Massachusetts Care Self-Insurance Group, Inc. v. Massachusetts Insurers Insolvency Fund, 458 Mass. 268

Mass Care is a not-for-profit workers’ compensation self-insurance group organized under G. L. c. 152, 25E-25U, approved by the Commissioner, with 39 member employers.
The Fund is a statutorily mandated nonprofit association that pays covered claims against an insolvent insurer up to $300,000 per claim.
Gorski, injured in 1995 while Longmeadow (Mass Care member) provided workers’ compensation coverage, led Mass Care to pay over $273,000 on the claim from 1996–2005.
Reliance National Indemnity Company issued excess and reinsurance policies to Mass Care; Reliance was insolvent in 2001; the Fund assumed administration of Reliance’s claims.
Mass Care sought reimbursement from the Fund for amounts exceeding Reliance’s retention; the Fund denied, and the Superior Court granted summary judgment that the Reliance policies were not direct insurance and Mass Care’s claim fell within an exclusion.
Mass Care appealed directly; the Supreme Judicial Court affirmed on grounds that Mass Care, as a member of the insurance industry, is not a covered claim under c. 175D § 1(2).

Issue	Plaintiff's Argument	Defendant's Argument	Held
Is Mass Care’s claim a covered claim under c.175D §1(2)?	Mass Care contends the claim is outside the exclusion and should be covered.	Fund argues Mass Care is within the exclusion as part of the insurance industry.	No; Mass Care’s claim is not a covered claim.
Should the term ‘insurer’ be expanded to include Mass Care for purposes of the exclusion?	Expansion is unnecessary and not required by context.	Expansion would be justified to treat Mass Care like an insurer for Fund purposes.	Expansion is not warranted; Mass Care is within the insurer-related exclusion as part of the insurance industry.
What is Mass Care’s status under the statutory framework—insurer or non-insurer—given §25E and §1(7)?	Statutory language supports Mass Care as not being an insurer under c.175D in context.	Mass Care functions like an insurer for market purposes and falls outside Fund coverage.	Mass Care is not deemed an insurer under §25E, yet is treated as a member of the insurance industry for Fund purposes, thus not eligible as a covered claim.

Ferrari v. Toto, 383 Mass. 36 (1981) (scope of exclusion to insurers and other groups analyzed)
Ulwick v. Massachusetts Insurers Insolvency Fund, 418 Mass. 486 (1994) (expansion of ‘insurer’ not justified by context; nonprofit or city self-insurers not within protection)
Barrett v. Massachusetts Insurers Insolvency Fund, 412 Mass. 774 (1992) (explanation of Fund coverage and insurer scope)
Wheatley v. Massachusetts Insurers Insolvency Fund, 456 Mass. 594 (2010) (fiduciary and statutory framework guiding covered claims)
Clark Equip. Co. v. Massachusetts Insurers Insolvency Fund, 423 Mass. 165 (1996) (NAIC model act guidance on guaranty funds)