W.Va. Employers' Mutual Insurance d/b/a Brickstreet Insurance Company & Michael D. Riley v. The Bunch Company

745 S.E.2d 212, 231 W. Va. 321, 2013 WL 2461356, 2013 W. Va. LEXIS 616
CourtWest Virginia Supreme Court
DecidedJune 6, 2013
Docket11-1750
StatusPublished
Cited by3 cases

This text of 745 S.E.2d 212 (W.Va. Employers' Mutual Insurance d/b/a Brickstreet Insurance Company & Michael D. Riley v. The Bunch Company) is published on Counsel Stack Legal Research, covering West Virginia Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
W.Va. Employers' Mutual Insurance d/b/a Brickstreet Insurance Company & Michael D. Riley v. The Bunch Company, 745 S.E.2d 212, 231 W. Va. 321, 2013 WL 2461356, 2013 W. Va. LEXIS 616 (W. Va. 2013).

Opinion

LOUGHRY, Justice:

Petitioners West Virginia Employers’ Mutual Insurance Company doing business as BrickStreet Mutual Insurance Company (“BrickStreet”) and Michael D. Riley, 1 the West Virginia Insurance Commissioner (“Commissioner”) appeal from the October 31, 2011, order of the Circuit Court of Kana-wha County, which reversed and vacated the Commissioner’s July 9, 2010, administrative order upholding previously approved rates. At issue below was an assertion by the respondent, the Bunch Company (“Bunch”), that the premium it paid to BrickStreet wrongly included a charge for an agent com *324 mission. Given that BrickStreet directly wrote and issued the workers’ compensation insurance policy at issue, Bunch contends that the rate component which pertained to an agent commission should not have been factored into its premium. In explanation of using the same premium charge for its direct and agent written business, BrickStreet maintains that it incurs increased expenses related to the servicing of its non-agent business. 2 After carefully reviewing the record as developed in this case in conjunction with applicable statutes, regulations, and case law, we are firmly convinced that the trial court committed error in reversing and vacating the decision of the Commissioner. Accordingly, the decision of the circuit court is reversed.

I. Factual and Procedural Background

The protracted history of this ease began with the respondent’s filing of an amended class action complaint in the Circuit Court of Cabell County on October 15, 2007. 3 Through that complaint, Bunch alleged that when BrickStreet became its insurer on January 1, 2006, 4 a charge for the expense of an agent commission was wrongly included in the workers’ compensation premium Briek-Street charged Bunch and other similarly situated insureds. Denying it charged any insured an expense for an agent commission, BrickStreet argued that the plaintiffs’ claims were barred by the filed rate doctrine 5 and that their exclusive remedy lay with the Commissioner. Presented with cross motions for summary judgment, the Circuit Court of Cabell County, the Honorable John L. Cummings, rejected the need for additional factual development. Viewing this matter as one rooted in law, the circuit court reasoned that “the sole issue is whether a component of the premium is lawful or unlawful.” 6 After considering the stipulated facts submitted by Bunch and BrickStreet along with the pleadings and argument of counsel, Judge Cummings decided that BrickStreet had wrongfully charged Bunch a commission as part of its premium without incurring a specific agent-related expense. 7

Shortly after Judge Cummings issued his ruling, this Court issued its decision in State ex rel. Citifinancial v. Madden, 223 W.Va. 229, 672 S.E.2d 365 (2008). 8 Central to the Citifinancial decision was this Court’s recognition of the Legislature’s clear disapproval of “judicial intrusion into issues of insurance *325 rate setting.” 9 Id. at 236, 672 S.E.2d at 372. In light of specific legislative amendments to the insurance statutes, we held in Citifinan-dal that there is a presumption of statutory compliance and validity which applies to approved insurance rates. See id. at 235, 672 S.E.2d at 371. Of critical import to the respondent in this case was our holding in Citifinancial that any challenge to an approved insurance rate has to be raised in an administrative proceeding before the Commissioner pursuant to West Virginia Code § 33-20-5(d). 223 W.Va. at 231, 672 S.E.2d at 367, syl. pt. 3. And, only after such an administrative challenge has transpired, can judicial review occur. Id. at 239, 672 S.E.2d at 375.

BrickStreet, in rebanee on the holdings of Citifinancial, sought relief from the ruling of Judge Cummings. 10 By ruling entered on March 5, 2009, Judge Hustead granted relief to BrickStreet, reversing and vacating the order of Judge Cummings. Judge Hustead ruled that Bunch was seeking to challenge an established insurance rate and that this Court was clear in Citifinancial that circuit courts do not have the authority to review rate-setting matters until those matters have first been challenged before the Commissioner.

Complying with the dictates of Citifinan-dal, Bunch filed a consumer complaint with the Commissioner on February 17, 2010, reasserting its allegation that BrickStreet was unlawfully charging an agent commission for its “direct-write” business. 11 In responding to the complaint, BrickStreet stated that it had not charged Bunch an agent commission. BrickStreet explained that an insured’s premium is based on multiple components, one of which is the loss cost multiplier (“LCM”). 12 Included in the LCM are component expenses for the costs of acquisition and service fees. For any of its insureds who do not have agents, BrickStreet maintains there are enhanced administrative needs that it is responsible for handling. For the additional services it provides to its “direct write” clients, BrickStreet is compensated through the premium components of acquisition costs and services fees.

The Commissioner denied the relief sought by Bunch through its administrative ruling issued on July 9, 2010. As part of that ruling, the Commissioner concluded:

5. The Insurance Commissioner finds there is no factual dispute concerning the filing and approval of the rates and forms of BrickStreet ... and as a matter of law the rate filings and BriekStreet’s use of the same should be upheld.
6. The Insurance Commissioner finds that the rates charged by BrickStreet were reasonable in relation to the benefits provided due to the fact that certain administrative costs and/or expenses are incurred by BrickStreet in handling direct written business which would otherwise be handled by appointed agents.

Addressing the statutory presumption that attaches to approved insurance rates, 13 the Commissioner found that Bunch had not “provided ... [any] information that would in fact rebut such a presumption.”

Bunch appealed the Commissioner’s ruling to the Circuit Court of Kanawha County and by ruling issued on October 31, 2011, Judge Kaufman reversed and vacated the Commissioner’s order. The circuit court found that (1) the Commissioner erred by allowing *326

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745 S.E.2d 212, 231 W. Va. 321, 2013 WL 2461356, 2013 W. Va. LEXIS 616, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wva-employers-mutual-insurance-dba-brickstreet-insurance-company-wva-2013.