Time Ins. Co. v. Commissioner

86 T.C. No. 20, 86 T.C. 298, 1986 U.S. Tax Ct. LEXIS 145
CourtUnited States Tax Court
DecidedMarch 10, 1986
DocketDocket No. 3075-80
StatusPublished
Cited by16 cases

This text of 86 T.C. No. 20 (Time Ins. Co. v. Commissioner) is published on Counsel Stack Legal Research, covering United States Tax Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Time Ins. Co. v. Commissioner, 86 T.C. No. 20, 86 T.C. 298, 1986 U.S. Tax Ct. LEXIS 145 (tax 1986).

Opinion

SHIELDS, Judge:

Respondent determined deficiencies in petitioner’s Federal income taxes as follows:

Year Deficiency
1972 . $1,935,682.54
1973 . 397,760.23
1974 . 193,267.27
1975 . 483,091.21

After a number of concessions, the issues remaining are: (1) Whether petitioner properly computed its claim reserves on certain accident and health policies during the years in. issue; (2) whether respondent’s disallowance of a portion of petitioner’s deductions for claim reserves was so arbitrary and unreasonable as to shift the burden of going forward with the evidence with respect to the correct amount of the reserves to respondent; and (3) if the deduction for claim reserves in 1972 is found to be improper, whether petitioner is entitled to spread forward any adjustment for that year over the 10-year period provided by section 810(d).1

FINDINGS OF FACT

Some of the facts have been stipulated by the parties and are so found. Their stipulation of settled issues, stipulation of facts, and supplemental stipulation of facts and the exhibits attached thereto are incorporated herein by reference.

Petitioner is Time Insurance Co. (Time). It is a stock life insurance company which was organized in 1910 under the laws of Wisconsin, and during all relevant times had its principal office and place of business in Milwaukee. For each of the calendar years 1972 through 1975, Time filed with the Internal Revenue Service Center at Kansas City, Missouri, original, amended, and “corrected amended” income tax returns as a life insurance company taxable under sections 801 through 820. Each return consisted of a Form 1120L, attached supporting schedules, and a copy of Time’s annual statement for the particular year on a form prescribed by the National Association of Insurance Commissioners (NAIC).

During the years under consideration, petitioner as a life insurance company was required by State law to file the NAIC annual statements on a calendar year basis with the insurance regulatory agency of each State in which it did business. It was also required to file copies of such statements with and as part of its Federal income tax returns. The form for and the information required by the annual statements are prescribed by the NAIC, an organization of which the insurance commissioner, or other principal insurance executive, of every State is a member.

During 1972 through 1975, petitioner sold life insurance and accident and health insurance in 45 States, including Wisconsin. Its accident and health (A & H) policies included both disability income and medical reimbursement insurance. The dispute in this case is limited, however, to the A & H medical reimbursement policies, which in the industry are sometimes referred to as medical expense policies. This type of policy insures against certain specified financial losses suffered by the insured as a result of an injury or sickness. Such policies generally provide for payment by the insurance company, either directly or through reimbursement to the insured, of all or part of the insured’s covered medical expenses.2

A & H Reimbursement Policies - Generally

For purposes of administering benefit claims and establishing claim reserves, petitioner, during the years under consideration, divided its A & H medical reimbursement policies into the following categories:

(1) Individual Guaranteed Renewable (GR) hospital/surgical (class 6);

(2) Individual Guaranteed Renewable (GR) major medical (class 7);

(3) Individual Optionally Renewable (OR) hospital/surgical (class G);

(4) Individual Optionally Renewable (OR) major medical (class H);

(5) Group policies.3

Petitioner’s GR policies were renewable by the insured at a premium based upon the insured’s age at original entry. Its OR policies were similar to GR policies except that they were renewable at the option of petitioner, not the insured, but petitioner never refused to renew such policies.4 Group policies remained in continuous effect so long as the premiums were paid, but either the group holder or petitioner could terminate the policy at the end of any policy year by giving 30 days written notice prior to the yearend.

All of petitioner’s reimbursement policies were of a “per cause” type as opposed to a “calendar year” type in that they provided benefits after the satisfaction of a deductible amount during the specified benefit periods (usually 2 or 3 years) arising from a particular claim event or cause, i.e., injury or sickness. However, with only slight variations not relevant here, each of petitioner’s policies contained the following provision:

TIME * * * does hereby insure * * * and agrees to pay the Insured for Covered Expenses * * * incurred while this policy is in force, resulting from injury or sickness * * * in the manner and to the extent herein provided. [Emphasis added.]

Each policy also contained a grace period of. 30 or 31 days for premium payments which was typically set out as follows:

A grace period of thirty-one days will be granted for the payment of each premium falling due after the first premium, during which grace period the policy shall continue in force. [Emphasis added.]

In the OR policies, the grace period did not apply if petitioner had given written notice of its intention not to renew the policy 30 days prior to the premium due date. However, such refusal to renew or any other cancellation or termination would be without prejudice to any claim arising while the policy was in force.

Hospital/Surgical Policies - GR and OR

In a typical GR hospital/surgical policy (Class 6), petitioner agreed to pay a percentage (usually 80 percent) of the first $2,000 of covered medical expenses and another percentage (usually 100 percent) of such expenses thereafter, up to a lifetime maximum aggregate. The covered expenses were also subject to a maximum daily benefit set out in a policy schedule. Under these policies, reoccurring hospitalizations or surgical procedures caused by the same injury or sickness and separated by less than 90 days in some policies, and 180 days in other policies, were considered to be part of the same injury or sickness.

A typical OR hospital/surgical policy (Class G), contained a deductible amount, a maximum daily reimbursement for hospital confinement, and a maximum hospital miscellaneous expense benefit for each separate injury or sickness. Petitioner also agreed to pay surgical expenses, up to a maximum amount, for each injury or sickness based on a schedule of surgical benefits. Successive surgical procedures for the same cause were treated as the same procedure when they were separated by less than 12 months.

Major Medical Policies - GR and OR

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Bluebook (online)
86 T.C. No. 20, 86 T.C. 298, 1986 U.S. Tax Ct. LEXIS 145, Counsel Stack Legal Research, https://law.counselstack.com/opinion/time-ins-co-v-commissioner-tax-1986.