Akron v. Ohio Dept. of Ins.
2014 Ohio 96
Ohio Ct. App.2014Background
- ODI issued a July 20, 2010 cease-and-desist order against Akron, MMO, and OP&F to coordinate benefits under Ohio’s coordination of benefits law.
- Akron challenged ODI’s jurisdiction, arguing its self-funded retiree health plans are not insurance and thus outside ODI’s authority.
- ODI hearing officer previously concluded Akron’s and OP&F’s self-funded plans are insurance under R.C. 3901.19 and 3902.11, triggering ODI’s jurisdiction.
- Franklin County and Summit County courts dismissed/enjoined proceedings, concluding ODI lacked subject-matter jurisdiction to regulate self-funded plans.
- The court of appeals ultimately affirmed, holding that self-funded plans are not insurance and thus not subject to R.C. 3902.13, limiting ODI’s jurisdiction; primary jurisdiction doctrine not applicable.
- ODI’s jurisdictional reach cannot be extended to self-funded plans; any relief for retirees would lie through collective bargaining agreements.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether ODI had subject-matter jurisdiction over self-funded plans. | ODI had jurisdiction to regulate COB for self-funded plans. | Self-funded plans are not insurance; ODI lacks jurisdiction. | ODI lacked jurisdiction over self-funded plans. |
| Whether self-funded plans constitute insurance under Ohio law. | Plans meet COB provisions and are insurance. | Self-funded plans are not insurance per PICO and related authorities. | Self-funded plans are not insurance under Ohio law. |
| Whether the doctrine of primary administrative jurisdiction applies. | Doctrine could vest jurisdiction in ODI. | No basis to confer jurisdiction where statute does not. | Doctrine does not apply; jurisdiction remains lacking. |
| Whether ODI could rely on R.C. 3902.13 to regulate such plans. | R.C. 3902.13 applies to COB in self-funded plans. | Statute does not apply to self-funded plans; not insurance. | R.C. 3902.13 not applicable to self-funded plans. |
Key Cases Cited
- Physicians Ins. Co. of Ohio v. Grandview Hosp. & Med. Ctr., 44 Ohio App.3d 157 (Ohio App. Dist. 1st Cir. 1988) (self-insurance not insurance; COB not applicable to self-insured plans)
- Thomas v. Freeman, 79 Ohio St.3d 221 (1997) (expressio unius est exclusio alterius; interpret statutes strictly)
- New Albany Park Condominium Assn. v. Lifestyle Communities, Ltd., 195 Ohio App.3d 459 (2011) (in pari materia; read statutes together for scope)
- State v. Herman v. Klopfleisch, 72 Ohio St.3d 581 (1995) (in pari materia; interpret related statutes cohesively)