Sun Life Assurance Co. of Canada v. Indiana Department of Insurance

868 N.E.2d 50, 2007 Ind. App. LEXIS 1257, 2007 WL 1696483
CourtIndiana Court of Appeals
DecidedJune 13, 2007
Docket49A05-0610-CV-547
StatusPublished
Cited by20 cases

This text of 868 N.E.2d 50 (Sun Life Assurance Co. of Canada v. Indiana Department of Insurance) is published on Counsel Stack Legal Research, covering Indiana Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Sun Life Assurance Co. of Canada v. Indiana Department of Insurance, 868 N.E.2d 50, 2007 Ind. App. LEXIS 1257, 2007 WL 1696483 (Ind. Ct. App. 2007).

Opinion

OPINION

RILEY, Judge.

STATEMENT OF THE CASE

Appellants-Petitioners, Sun Life Assurance Company of Canada, and Sun Life Assurance Company of Canada (U.S.) (collectively, Sun Life), appeal the trial court’s Findings of Fact and Conclusions of Law denying its Petition for Judicial Review in favor of Appellees-Respondents, Indiana Department of Insurance and Indiana Comprehensive Health Insurance Association (collectively, ICHIA).

We affirm.

ISSUES

Sun Life raises three issues on appeal, which we consolidate and restate as the following two issues:

(1) Whether the trial court erred by concluding that, pursuant to Indiana Code sections 27-8-10-2.1(g) and 27-8-10-14, ICHIA appropriately calculated Sun Life’s 2004 True-Up Assessment based on the statutory methodology prescribed for the assessment period through December 31, 2004; and
(2) Whether the trial court erred by denying Sun Life’s Motion to Strike certain facts which were not contained in the administrative record or attested to in affidavits, or included within other supporting testimony.

On Cross-Appeal, ICHIA raises one issue, which we restate as follows: Whether the trial court erred in finding that the Commissioner of the Indiana Department of Insurance acted arbitrarily and capriciously in dismissing Sun Life’s appeal as untimely.

FACTS AND PROCEDURAL HISTORY

ICHIA is a not-for-profit entity, created by statute in 1981, to “assure that health insurance is made available throughout the year to each eligible Indiana resident applying to [ICHIA] for coverage.” See Ind. Code § 27-8-10-2.1. In other words, IC-HIA is a legislatively created health insurance provider whose essential purpose is to provide health insurance coverage for certain high risk individuals in Indiana. Specifically, ICHIA insures Indiana residents who, as a result of their chronic and/or catastrophic illnesses have: 1) been refused coverage by at least one private insurer; 2) have one or several catastrophic illnesses automatically qualifying them for ICHIA coverage; or 3) would otherwise be able to obtain insurance only at a price higher than ICHIA’s premium rate or with material underwriting restrictions. See I.C. § 27 — 8—10—5.1 (b); Avemco Ins. Co. v. State ex rel. McCarty, 812 N.E.2d 108, 111 (Ind.Ct.App.2004).

The General Assembly requires all companies “providing health insurance or health care services in Indiana” to be members of ICHIA as a condition of doing business in the State. I.C. § 27-8-10-2.1(a). As a medical stop loss insurer registered to do business in Indiana, Sun Life is a member of ICHIA. See Avemco, 812 N.E.2d at 122. ICHIA exercises its powers through a Board of Directors (Board) and operates under a plan of operation established by its Board and approved by *53 the Commissioner of the Indiana Department of Insurance. Id. at 111.

Because ICHIA’s premiums are limited by statute to 150-200 percent of the average rate for a designated market sector, while it, by its purpose and design, insures Indiana residents with the most serious health difficulties, ICHIA generates substantial operating losses. I.C. § 27-8-10-2.1(f). To recoup these losses, the General Assembly authorized and directed ICHIA to collect assessments from the member health insurance providers. I.C. § 27-8-10-2.1(g). Although the ICHIA statute provides that the assessment of members will occur following the close of the fiscal year, when the actual losses can be determined, the statute also authorizes interim assessments against members of the association if necessary to assure the financial capability of ICHIA to meet the incurred or estimated claims expenses or operating expenses of the association until the association’s next fiscal year is completed. See I.C. § 27-8-10-2.1(g); Avemco, 812 N.E.2d at 112. Interim assessments are adjusted as necessary from one interim period to the next based on changes in facts and circumstances. ICHIA depends on its members’ payment of these assessments, including interim assessments, to stay in operation and to provide the required healthcare coverage for its participants. Avemco, 812 N.E.2d at 112. At the close of the fiscal year, ICHIA issues to its members a final, true-up assessment based on the actual, final operating results for the fiscal year. In the true-up, each member’s portion of the actual, total losses for the year is billed to that member, and ICHIA applies credit against the billed amount for all interim payments made during that year. See id.

In 2003, the ICHIA statute was revised to specify the methodology for its assessments. Specifically, the ICHIA assessment methodology was converted into a two-step process, requiring fifty percent of ICHIA’s losses to be assessed according to the members’ respective shares of the State’s total insurance premiums with the other fifty percent assessed in proportion to the members’ respective shares of the number of individuals in Indiana receiving health insurance. See I.C. § 27-8-10-14 (West 2004). Indiana Code section 27-8-10-14 was originally expected to be in effect from July 1, 2003 through March 15, 2004, but the legislature extended its applicability through the end of ICHIA’s 2004 fiscal year, changing the expiration date to January 1, 2005. See P.L. 97-2004 § 101. Effective January 1, 2005, ICHIA’s funding mechanism changed again, with the State providing a direct appropriation for seventy-five percent of the anticipated net loss with the members being assessed for twenty-five percent, based on the relative percentage of total premiums received. See I.C. § 27-8-10-2.1(g).

On December 1, 2004, ICHIA, through its executive director, issued the 2004 Interim III Assessment. This assessment notice was accompanied by a memorandum explaining that the 2004 Interim III Assessment, a total of $ 5,000,000, would be calculated in accordance with the 50-50 methodology described in I.C. § 27-8-10-14 and that assessments “for the entire year of 2004” would be based on that method. (Appellant’s App. p. 91). The notice further added that beginning January 1, 2005, the assessments would be calculated pursuant to the 75-25 methodology stipulated in I.C. § 27-8-10-2.1(g).

On May 25, 2005, ICHIA issued its Notice of 2005 Interim I and 2004 True-Up Assessment, together with a memorandum, an invoice, and supporting calculation. The documents indicated that the 2004 True-Up Assessment was calculated pursuant to the 50-50 methodology, while *54 the first assessment for 2005 was based upon the new 75-25 methodology. Sun Life’s total invoice amounted to $219,465.58, which was paid on June 14, 2005.

In a letter dated July 7, 2005, Sun Life notified ICHIA that it appealed ICHIA’s use of the 50-50 methodology for the 2004 True-Up Assessment, as prescribed by I.C. § 27-8-10-14. Sun Life asserted that the January 1, 2005 expiration of I.C.

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868 N.E.2d 50, 2007 Ind. App. LEXIS 1257, 2007 WL 1696483, Counsel Stack Legal Research, https://law.counselstack.com/opinion/sun-life-assurance-co-of-canada-v-indiana-department-of-insurance-indctapp-2007.