UNITED AMER. INS. v. Ins. Dept. of Ga.

574 S.E.2d 830, 258 Ga. App. 735
CourtCourt of Appeals of Georgia
DecidedNovember 19, 2002
DocketA02A1006
StatusPublished
Cited by3 cases

This text of 574 S.E.2d 830 (UNITED AMER. INS. v. Ins. Dept. of Ga.) is published on Counsel Stack Legal Research, covering Court of Appeals of Georgia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
UNITED AMER. INS. v. Ins. Dept. of Ga., 574 S.E.2d 830, 258 Ga. App. 735 (Ga. Ct. App. 2002).

Opinion

574 S.E.2d 830 (2002)
258 Ga. App. 735

UNITED AMERICAN INSURANCE COMPANY
v.
INSURANCE DEPARTMENT OF GEORGIA et al.

No. A02A1006.

Court of Appeals of Georgia.

November 19, 2002.
Reconsideration Denied December 6, 2002.

*831 King & Spalding, Byron Attridge, Richard L. Shackelford, Robert M. Keenan III, Atlanta, for appellant.

Thurbert E. Baker, Atty. Gen., Robert S. Bomar, Deputy Atty. Gen., Harold D. Melton, Senior Asst. Atty. Gen., Sidney R. Barrett, Jr., Asst. Atty. Gen., for appellees.

SMITH, Presiding Judge.

We granted United American Insurance Company's application to appeal after the superior court affirmed the decision of the Georgia Insurance Commissioner to disapprove United American's 2000 rate filings for its Medicare Supplement policies. In four enumerations of error, United American contends the Commissioner's order was erroneous and the superior court erred in affirming it. We do not agree, and we affirm.

The type of insurance involved in this appeal is known in the industry as Medsup. The policies insure against medical costs not covered by Medicare. Georgia began regulating such policies in 1989. Ga. L. 1989, p. 1276. In 1990 the federal government became involved in their regulation. Under the Omnibus Budget Reconciliation Act of 1990, the terms of all new Medsup policies were standardized. Existing policies could be renewed, however, and became known as "prestandardized" policies. Federal regulations were promulgated to set minimum standards for states in their regulation of Medsup policies. The National Association of Insurance Commissioners (NAIC) then developed model state statutes and regulations for Medsup insurance rates and forms. Georgia's original Medsup statutes were repealed in 1992, and they were replaced with the model statutes. OCGA §§ 33-43-1 through 33-43-9. The Georgia Department of Insurance also adopted the new model Medsup regulations drafted by NAIC. Ga. Comp. R. & Regs. r. 120-2-8 et seq.

Rates for Medsup policies are based upon a loss ratio, the ratio of premium dollars collected to claim dollars paid. Regulations establish a minimum loss ratio an insurer must meet before it is entitled to impose higher premiums. For "prestandardized" policies, issued before July 29,1992, the minimum *832 acceptable loss ratio is 60 percent. Ga. Comp. R. & Regs. r. 120-2-8-.14(1)(a)2. For "standardized" policies, it is 65 percent. Ga. Comp. R. & Regs. r. 120-2-8-.14(1)(d)1. The loss ratios must be recalculated every year, using historical and projected data, based partly on how the policies have performed since their inception and how they will perform in the future. R. 120-2-8.14(3). These calculations are performed by actuaries, and the rates are governed by OCGA § 33-43-4, which provides:

Medicare supplement policies shall return to policyholders benefits which are reasonable in relation to the premium charged. The Commissioner shall issue reasonable regulations to establish minimum standards for loss ratios of medicare supplement policies on the basis of incurred claims experience ... and earned premiums in accordance with accepted actuarial principles and practices.

(Emphasis supplied.) These accepted principles and practices are set forth in Actuarial Standard of Practice ("ASOP") No. 8, which was adopted by the Actuarial Standards Board to guide actuaries in calculating health insurance rate filings. The standard sets out factors and assumptions that must be considered when making actuarial calculations for such filings. One such assumption is that an insurance company will invest premiums to generate income. This is called the "time value of money," and is known as the "interest assumption."

The record shows that United American was granted a rate increase in 1999. In 2000, it sought another rate increase of five percent for its prestandardized policies and 6.4 to 14 percent for its standardized policies. The Consumers' Insurance Advocate opposed these increases on the ground that they were not justified by the company's losses. In accordance with OCGA § 33-2-11, the Commissioner hired an actuarial consultant, Dr. Joseph Tan, to examine the rate filings. Dr. Tan found that an interest assumption had not been included in the income calculations for the company. In his career, during which he had reviewed "hundreds" of Medsup rate filings, Dr. Tan had seen only one or two such filings that did not include an interest assumption. He notified the Department, which then contacted an actuary with NAIC, who confirmed that interest assumptions must be included in Medsup rate filings. After checking every pending Medsup rate filing, the Department confirmed that all 120-150 filings included an interest assumption, except for the filings of United American and a related company, Globe Life & Accident Insurance Company.

On June 18, 2000, the Department disapproved petitioner's rate filings, noting that the filings did not comply with the provisions of OCGA § 33-43-4 and Ga. Comp. R. & Regs. r. 120-2-8-.14, in that they failed to follow accepted actuarial principles and practices because the loss ratio projections did not include a reasonable assumption for interest. Another reason for disapproval was that additional information requested by the Department's contract examiner had not been provided. United American appealed this decision to the Superior Court of Fulton County. The superior court announced an oral ruling from the bench, affirming the decision of the Commissioner. Reconsideration was denied, and final judgment later was entered affirming the Commissioner's ruling.

1. We note initially, as appellees point out, that United American does not address on appeal the portion of the Commissioner's order disapproving the rate filings because of failure to cooperate by providing the additional information requested by the Department's contract examiner. Appellees argue that the Commissioner's order could be affirmed on this basis alone. We address United American's enumerations of error, however, because the Commissioner's ruling appears to have been based upon the determinations enumerated, as well as United American's failure to cooperate, and because the enumerations raise important issues of first impression.

2. In its ruling, the Commissioner ordered United American to recalculate loss ratios from the inception of the policies. United American contends that this portion of the order violates constitutional and statutory prohibitions on retroactive laws. We do not agree.

*833 The seminal Georgia case on retroactive laws is Ross v. Lettice, 134 Ga. 866, 868, 68 S.E. 734 (1910). In that case, the Supreme Court held:

A statute is retroactive in its legal sense which creates a new obligation on transactions or considerations already past, or destroys or impairs vested rights.

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