Jules CIAMAICHELO and Rob Stevens, Inc., Appellants, v. INDEPENDENCE BLUE CROSS, Appellee.
Supreme Court of Pennsylvania.
Decided Nov. 21, 2006.
Argued Oct. 19, 2004.
909 A.2d 1211
Melissa J. Lopes, pro hac vice, Dawn M. Touzin, pro hac vice, for amicus curiae Community Catalyst.
Brendan Patrick Lynch, Esq., Jonathan M. Stein, Esq., Richard P. Weishaupt, Esq., Michael J. Campbell, Esq., for amicus curiae Philadelphia Citizens for Children & Youth, et al.
Coleen Mary Meehan, Esq., Joseph J. McAlee, Esq., Joseph R. Podraza, Esq., Maureen Murphy McBride, Esq., Robert J. Donaghy, Esq., Geoffrey R. Johnson, Esq., William H. Lamb, Esq., Richard A. Sprague, Esq., Jay H. Calvert, Esq., James C. Sargent, Esq., Philadelphia, for Independence Blue Cross.
Paul Kevin Brobson, Esq., Jack Mentzer Stover, Esq., for amicus curiae Highmark Inc.
Steven Jeffrey Fram, Esq., for amicus curiae Capital Blue Cross.
Terrance A. Keating, Esq., Jodi A. Beierschmitt, Esq., for amicus curiae M. Diane Koken, PA Ins. Commissioner & The PA Ins. Dept.
Aaron Richard Krauss, Esq., Patricia Sons Biswanger, Esq., John P. Moses, Esq., Patrick J. O‘Connor, Esq., Gaele M.
BEFORE: CAPPY, C.J., and CASTILLE, NIGRO, NEWMAN, SAYLOR, EAKIN and BAER, JJ.
OPINION
Chief Justice CAPPY.*
Appellants Jules Ciamaichelo and Rob Stevens, Inc. commenced a class action against Appellee Independence Blue Cross (“IBC“) in the Court of Common Pleas of Bucks County on behalf of themselves and other IBC subscribers, policyholders and members. In their Class Action Complaint (“Complaint“), Appellants alleged that IBC violated the Nonprofit Corporation Law of 1988 (“Non-Profit Law“),
Appellants commenced this action on August 21, 2001. Appellants’ Complaint alleges in relevant part that: IBC is a non-profit hospital corporation governed by the Non-Profit Law and has a corporate mandate to be a health care insurer of last resort; that IBC “accumulated excess funds (called ‘surplus’ or ‘reserves and unassigned funds‘) of at least $349 million and perhaps as much as $438 million“; that “surplus is the amount that remains when an insurer subtracts its liabilities from its assets” and constitutes funds “not necessary for the ongoing operations of an insurer but rather constitutes
In Count I, the Complaint claims that IBC violated Section 5545 of the Non-Profit Law,
By way of relief, the Complaint requests that the court authorize the class action; declare that IBC violated the Non-Profit Law by accumulating the excess surplus and engaging in for-profit activities; order such relief under the Non-Profit Law as it may deem appropriate with regard to the disposition of the excess surplus and in general; award them reasonable attorneys’ fees from the excess surplus; require that IBC specifically perform the requirements of the Non-Profit Law; order an accounting and impose a constructive trust over the excess surplus; and order that IBC produce documents that fall within thirteen categories.
On October 22, 2001, IBC filed preliminary objections to the Complaint. In one preliminary objection, IBC asserted that since Counts I, II, and III essentially challenge IBC‘s rates and reserves, the Counts must be dismissed for lack of subject matter jurisdiction because under the insurance statutes, such matters are committed to the exclusive jurisdiction of the Pennsylvania Department of Insurance (“Department“). In a second preliminary objection in the nature of a demurrer, IBC asserted that since Counts I, II, and III essentially challenge rates that were reviewed and approved as reasonable and nondiscriminatory by the Department, the Counts are barred under the filed-rate doctrine. See Montana-Dakota Utilities Co. v. Northwestern Public Service Co., 341 U.S. 246, 251, 71 S.Ct. 692, 95 L.Ed. 912 (1951) (holding that the right to a reasonable utility rate is the right to the rate that the Federal Power Commission files or fixes, and that, except for review of the Commission‘s orders, the courts can assume no right to a different rate on the ground that it is the only or the more reasonable one). In a third preliminary objection, IBC asserted that Counts I and IV must be dismissed because Appellants are not among the persons upon whom the Non-Profit
By order dated June 13, 2001, the trial court overruled IBC‘s preliminary objections. The trial court‘s decision was premised on the principle that preliminary objections should be sustained and a complaint dismissed only in cases that are clear and free from doubt. See, e.g., Schott v. Westinghouse Elec. Corp., 436 Pa. 279, 259 A.2d 443, 449 (1969). On July 1, 2002, IBC moved for reconsideration of the trial court‘s June 13, 2001 order or alternatively, to vacate the order. On July 15, 2002, IBC filed an Application to Amend Interlocutory Order to Include Statement Specified in
On August 19, 2002, IBC filed a Petition for Review in the Commonwealth Court, seeking review of the trial court‘s denial of certification under
On December 20, 2002, the Commonwealth Court en banc issued a published opinion and order. Ciamaichelo v. Independence Blue Cross, 814 A.2d 800 (Pa.Cmwlth.2002). On the question of jurisdiction, the Commonwealth Court agreed with IBC. Concluding that Appellants’ claims were in actuality challenges to the level of IBC‘s rates and reserves and that Appellants did not request any relief that the court of common pleas was authorized to order, the court held that only the Department has the jurisdiction to resolve Appellants’ claims. Id. at 802 (citing
Appellants filed a Petition for Allowance of Appeal, which this Court granted. Ciamaichelo v. Independence Blue Cross, 574 Pa. 749, 829 A.2d 1158 (2003).7
Turning to the competing positions the parties presently set forth for our consideration in applying this legal framework, Appellants contend that the Commonwealth Court made two errors. First, the court mischaracterized the allegations
We agree with Appellants. At his juncture in the proceedings, on preliminary objections, we do not conclude that it is clear and free from doubt that Appellants’ Complaint amounts to nothing more than a request that the court of common pleas second-guess an approved rate, as IBC argues, or that the court assume the Department‘s regulation of IBC‘s reserves or risk-based capital. See Hospital Healthsystem Ass‘n of Pennsylvania v. Department of Public Welfare, 888 A.2d at 607. Rather, we view the Complaint as raising whether IBC violated the Non-Profit Law and committed breaches of contractual and fiduciary duties in amassing a fund designated as surplus that was in amount, over and above that necessary for IBC to operate properly, meet its legal obligations, or secure its financial solvency, and in dedicating that fund to certain purposes. These are claims that the Legislature has empowered the court of common pleas, not the Department, to adjudicate. See
In this regard, we find guidance in one of our recent decisions. In Drain v. Covenant Insurance Company, 551 Pa. 570, 712 A.2d 273 (1998), Covenant Life Insurance Company (“Covenant” or “Company“) sought and received the Depart-
Likewise, even though the Complaint in this case refers to IBC‘s surplus, we conclude that Appellants’ action was properly brought in the court of common pleas inasmuch as the claims asserted therein concern violations of the Non-Profit Law and breaches of common law duties, which are claims that the Legislature has committed to that court‘s jurisdiction. See
It is our additional view that in this action, the doctrine of primary jurisdiction that this Court articulated in Elkin v. Bell Telephone Company of Pennsylvania, 491 Pa. 123, 420 A.2d 371 (1980), controls. As Elkin teaches, the doctrine of primary jurisdiction is concerned with promoting proper relationships between the courts and administrative agencies charged with particular regulatory duties. Id. at 376. Primary jurisdiction applies where a claim is originally cognizable in the courts, and comes into play whenever enforcement of the claim requires the resolution of issues which, under a regulatory scheme, have been placed within the jurisdiction of an administrative body; in such a case the judicial process is suspended pending referral of such issues to the administrative body for its views. Id.
In light of the Department‘s authority to oversee IBC‘s financial condition and approve or monitor many of IBC‘s operations, see supra p. 8, and the trial court‘s subject matter jurisdiction, see id., we conclude that instead of placing this case in the exclusive domain of either the Department or that of the trial court, the proper course is to allow the trial court to refer to the Department any issue or matter that is revealed to lie within the Department‘s regulatory jurisdiction, including any remedial action should that become necessary, and is of sufficient complexity to require the Department‘s special competence. See id. at 377.
Therefore, for all of the foregoing reasons, the order of the Commonwealth Court is reversed, and this case is remanded to the Commonwealth Court with instructions to resolve the outstanding issue raised by IBC in its Petition for Review filed in the Commonwealth Court.
Justice CASTILLE, Justice NEWMAN and Justice SAYLOR and BAER join the opinion.
Former Justice NIGRO did not participate in the decision of this case.
Justice EAKIN files a dissenting opinion.
Justice EAKIN, dissenting.
The majority frames the issues raised by the Complaint in a broad fashion, see Majority Slip Op., at 9, but in the end, these issues are resolved by determining whether IBC‘s surplus is excessive. Although appellants allege IBC violated the non-profit corporation law, breached its fiduciary duties, and breached its contract, these claims necessarily involve resolution of proper setting of rates and reserves. The setting of rates and reserves is within the Insurance Department and its Commissioner‘s province and expertise.
The practical question before this Court is who should make that determination, for both trial court and Insurance Department have authority to do so1. If both have the authority,
The appellants bypassed the Department‘s area of expertise by asking the courts to determine whether their insurance provider is holding excess reserves and surpluses2. In my judgment, IBC‘s reserve holdings should be challenged there, for the Insurance Department can provide complete redress of
Therefore, I would affirm the Commonwealth Court‘s grant of preliminary objections.
* This matter was reassigned to this author.
