Mississippi Insurance Guaranty Ass'n v. Mississippi Workers' Compensation Individual Self-Insurer Guaranty Ass'n
Mississippi Insurance Guaranty Ass'n v. Mississippi Workers' Compensation Individual Self-Insurer Guaranty Ass'n
Opinion of the Court
for the Court:
¶ 1. The Mississippi Legislature created the Mississippi Workers’ Compensation Self-Insurers Guaranty Association (“SIGA”) to pay workers’ compensation claims on behalf of insolvent self-insured employers; and it created the Mississippi Insurance Guaranty Association (“MIGA”)
BACKGROUND
¶ 2. The Legislature abolished most lawsuits by injured employees against their employers, and provided compensation through the workers’ compensation statutes. Most employers cover all their workers’ compensation claims filed against them with insurance; some “self-insure,” that is, they pay the workers’ compensation claims without benefit of any insurance coverage; and some employers — such as B.C. Rogers Poultry, Inc., the employer involved in today’s case — self-insure up to a certain limit and then cover claims that exceed that limit with insurance.
¶ 3. The Legislature created MIGA to provide for the payment of benefits due under insurance policies issued by insurance companies that become insolvent, (with statutory restrictions);
¶ 4. After Bobby Warren was injured on the job, his self-insured employer, B.C. Rogers Poultry, Inc., paid $225,000 in workers’ compensation benefits and then turned the claim over to its excess insur-anee carrier, Reliance National Indemnity Company.
¶ 5. Reliance paid $129,205.73 in benefits but then became insolvent, requiring Rogers again to assume responsibility for the claim. Rogers paid an additional $167,419.53, but then it became insolvent and ceased payments, prompting SIGA to step in and pay Warren’s claim. After paying benefits exceeding $100,000, SIGA suggested that MIGA consider stepping into Reliance’s shoes and pay the amount Reliance should have paid, effectively reimbursing SIGA. MIGA refused, so SIGA filed suit. Meanwhile, Warren sued the other driver from the accident for personal injuries and collected more than $4 million from uninsured motorist (“UM”) carriers.
¶ 6. SIGA argued to the trial court that MIGA should reimburse it for the money it paid to Warren, because MIGA had a statutory duty to step into Reliance’s shoes when Reliance became insolvent. MIGA responded that it was not obligated to pay SIGA, because SIGA was not a “claimant” or “policyholder” and did not have a “covered claim” under its laws. MIGA also argued that the Reliance excess policy was not “direct insurance” as to SIGA.
¶ 7. Finally, MIGA argued that any reimbursement SIGA might be entitled to must be reduced, or offset, by the amount Warren received in UM benefits — effectively wiping out the claim. SIGA responded that, because it stepped into Rogers’s shoes, it should be paid what Rogers would have been paid had Reliance not become insolvent.
¶ 8. SIGA filed a motion for summary judgment, which the trial court granted, holding that the Reliance excess insurance policy was “direct insurance” and that
¶ 9. MIGA appealed, asking us to consider whether MIGA is obligated to pay SIGA; whether MIGA is entitled to a reduction, setoff, or credit for the amount Warren received from UM policies; and whether SIGA is entitled to an award of interest and costs. Because we hold that MIGA is not obligated to pay SIGA, we decline to address the other issues.
ANALYSIS
¶ 10. We follow our usual standards of review: Summary judgment is appropriate where “there is no genuine issue as to any material fact” and “the moving party is entitled to a judgment as a matter of law.”
¶ 11. The Legislature created MIGA to “provide a mechanism for the payment of covered claims under certain insurance policies to avoid excessive delay in payment and to avoid financial loss to claimants or policyholders because of the insolvency of an insurer... ,”
MIGA is not obligated to reimburse SIGA for its payments to Warren, because SIGA does not have a “covered claim.”
¶ 12. Under Mississippi Code Section 83 — 23—115(1)(a), MIGA is “obligated to the extent of the covered claims existing prior to the determination of insolvency....”
an unpaid claim, including one of unearned premiums, which arises out of and is within the coverage and not in excess of the applicable limits of an insurance policy to which this articles applies issued by an insurer, if such insurer becomes an insolvent insurer....11
¶ 13. Thus, to obligate MIGA to pay SIGA, SIGA must be a claimant or policyholder with an unpaid claim. SIGA argues that its payments to Warren — in satisfaction of its obligation to take over Rogers’s workers’ compensation obligations — are unpaid claims. MIGA, however, argues that SIGA cannot have an “unpaid claim,” because SIGA is not a “claimant” or “policyholder” under the statute; we agree.
¶ 15. The MIGA statutes must be interpreted according to the association’s purpose:
[T]o provide a mechanism for the payment of covered claims under certain insurance policies to avoid excessive delay in payment and to avoid financial loss to claimants or policyholders because of the insolvency of an insurer, to assist in the detection and prevention of insurer insolvencies, and to provide an association to assess the cost of such protection among insurers.15
¶ 16. MIGA’s purpose, though, is not achieved by ordering MIGA to reimburse SIGA, because doing so would not prevent financial losses to a claimant or policyholder. SIGA is not seeking money for Rogers (the actual claimant or policyholder); instead, it is seeking reimbursement for complying with its own statutory duties. While the dissent correctly observes that SIGA steps into Rogers’s shoes and inherits its rights and obligations, it overlooks the fact that — with respect to SIGA’s payment to Warren — Rogers has no outstanding rights or obligations. Rogers — were it not insolvent — would have no right of reimbursement for SIGA’s payments to Warren; so SIGA has no right of reimbursement and no unpaid claim. And no statutory provision allows, or requires, one guaranty association to pay another. SIGA and the dissent ignore the one avenue of reimbursement authorized by SIGA’s statute: “An association may recover from the self-insurer in default ... all amounts paid by such association on account of covered claims of employees of the member self-insurer in default....”
¶ 17. SIGA is not an “insured making a first-party claim,” as the definition of “claimant” requires; instead, Rogers is the insured. Nor is SIGA “instituting a liability claim”; instead, it seeks reimbursement only. So MIGA’s statutes neither authorize nor obligate it to pay SIGA.
¶ 18. The dissent says that Rogers’s claim against Reliance remains unpaid. But we find nothing in the record before us concerning any claim Rogers has, or is asserting, against Reliance, MIGA, or anyone else. The claim presented today — and the only claim presented for our consider
¶ 19. SIGA’s claim against MIGA is best characterized as an attempt at no-vation. Novation may occur where one debtor is substituted by another in a contract,
¶ 20. Contrary to the dissent’s assertion, our decision today does not favor the MIGA statutes over the SIGA statutes. MIGA’s authority to make payments is limited by the statutes that created it, and those statutes do not authorize it to reimburse SIGA. Because SIGA is not a claimant or policyholder with an unpaid claim, it does not have a “covered claim” under MIGA’s statute.
CONCLUSION
¶ 21. MIGA is not obligated to reimburse SIGA for SIGA’s statutorily obligated payments to Warren. Neither party has presented a genuine issue of material fact. Thus, MIGA is entitled to judgment as a matter of law. Accordingly, we reverse the trial court’s ruling and find that the trial court erred in granting SIGA’s motion for summary judgment and in denying MIGA’s motion for summary judgment. MIGA’s motion for summary judgment is granted.
¶ 22. REVERSED AND RENDERED.
. Miss.Code Ann. § 83-23-103 (Rev. 2011).
. Miss.Code Ann. § 71-3-153 (Rev. 2011).
. Miss. R. Civ. P. 56(c).
. Crist v. Loyacono, 65 So.3d 837, 842 (Miss. 2011).
. Id.
. Delta Reg’l Med. Ctr. v. Green, 43 So.3d 1099, 1100 (Miss. 2010).
. Miss.Code Ann. § 83-23-103 (Rev. 2011).
. Miss.Code Ann. § 83-23-107 (Rev. 2011). The dissent incorrectly attributes the statute’s phrase "liberally construe” to this majority.
. Miss.Code Ann. § 83-23-115(1)(a) (Rev. 2011) (emphasis added).
. Id. (emphasis added).
. Miss.Code Ann. § 83-23-109(f) (Rev. 2011) (emphasis added).
. Miss. Code Ann. § 83-23-109(c) (Rev. 2011).
. Miss.Code Ann. § 71 — 3—163(1 )(b) (Rev. 2011) (emphasis added).
.Miss. Ins. Guar. Ass’n v. Blakeney, 54 So.3d 203, 206 (Miss. 2011).
. Miss.Code Ann. § 83-23-103 (Rev. 2011).
. Miss.Code Ann. § 71-3-169(2) (Rev. 2011) (emphasis added).
. Miss. Ins. Guar. Ass’n v. MS Casualty Ins. Co., 947 So.2d 865, 871 (Miss. 2006).
. Id.
Dissenting Opinion
dissenting:
¶ 23. This is a case of first impression for this Court. Never before has this Court been presented a situation in which a self-insured and a direct insurer became insolvent on the same claim involving the same transaction. The Mississippi Insurance Guaranty Association (“MIGA”) and the Mississippi Workers’ Compensation Individual Self-insurer Guaranty Association (“SIGA”) are legal entities with similar duties and obligations. In fact, each’s respective statute mimics the other but for some select wording in each statute.
¶ 24. Throughout this case, words “claimant” and “covered claim” were often used. Yet, each word has a specific meaning as announced by both SIGA’s and MIGA’s respective statutes. SIGA’s statute does not define “claimant,”
“Covered claim” means an unpaid claim upon which compensation or medical is payable by an individual self-insurer or a group self-insurer under the Worker’s Compensation Law.20
MIGA’s statute defines “claimant” and “covered claim” as:
*6 “Claimant” means any insured making a first-party claim or any person instituting a liability claim, provided that no person who is an affiliate of the insolvent insurer may be a claimant.21 “Covered Claim” means an unpaid claim, including one of unearned premiums, which arises out of and is within the coverage and not in excess of the applicable limits of an insurance policy to which this article applies issued by an insurer, if such insurer becomes an insolvent insurer.... “Covered Claim” shall not include any amount awarded as punitive or exemplary damages; or sought as a return of premium under any retrospective rating plan; or due any reinsurer, insurer, insurance pool, or underwriting association, as subrogation recoveries or otherwise and shall preclude recovery thereof from the insured of any insolvent carrier to the extent of the policy limits.22
¶ 25. Looking at SIGA’s statute specifically, it commands that SIGA must “have all rights, duties and obligations” of the insolvent self-insurer — B.C. Rogers — “as if such self-insurer were not in default.”
¶ 26. The majority opinion favors MIGA’s statute, yet casts aside SIGA’s statute. Quite frankly, the majority fails to recognize the importance of SIGA’s statute when aligned with MIGA’s. As mentioned previously, never before has a self-insured and a direct insurer become insolvent on the same claim involving the same transaction. Therefore, each respective statute must be applied accordingly.
¶ 27. The majority is correct that, “[t]he Legislature created MIGA to ‘provide a mechanism for the payment of covered claims under certain insurance policies to avoid excessive delay in payment and to avoid financial loss to claimants or policyholders, because of the insolvency of an insurer....’”
¶ 28. The majoi’ity reasons that “to obligate MIGA to pay SIGA, SIGA must be a claimant or policyholder with an unpaid claim.”
Be deemed the self-insurer to the extent of obligations on its covered claims and to such extent shall have the rights, duties and obligations of the individual self-insurer in default or insolvent group self-insurer in default as if such self-insurer were not in default.27
¶ 29. Reading SIGA’s statute and reconciling it with MIGA’s, SIGA could be considered both a claimant and a policyholder. First, SIGA’s statute allows it to cloak itself as the self-insured, entitling it to the same coverage as B.C. Rogers under the Reliance policy. Because B.C. Rogers would be treated as “any insured making a first-party claim,” SIGA should be afforded similar treatment. Secondly, SIGA could also be considered a policyholder, because SIGA’s statute allows it to possess the rights, duties and obligations of the individual self-insurer in default. Ultimately, SIGA paid out money on B.C. Rogers’s behalf, and it wants that money to be returned through an insurance policy B.C. Rogers purchased to cover its liability-
11 30. We must be mindful of what took place. B.C. Rogers was a self-insured employer up to $225,000. To cover any liability on workers’ compensation claims in excess of $225,000, B.C. Rogers purchased a policy with Reliance National Indemnity Company. One of B.C. Rogers’s employees, Warren, was injured during his employment. As a result, B.C. Rogers paid $225,000, and then filed a claim with Reliance for the excess amount. Reliance paid $129,205.73 before becoming insolvent. Because of Reliance’s insolvency, B.C. Rogers began repaying Warren’s claim, and paid $167,419.53. But then, B.C. Rogers became insolvent, and SIGA assumed responsibility, paying $111,739.78 to satisfy the rest of Warren’s claim against B.C. Rogers. Therefore, a total of $279,159.31 was paid by B.C. Rogers and SIGA, when that amount should have been paid by Reliance under the policy B.C. Rogers purchased to cover its excess liability.
¶ 31. Interestingly, the majority admits that SIGA inherited the rights and obligations of B.C. Rogers, but found that B.C. Rogers did not possess any outstanding rights or obligations, even though Reliance only partially had met its contractual duty under the policy with B.C. Rogers.
¶ 32. Of note, MIGA admitted in its brief that B.C. Rogers could bring a claim under the excess policy held with Reliance, but that SIGA could not do so without providing authority as to why. The majority fails to recognize MIGA’s admission. And I am unable to reconcile how B.C. Rogers could bring a claim, yet SIGA cannot, even though all agree that SIGA inherits the rights, duties, and obligations of the defaulted self-insurer.
¶ 33. Additionally, the majority states that SIGA has only one avenue for reimbursement in that it can recover only from the self-insurer in default.
¶ 35. SIGA’s statute commands that SIGA be treated with the same pleasantries of the self-insurer as if that self-insurer were not in default.
¶ 36. The questions to be answered are: 1) what is the claim; and 2) who is the claimant? The “claim” is that which B.C. Rogers would have received under its policy with Reliance. MIGA misconstrued who the claimant is, as it reasoned that Warren was the “claimant.” Although it is true that Warren is a claimant, he is, unmistakably, a workers’ compensation claimant, not a “claimant” with regard to the policy B.C. Rogers had with Reliance. MIGA’s statute defines “claimant” as “any insured making a first-party claim or any person instituting a liability claim....”
¶ 37. And the issue to be decided now is, who is the “claimant” with respect to the Reliance policy held and purchased by B.C. Rogers? The “claimant,” as defined by MIGA’s own statute, was and is B.C. Rogers. B.C. Rogers owned the policy. B.C. Rogers was liable to Warren in excess of $225,000, and thus, B.C. Rogers made a claim on its policy with Reliance. Due to B.C. Rogers’s insolvency, SIGA is now cloaked with B.C. Rogers’s rights, duties, and obligations.
¶ 38. After reviewing caselaw in other jurisdictions, we do not find any case directly on point with the issues presented here. However, in other states, it seems to be an emerging trend NOT to expand the language of a guaranty association statute beyond that of the statute.
¶ 39. However, in one interesting case from Pennsylvania from 2009 — General Reinsurance Corporation v. American Bankers Insurance Company of Florida,
¶40. B.C. Rogers’s claim on its policy with Reliance remains unsatisfied. Otherwise, SIGA would have no right to enforce the claim on B.C. Rogers’s behalf. We must remember that B.C. Rogers purchased a policy with Reliance to cover all its liability on workers’ compensation claims in excess of $225,000. B.C. Rogers’s claim has been only partially paid by Reliance, as Reliance paid $129,205.73 before becoming insolvent, leaving $279,159.31 to be paid in order to satisfy Warren’s workers’ compensation claim. SIGA stated at oral argument that neither it nor B.C. Rogers had received anything on the Reliance policy, but as shown above,
¶ 41. The majority concludes by characterizing SIGA’s attempt at reimbursement as a novation.
KITCHENS, J., JOINS THIS OPINION.
. Regardless, SIGA's definition, even if its statute provided one, is irrelevant to this case, as it is "claimant” under MIGA’s statute that bears directly upon this case.
. Miss.Code Ann. § 71-3-157(e) (Rev. 2011).
. Miss.Code Ann. § 83-23-109(c) (Rev. 2011).
. Miss.Code Ann. § 83-23-109(f) (Rev. 2011).
. Miss.Code Ann. § 71-3-163(1 )(b) (Rev. 2011).
. Maj. Op. ¶ 11; see also Miss.Code Ann. § 83-12-103 (Rev. 2011).
. Miss.Code Ann. § 83-23-107 (Rev. 2011).
. Maj. Op. ¶ 13.
. Miss.Code Ann. § 71-3-163(1)(b) (Rev. 2011) (emphasis added).
. Miss.Code Ann. § 71-3-155 (Rev. 2011).
. Maj. Op. ¶ 16.
. Maj. Op. ¶ 16.
. Maj. Op. ¶ 16.
. See Miss.Code Ann. § 71-3-163(1)(b).
. Id.
. Maj. Op. ¶ 14; but see Miss. Ins. Guar. Ass'n v. Blakeney, 54 So.3d 203, 206 (Miss. 2011) (finding that insolvent insurer's shoes did not fit because the insolvent insurer's duties and obligations passed to MIGA under one subsection of the statute but were limited under another subsection that stated that MIGA may pay covered claims only to the extent of the association's obligation).
. Maj. Op. ¶ 16.
. Miss.Code Ann. § 83-23-109(c) (Rev. 2011).
. See Miss.Code Ann. § 71-3-163(1 )(b) (Rev. 2011).
. See Miss.Code Ann. § 83-23-115(1)(a)(iii) (Rev. 2011).
. See Wyoming Med. Ctr., Inc. v. Ins. Guar. Assn, 225 P.3d 1061, 1067-68 (Wyo. 2010).
. See T & N PLC v. Pennsylvania Ins. Guar. Ass’n, 800 F.Supp. 1259, 1263 (E.D.Pa. 1992); Nebraska Life & Health Ins. Guar. Ass’n v. Dobias, 247 Neb. 900, 531 N.W.2d 217, 220 (1995); Saylin v. Cal. Ins. Guar. Ass’n, 179 Cal.App.3d 256, 224 Cal.Rptr. 493, 497 (1986); Virginia Property & Casualty Ins. Guar. Ass’n v. International Ins. Co., 238 Va. 702, 385 S.E.2d 614, 616 (1989); Wyoming Med. Ctr., Inc. v. Ins. Guar. Ass’n, 225 P.3d 1061, 1067-68 (Wyo. 2010).
. See Miss.Code Ann. § 71-3-163(1 )(b) (Rev. 2011).
. Gen. Reinsurance Corp. v. Am. Bankers Ins. Co. of Fla., 996 A.2d 26 (2009).
. Id.
. Id. at 28.
. Id. at 36.
. See Miss.Code Ann. § 83-23-115(1 )(a) (Rev. 2011).
. Maj. Op. ¶ 19.
. See Miss.Code Ann. § 83-23-115(1)(a) (Rev. 2011).
Reference
- Full Case Name
- MISSISSIPPI INSURANCE GUARANTY ASSOCIATION a/k/a MIGA v. MISSISSIPPI WORKERS' COMPENSATION INDIVIDUAL SELF-INSURER GUARANTY ASSOCIATION f/k/a Mississippi Workers' Compensation Self-Insurer Guaranty Association
- Cited By
- 1 case
- Status
- Published