidence relating to the amount of capital necessary to engage in the workmen's compensation insurance business in North Carolina and the rate of return needed to attract such investment capital. This contention has been rejected in several North Carolina cases.

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198 S.E.2d 575, 19 N.C. App. 263, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-ex-rel-comr-of-ins-v-state-ex-rel-atty-gen-ncctapp-1973.