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IN THE SUPREME COURT OF APPEALS OF WEST VIRGINIA
September 1998 Term
No. 24625
STATE OF WEST VIRGINIA EX REL. HANLEY C. CLARK,
INSURANCE COMMISSIONER OF THE STATE OF WEST VIRGINIA,
Plaintiff Below, Appellee,
V.
BLUE CROSS BLUE SHIELD OF WEST VIRGINIA, INC.,
Defendant Below,
WEST VIRGINIA STATE MEDICAL ASSOCIATION,
Intervenor Below, Appellee,
WEST VIRGINIA HOSPITAL ASSOCIATION;
BLUE CROSS WESTERN PENNSYLVANIA; INTERNATIONAL UNION;
UNITED MINE WORKERS; AND JOANN WILLIAMS, ET AL.,
Intervenors Below,
PENNSYLVANIA BLUE SHIELD,
Intervenor Below, Appellant.
AND
No. 24626
STATE OF WEST VIRGINIA EX REL. HANLEY C. CLARK,
INSURANCE COMMISSIONER OF THE STATE OF WEST VIRGINIA,
Plaintiff Below, Appellee,
V.
BLUE CROSS BLUE SHIELD OF WEST VIRGINIA, INC.,
Defendant Below,
WEST VIRGINIA STATE MEDICAL ASSOCIATION,
Intervenor Below, Intervenor, Appellee,
WEST VIRGINIA HOSPITAL ASSOCIATION;
PENNSYLVANIA BLUE SHIELD; INTERNATIONAL UNION;
UNITED MINE WORKERS; AND JOANN WILLIAMS, ET AL.,
Intervenors Below,
BLUE CROSS WESTERN PENNSYLVANIA,
Intervenor Below, Appellant.
AND
No. 24627
STATE OF WEST VIRGINIA EX REL. HANLEY C. CLARK,
INSURANCE COMMISSIONER OF THE STATE OF WEST VIRGINIA,
Plaintiff Below, Appellee,
V.
BLUE CROSS BLUE SHIELD OF WEST VIRGINIA, INC.,
Defendant Below,
WEST VIRGINIA STATE MEDICAL ASSOCIATION,
Intervenor Below, Intervenor, Appellee,
WEST VIRGINIA HOSPITAL ASSOCIATION;
BLUE CROSS WESTERN PENNSYLVANIA;
PENNSYLVANIA BLUE SHIELD; INTERNATIONAL UNION;
UNITED MINE WORKERS; AND JOANN WILLIAMS, ET AL.,
Intervenors Below,
UNITED STATES OF AMERICA, ON BEHALF OF CHAMPUS,
DEPARTMENT OF VETERANS AFFAIRS - VA HOSPITALS,
DEPARTMENT OF DEFENSE,
DEPARTMENT OF HEALTH AND HUMAN SERVICES,
OFFICE OF PERSONNEL MANAGEMENT AND MEDICAID, ET AL.,
Claimant Below, Appellant.
Appeal from the Circuit Court of Kanawha County
Honorable Charles E. King, Jr., Judge
Civil Action No. 90-C-3825
AFFIRMED IN PART, REVERSED IN PART AND REMANDED.
Submitted: September 23, 1998
Filed: December 4, 1998
James A. McKowen
James F. Humphreys & Associates
Charleston, West Virginia,
Edward L. Springer
Gerri L. Sperling
James H. Webster
Springer, Bush & Perry
Pittsburgh, Pennsylvania
Attorneys for the Appellants,
Highmark, Inc.
(formerly Pennsylvania Blue Shield, and
Blue Cross of Western Pennsylvania)
Frank W. Hunger
Assistant United States Attorney General
Rebecca A. Betts
United States Attorney
Southern District of West Virginia
Charleston, West Virginia
Stephen M. Horn
Assistant United States Attorney
J. Christopher Kohn
Sandra P. Spooner
Mary R. Bohan
Department of Justice
Washington, District of Columbia
Attorneys for the Appellant,
The United States of America
John T. Miesner
Hoyer, Hoyer, Smith & Miesner
Robert L. Greer
Assistant Deputy Receiver
West Virginia Department of Insurance
B. Keith Huffman
Office of the Insurance Commissioner
Charles R. McElwee
Paul G. Papadopoulos
Robinson & McElwee
Charleston, West Virginia
Attorneys for the Appellee,
Hanley C. Clark,
Insurance Commissioner of the State of West Virginia
Steven L. Thomas
Kay, Casto, Chaney, Love & Wise
Charleston, West Virginia
Attorney for the Intervenor, Appellee,
West Virginia State Medical Association
Michael E. Surguine
Kansas City, Missouri,
Ancil G. Ramey
Steptoe & Johnson
Charleston, West Virginia
Attorneys for Amicus Curiae,
National Association of Insurance Commissioners
F. James Foley
Vorys, Sater, Seymour and Pease
Columbus, Ohio,
Cheryl Connelly
Dustin C. Haley
Campbell, Woods, Bagley, Emerson, McNeer & Herndon
Huntington, West Virginia
Attorneys for Amici Curiae,
National Organization of Life & Health Insurance Guaranty Associations
and National Conference of Insurance Guaranty Funds
CHIEF JUSTICE DAVIS delivered the Opinion of the Court.
SYLLABUS BY THE COURT
1. When the procedures set forth in
W. Va. Code § 33-24-25 (1990) (Repl. Vol. 1996) have been followed, and the circuit
court has entered a final order, that order may be appealed even though it does not
completely and finally resolve a cause of action arising in the liquidation proceedings,
or terminate litigation between parties to the liquidation proceedings, so long as the
issue appealed may impact the ultimate disposition of the litigation. Moreover, because
Section 33-24-25 permits a party to appeal the circuit court's final order directly to
this Court, a party is not required to challenge the final order in the circuit court
before pursuing its appeal. Any error by the circuit court in connection with the entry of
its Section 33-24-25 final order, of which the party could not have reasonably known or
which the party could not have reasonably brought to the circuit court's attention prior
to the court's entry of its final order, may be raised on an appeal of that final order to
this Court.
2. On the rare occasion
that this Court must decide an issue that has not been raised before a lower court, our
consideration will be plenary, and we will apply a de novo standard of review.
3. "Strict adherence
must be given to the express legislative procedures governing the liquidation of health
service corporations found in West Virginia Code §§ 33-24-14 to -44 (1992 & Supp.
1995)." Syllabus point 1, in part, State ex rel. Clark v. Blue Cross Blue Shield
of West Virginia, Inc., 195 W. Va. 537, 466 S.E.2d 388 (1995).
4. W. Va. Code §
33-24-37(b) (1990) (Repl. Vol. 1996), which directs that proofs of claim filed after the
time prescribed by the circuit court pursuant to W. Va. Code § 33-24-37(a) (1990)
(Repl. Vol. 1996) shall not share in the distribution of assets of the company in
liquidation until all allowed claims that were timely filed have been paid in full with
interest, and W. Va. Code § 33-24-27(g) (1996) (Supp. 1998), which assigns
late-filed proofs of claim to Class VII for purposes of distribution, do not violate the
principle that the United States is not bound by state statutes of limitation when
enforcing its rights as sovereign.
5. W. Va. Code §
33-24-27 (1996) (Supp. 1998), which specifies the order of distribution for claims against
the liquidated estate of certain insolvent insurance companies and assigns late-filed
claims to distribution priority VII, is a law that was enacted for the purpose of
regulating the business of insurance in that it operates to protect the claims of
policyholders. Thus, under the operation of the McCarran-Ferguson Act, 15 U.S.C. §§
1011, 1012 (1994 ed.), W. Va. Code § 33-24-27 reverse preempts the federal priority
statute found at 31 U.S.C. § 3713 (1982) (1994 Ed.).
Davis, Chief Justice:
In three appeals consolidated for purposes of rendering this
opinion, Pennsylvania Blue Shield [hereinafter "PBS"], Blue Cross of Western
Pennsylvania [hereinafter "BCWP"] and the United States of America [hereinafter
"the United States"] challenge orders entered by the Circuit Court of Kanawha
County in liquidation proceedings involving Blue Cross Blue Shield of West Virginia
[hereinafter "BCBSWV"]. PBS and BCWP raise various issues, however, each
complain that it did not receive adequate notice of the recommended decision of the
court-appointed Referee regarding its respective claim, which decisions were adopted by
the circuit court without a hearing. We find this issue is dispositive of the appeals of
these two companies. Based upon our conclusion that the lower court failed to follow the
mandatory directives of W. Va. Code § 33-24-25 (1990) (Repl. Vol. 1996), we remand
these two cases for additional proceedings consistent with that governing statute. In the
third appeal herein consolidated, the United States first argues that the Receiver
improperly applied state law and classified its late-filed proofs of claim in Class VII
for purposes of distributing the BCBSWV liquidated estate. We find that the West Virginia
priority scheme for late-filed claims, as expressed in W. Va. Code §§ 33-24-27(g)
(1996) (Supp. 1998) and 33-24-37(b) (1990) (Repl. Vol. 1996), does not exceed state power,
and furthermore, under the McCarran- Ferguson Act, 15 U.S.C. §§ 1011 et seq.,
W. Va. Code § 33-24-27 reverse preempts the federal priority statute asserted by the
United States. Therefore, the classification assigned by the Receiver to the late-filed
claims of the United States, which was subsequently adopted by the circuit court, was
correct. Finally, the United States contends that the circuit court erred in finding that
BCBSWV was not party to a contract entered between the Office of Personnel Management and
the Blue Cross Blue Shield Association. On the contrary, we find that the Blue Cross Blue
Shield Association acted as an agent for BCBSWV when it entered the contract. Therefore,
the order appealed by the United States is affirmed in part, reversed in part, and
remanded for further proceedings.
I.
STATEMENT OF FACTS
This case pertains to liquidation proceedings
involving BCBSWV. By an "ORDER OF LIQUIDATION AND INJUNCTION" entered in the
Circuit Court of Kanawha County on October 26, 1990, BCBSWV was placed into receivership.
Hanley C. Clark, Insurance Commissioner of the State of West Virginia, was named as
Receiver.
Three separate appeals have been filed in this
Court challenging certain aspects of the BCBSWV liquidation proceedings below. The three
parties appealing are PBS,See footnote 1 1
BCWPSee footnote 2 2 and the
United States. Because these appeals all relate to the BCBSWV liquidation proceedings, we
have consolidated them for the purpose of rendering this opinion. However, the facts
relevant to the appeals of PBS and BCWP differ from those relevant to the appeal of the
United States. Therefore, we first relate the facts relevant to the appeals of PBS and
BCWP. The facts pertaining to the appeal of the United States are reviewed thereafter.
A.
Pennsylvania Blue Shield and
Blue Cross of Western Pennsylvania
The facts relevant to the appeals of PBS and BCWP are similar, and
are described together in this section of the opinion. Appellants PBS and BCWP, and the
appellee BCBSWV, are all members of the Blue Cross and Blue Shield Association
[hereinafter "the Association"], a national organization to which all Blue Cross
and Blue Shield plans belong.
The Association oversees the national system of
Blue Cross Blue Shield plans. According to the parties, regional "Blue" plans
interact with each other to provide, inter alia, health insurance coverage and
claims servicing across state lines. This interaction is necessary to accommodate
employer-subscribers having employees in two or more states. These employer-subscribers,
who must interact with two or more "Blue" plans in order to provide health
insurance for their employees, are referred to as "National Accounts."
At the time liquidation of BCBSWV was ordered,
agreements were in place between BCBSWV and PBS, and between BCBSWV and BCWP, to
administer health claim benefits for various National Accounts. In connection with these
agreements, PBS and BCWP made certain payments, referred to as "advance
deposits," to BCBSWV.See footnote 3 3
After BCBSWV was placed into receivership, the
Receiver took control of its assets and liabilities (the liquidation estate) pursuant to
W. Va. Code §§ 33-24-1 et seq. In accordance with the statutory
requirements, and after consultation with certain potential claimants, the Receiver filed
a liquidation plan in the circuit court. The court approved the plan, which included a
procedure whereby parties holding claims against the liquidated estate could assert them
by filing proofs of claim. Pursuant to the court-approved plan, proofs of claim would be
reviewed by the Receiver, who would then issue notices of determination to each
claimant. Thereafter, the claimants could submit objections for resolution by a
court-appointed referee.See footnote 4 4
In accordance with the court-approved procedure,
PBS and BCWP each filed a proof of claim in which they sought to recover the amount of
their advance deposits. In addition, PBS's proof of claim sought $77,224.02 for payments
made to Pennsylvania health care providers for the satisfaction of obligations incurred by
BCBSWV, and $47,153.70 as reimbursement for funds made available by PBS to cover
dishonored health care claims payment checks issued by BCBSWV.
The Receiver made his determinations regarding the
proofs of claim filed by PBS and BCWP, and sent each company a notice of determination.
The notices revealed that the Receiver had effectively categorized PBS's and BCWP's claims
as Priority Class V, under W. Va. Code § 33-24-27 (1996) (Supp. 1998),See footnote 5 5 for purposes of
payment. The two companies timely filed objections to the Receiver's determinations. The
disputed claims were then referred to a court-appointed Referee.
Presumably to assist in the management of the
numerous disputed claims to be addressed by the Referee, the circuit judge, by order
entered June 16, 1993, adopted specific rules to guide the proceedings before the Referee.
These rules were titled "CLAIMANTS' RULES OF PROCEDURE BEFORE REFEREE"
[hereinafter "Claimants' Rules"]. The circuit court order adopting the
Claimants' Rules stated that they "shall govern all proceedings and hearings to be
held before the Court appointed Referee pursuant to the Amended Reference Order entered by
the Court on March 12, 1993."
Pursuant to the Claimants' Rules, the Referee
conducted hearings regarding the disputed claims of PBS and BCWP and, sometime thereafter,
rendered a recommended order in each case. Each recommended order advised the circuit
court to reject the objections to the Receiver's determinations made by PBS and BCWP.
The Claimants' Rules required notice to the
"parties of record" when the Referee's recommended order was filed in the
circuit court. The relevant portion of the rules states: "The original of the
Recommended Order will be filed with the Circuit Clerk, and notice of the filing will be
made to the parties of record." (Emphasis added).
A certificate of service attached to the Referee's
recommended order issued in response to the objections filed by PBS indicated that the
Referee served copies of his recommended order by U.S. on various local counsel for the
interested parties on December 23, 1996. The certificate of service further indicates that
copies of the order were not served upon PBS individually or its out-of-state counsel. No
objections to the recommended order were subsequently filed in the circuit court.
Therefore, the court adopted, in full, the recommended order and entered the same as its
final order on January 21, 1997.
A similar course of events occurred with regard to
BCWP. The certificate of service attached to the Referee's recommended order issued in
response to the objections filed by BCWP revealed that, also on December 23, 1996, the
Referee served copies of this recommended order by U.S. Mail on various local counsel for
the interested parties. As with the PBS recommended order, no copies were served upon BCWP
individually or its out-of-state counsel. In the absence of any objections to the
recommended order, the circuit court adopted the order and entered the same as its final
order on January 13, 1997.
PBS and BCWP both claim that they did not receive
notice or have knowledge that the Referee had made his recommendations regarding their
objections until January 20, 1998. Thus, PBS received notice one day prior to the circuit
court's January 21, 1997, entry of its final order denying PBS's objections, and BCWP
received notice seven days following the court's January 13, 1997, entry of its final
order rejecting BCWP's objections.
As evidenced by the aforementioned certificates of
service that were attached to the Referee's recommended decisions, notice regarding the
recommended decisions and their submission to the circuit court had been sent to James
McKowen, local counsel for PBS and BCWP, at a law firm with which he no longer associated.
However, evidence contained in the record indicated that formal notice of McKowen's change
of address was not attempted until January 21, 1997, the day after McKowen received notice
of the Referee's recommended decisions.See footnote 6
6
It is from the circuit court's final orders of
January 21, 1997, and January 13, 1997, respectively, that PBS and BCWP now appeal to this
Court.
B.
The United States of America
The appeal of the United States involves claims against the BCBSWV
liquidated estate made by three separate agencies of the United States government.See footnote 7 7 While some of the
United States' claims involve more than one of the various agencies, the facts with
respect to each agency are different. Consequently, the relevant facts are provided
separately for each agency. Following the separate statements of fact, we briefly review
the procedural history that brought the United States' claims before us. Each of the three
issues raised by the United States will be addressed following a discussion of the issues
raised by PBS and BCWP.
The following background information pertaining to
each of the federal agencies filing claims against the BCBSWV liquidated estate was
provided by the United States, and was not disputed by the Receiver.
1. Claim of the Department of Veterans Affairs
A number of medical centers operated under the Department of
Veterans Affairs [hereinafter "VA"] submitted proofs of claim prior to the
deadline for timely filing such claims. Other VA medical centers did not meet the
deadline, but filed their proofs of claim after that date. Notices of determination
subsequently issued by the Receiver placed timely-filed VA claims into priority Class II
under W. Va. Code § 33-24-27, as amended.See
footnote 8 8 Late-filed claims were placed into priority Class VII of the
amended statute.See footnote 9 9 The
dollar amounts of the claims have not yet been quantified.
2. Claim of the Health Care Financing Administration
The Health Care Financing Administration [hereinafter
"HCFA"] is an agency within the Department of Health and Human Services. The
HCFA administers the Medicare program, which provides health insurance for the elderly,
disabled and those suffering from end-stage renal disease. In connection with the BCBSWV
liquidation proceedings, HCFA filed a proof of claim related to its administration of the
Medicare program. The claim submitted by HCFA had two components.
The first component of HCFA's claim arose from its
contract with BCBSWV as an intermediary to process Medicare claims. The United States
submits that from 1985 through 1991, BCBSWV contracted with HCFA to act as an intermediary
to process and pay Part A Medicare claims, which provide insurance for inpatient
institutional services, home health services, and other post-hospital services. During
this time, HCFA reimbursed BCBSWV for its administrative costs pursuant to the contract.
However, upon completion of its audit, HCFA disallowed a total of $12,962.00 in
administrative costs. According to the United States, the Medicare statute and regulations
authorize recovery of these overpayments.
Under the Medicare intermediary contract, BCBSWV
is also obliged to refund pension assets in excess of actuarial liability when its
contract with HCFA is terminated.See footnote 10 10 Medicare made excess pension contributions in the amount of $617,644.00 to
cover its pension liability for BCBSWV employees. In addition, $76,799.00 of claimed
pension expenses were disallowed by HCFA auditors. Consequently, the United States asserts
that the total overpayments, including disallowed administrative payments, excess pension
contributions, and disallowed pension expenses, must be refunded to Medicare in full.
However, the Receiver's notice of determination gave no separate class determination to
this portion of HCFA's claim, nor was the disputed claim submitted to the Referee for
adjudication.
The second component of the HCFA's claim arose
under the Medicare Secondary Payer [hereinafter "MSP"] statute. See 42
U.S.C. § 1395y(b) (1994) (1994 ed.). According to the United States, The MSP statute
applies to Medicare beneficiaries who have alternative sources of payment for health care
services, including those provided through private insurers like BCBSWV. Where an
alternative source of payment exists, the MSP statute mandates that the alternative source
act as the primary insurer, with Medicare acting as the secondary insurer. Under the MSP
statute, when Medicare erroneously pays a claim that should have been paid by a primary
insurer, it has the right to recover such payments from the primary insurer. Moreover, the
United States contends that it is subrogated to the rights of the individual or entity
entitled to payment from the third-party payer.
The HCFA claims that BCBSWV is an entity
responsible for payment under the MSP statute, both in its capacity as a private primary
insurer and as a third-party administrator of group health insurance plans. The amount of
the MSP portion of the HCFA's claim is approximately $570,000. The BCBSWV liquidation
Receiver placed this portion of the HCFA's claim into the equivalent of priority Class V
under W. Va. Code § 33-24-27, as amended,See
footnote 11 11 with claims of general creditors.
3. Claim of Office of Personnel Management
A contract, designated Contract No. C.S. 1039, was executed
between the Office of Personnel Management [hereinafter "OPM"] and the Blue
Cross and Blue Shield Association [hereinafter "the Association"] for provision
of health care services for federal employees. The United States submits that the
Association executed the agreement as an agent for BCBSWV. In addition, the Association
entered a "Participation Agreement" with BCBSWV, which set forth the obligations
of the Association and BCBSWV regarding the OPM contract. After BCBSWV was placed into
liquidation, the OPM filed a proof of claim arising out of the aforementioned contract it
executed with the Association. However, on the recommendation of the Referee, the OPM's
claim was disallowed in full by the circuit court based upon its ruling that OPM's
contract was with the Association, and not with BCBSWV, and that BCBSWV was merely a
third-party administrator of the contract between the Association and OPM.
4. Procedural History of United States' Claims
The United States of America, acting on behalf of the above-named
agencies, timely filed objections to the provisional plan of distribution proposed by the
Receiver, and to the Receiver's notices of determination regarding the above-described
federal claims. The objections were directed to the court-appointed Referee, who conducted
a hearing on several preliminary legal issues. The Referee subsequently tendered a
recommended order rejecting the United States' arguments on each of the preliminary legal
issues raised. Because it addressed only preliminary issues, the recommended order did not
conclusively resolve all of the United States' claims. By final order entered on January
21, 1997, the Circuit Court of Kanawha County adopted, in full, the recommended order of
the Referee resolving the preliminary issues. It is from this January 21, 1997, order that
the United States now appeals.
II.
APPELLATE JURISDICTION AND STANDARD OF REVIEW
A.
Appellate Jurisdiction
Before we address the substantive issues raised by the parties, we
must first explore the threshold question of our jurisdiction to consider these appeals.
PBS and BCWP complain that the circuit court erred by entering its final orders when they
did not receive proper notice of the Referee's recommended orders and an opportunity to
object to the same. In this particular instance, the errors complained of were not known,
in one case, until one day prior to the circuit court's entry of its final order, and, in
the other case, until seven days after the entry of the circuit court's final order. Thus,
PBS and BCWP could not reasonably have complained of these errors to the circuit court
before it entered its final orders. After the circuit court's entry of its final orders in
these two cases, the parties did not challenge their lack of notice before that court.
Instead, they appealed to this Court. Because PBS and BCWP did not challenge the lack of
notice in the lower court, we are presented with an issue that has not been determined by
the circuit court.
Similarly, the appeal of the United States is
before us under rather unique procedural circumstances. As previously mentioned, the
issues resolved in the order appealed by the United States were preliminary legal issues.
While the order, titled "FINAL ORDER" by the circuit court, conclusively
resolved the issues that were before the court, it did not finally terminate the
litigation between the United States and BCBSWV.
Typically, we have steadfastly held to the rule
that we will not address a nonjurisdictional issue that has not been determined by the
lower court. See Hartwell v. Marquez, 201 W. Va. 433, 442, 498 S.E.2d
1, 10 (1997) ("'It is a well established principle that this Court will not decide
nonjurisdictional questions which have not been raised in the court below.'" (quoting
Stonebraker v. Zinn, 169 W. Va. 259, 266, 286 S.E.2d 911, 915 (1982)
(additional citations omitted))); Syl. pt. 2, Trent v. Cook, 198 W. Va. 601,
482 S.E.2d 218 (1996) ("'[T]he Supreme Court of Appeals is limited in its authority
to resolve assignments of nonjurisdictional errors to a consideration of those matters
passed upon by the court below and fairly arising upon the portions of the record
designated for appellate review.' Syl. Pt. 6, in part, Parker v. Knowlton Const. Co.,
Inc., 158 W. Va. 314, 210 S.E.2d 918 (1975)."); Syl. pt. 3, Voelker v.
Frederick Business Properties Co., 195 W. Va. 246, 465 S.E.2d 246 (1995)
("'"In the exercise of its appellate jurisdiction, this Court will not decide
nonjurisdictional questions which were not considered and decided by the court from which
the appeal has been taken." Syllabus Point 1, Mowery v. Hitt, 155 W. Va.
103[, 181 S.E.2d 334] (1971).' Syl. pt. 1, Shackleford v. Catlett, 161 W. Va.
568, 244 S.E.2d 327 (1978)").
The mere fact that an issue has been decided by the lower court, however, does not automatically render the issue appealable. We have also generally declined to accept the appeal of a decision of a circuit court that does not finally terminate the litigation between parties:
Under W. Va. Code,
58-5-1 (1925),[See footnote 12 12
] appeals only may be taken from final decisions of a circuit court. A
case is final only when it terminates the litigation between the parties on the merits of
the case and leaves nothing to be done but to enforce by execution what has been
determined.
Syl. pt. 3, James M.B. v. Carolyn M., 193 W. Va. 289, 456 S.E.2d 16 (1995)
(footnote added). We have further explained that
The purpose of the "rule of finality,"
as it is known, is "to prohibit 'piecemeal appellate review of trial court decisions
which do not terminate the litigation[.]' United States v. Hollywood Motor Car Co.,
Inc., 458 U.S. 263, 265, 102 S. Ct. 3081, 3082, 73 L. Ed. 2d 754, 756
(1982)." [James M.B. v. Carolyn M.], 193 W. Va. at 292, 456 S.E.2d at 19.
Gooch v. W. Va. Dep't of Pub. Safety, 195 W. Va. 357, 362, 465 S.E.2d
628, 633 (1995). As with many rules, the "rule of finality" is subject to
exceptions. See, e.g., W. Va. R. Civ. P., Rule 54(b)
(permitting, under certain circumstances in cases involving multiple claims or multiple
parties, appeal of final judgment "as to one or more but fewer than all of the claims
or parties").
Notwithstanding our general refusal to address
nonjurisdictional issues not decided below, and our adherence to the rule of finality, we
find the issues raised by PBS, BCWP and the United States are properly before us. With
regard to the underlying liquidation proceedings, the West Virginia Legislature has
provided a statutory exception to the two appellate principles discussed above. See
W. Va. Code § 33-24-25 (1990) (Repl. Vol. 1996). W. Va. Code § 33-24-25
establishes procedures to be followed in liquidation proceedings involving hospital
service corporations, medical service corporations, dental service corporations or health
service corporations. Included in the liquidation procedures of W. Va. Code §
33-24-25 are directions for resolving objections to the Receiver's determinations in such
proceedings. W. Va. Code § 33-24-25 states, in part:
(c) When a claim is denied in whole or in
part by the liquidator . . . the claimant may file his objections with the
liquidator. . . .
(d) Whenever objections are filed with the
liquidator and the liquidator does not alter his denial of the claim as a result of the
objections, the liquidator shall ask the court for a hearing . . . . The
matter may be heard by the court or by a court-appointed referee who shall submit findings
of fact along with his recommendation. Upon receipt of such report, the court shall fix a
time for hearing the claim . . . .
(e) At the hearing, all persons interested
shall be entitled to appear and the court shall enter an order allowing, allowing in part,
or disallowing the claim. Any such order shall be deemed to be an appealable order.
(Emphasis added).
By virtue of W. Va. Code § 33-24-25, the
West Virginia Legislature has removed, in the context of liquidation proceedings involving
a hospital service corporation, medical service corporation, dental service corporation or
health service corporation, any requirement that parties challenge final orders in the
circuit court before pursuing appeals. The omission of a requirement that parties
challenge a final order in the circuit court prior to appealing the order to this Court
does not, under normal circumstances, require us to consider issues not addressed in the
first instance by the circuit court. However, the error presently raised by PBS and BCWP
was not known to the parties at a time when it could reasonably have been presented to the
circuit court prior to the entry of that court's final order. Thus, our refusal to
consider this issue would forever bar PBS and BCWP from raising this error.
Similarly, through W. Va. Code § 33-24-25, the West Virginia Legislature has removed the requirement that a final order must completely and finally resolve a cause of action or terminate litigation between parties to a law suit before such order may be appealed. However, this Court must not be burdened with hearing appeals of every interlocutory order entered by a circuit court in a liquidation proceeding. Thus, we will consider on appeal an order that does not completely and finally resolve a cause of action or terminate litigation between parties to a law suit only when the order purports to dispense with interlocutory issues that may impact the ultimate disposition of the litigation.
Consequently, we hold that when the procedures set forth in
W. Va. Code § 33-24-25 (1990) (Repl. Vol. 1996) have been followed, and the circuit
court has entered a final order, that order may be appealed even though it does not
completely and finally resolve a cause of action arising in the liquidation proceedings,
or terminate litigation between parties to the liquidation proceedings, so long as the
issue appealed may impact the ultimate disposition of the litigation. Moreover, because
Section 33-24-25 permits a party to appeal the circuit court's final order directly to
this Court, a party is not required to challenge the final order in the circuit court
before pursuing its appeal. Any error by the circuit court in connection with the entry of
its Section 33-24-25 final order, of which the party could not have reasonably known or
which the party could not have reasonably brought to the circuit court's attention prior
to the court's entry of its final order, may be raised on an appeal of that final order to
this Court.
B.
Standard of Review
Having determined our jurisdiction to consider the issues raised
by PBS, BCWP and the United States, we must now consider the appropriate standard for our
review of the issues. As explained below, we conclude the appropriate standard of review
for the appeals of PBS and BCWP is de novo. We have previously recognized that "[t]he
term 'de novo' means '"[a]new; afresh; a second time."'" West Virginia Div.
of Envtl. Protection v Kingwood Coal Co., 200 W. Va. 734, 745, 490 S.E.2d 823, 834
(1997) (quoting Frymier-Halloran v. Paige, 193 W. Va. 687, 693, 458 S.E.2d 780, 786
(1995) (quoting Black's Law Dictionary 435 (6th ed. 1990))).
We have often used the term "de novo"
in connection with the term "plenary." See, e.g., Matter of Starcher,
___ W. Va. ___, ___, ___ S.E.2d ___, ___, slip op. at 8 (No. 23681 January 23, 1998)
(describing the Court's independent evaluation as "de novo or plenary
review"); Syl. pt. 3, in part, Matter of Steven William T., 201 W. Va.
654, 499 S.E.2d 876 (1997) (indicating the applicable review by this Court is
"'plenary, independent, and de novo'" (citation omitted)); Tolliver v.
Kroger Co., 201 W. Va. 509, 513, 498 S.E.2d 702, 706 (1997) (identifying
appropriate review as "plenary," and citing for support a case utilizing the
term "'de novo'" (citing Syl. Pt. 1, Painter v. Peavy, 192 W. Va.
189, 451 S.E.2d 755 (1994))); Blake v. John Skidmore Truck Stop, Inc., 201
W. Va. 126, 129, 493 S.E.2d 887, 890 (1997) (characterizing proper review as "de
novo and plenary"). Perhaps more instructive for our present purposes is the
definition of the term "plenary," which means "[f]ull, entire, complete,
absolute, perfect, unqualified." Black's Law Dictionary 1154 (6th ed. 1990) (citation
omitted).
Common sense dictates that when this Court
addresses a previously undecided issue, our review must necessarily be anew and afresh,
and it must be full, entire and complete. Therefore, we hold that on the rare occasion
that this Court must decide an issue that has not been raised before a lower court, our
consideration will be plenary, and we will apply a de novo standard of review.
The errors assigned by the United States in this
appeal challenge the findings of fact and conclusions of law made by the circuit court:
In reviewing challenges to the findings
and conclusions of the circuit court, we apply a two-prong deferential standard of review.
We review the final order and the ultimate disposition under an abuse of discretion
standard, and we review the circuit court's underlying factual findings under a clearly
erroneous standard. Questions of law are subject to a de novo review.
Syl. pt. 2, Walker v. West Virginia Ethics Comm'n, 201 W. Va. 108, 492 S.E.2d
167 (1997).
III.
DISCUSSION
A.
Discussion of Issues Raised by Pennsylvania Blue Shield and
Blue Cross of Western Pennsylvania
PBS and BCWP argue that the circuit court erred by entering its
final orders adopting the recommended orders of the court-appointed Referee when the
Referee's recommended orders were not actually served upon PBS and BCWP, individually, or
their Pennsylvania counsel, and had not been adequately served upon their West Virginia
counsel. This lack of notice, PBS and BCWP argue, effectively denied them of their
opportunity to object to the recommended orders.
In response, the Receiver argues that PBS
and BCWP have failed to demonstrate that their local counsel provided any notice of a
change of address, written or otherwise, to the Referee or the circuit court prior to the
issuance of the recommended final order. The Receiver asserts that notice was properly
sent to West Virginia counsel at his last-known address. See W. Va. R. Civ. P.
Rule 5(b). Furthermore, the Receiver argues, throughout the proceedings service was made
only on local counsel for PBS and BCWP, and neither company ever complained that their
Pennsylvania counsel was not receiving sufficient service of pleadings and orders.
To address this issue, we must resolve whether PBS
and BCWP were given adequate notice of, and an opportunity to assert their objections to,
the recommended orders submitted to the circuit court by the Referee. We have considered
the arguments of the parties and looked to the relevant law. We conclude that adequate
service was not made pursuant to the governing statute.
The parties note that the court-adopted Claimants'
Rules, which were intended to govern, procedurally, the proceedings before the
court-appointed Referee, contained a provision regarding notice of the Referee's
recommended order. Pursuant to a provision contained in § IV of the Claimants' Rules:
"The original of the Recommended Order will be filed with the Circuit Clerk, and
notice of the filing will be made to the parties of record."
We find this rule to be enigmatic. It fails to
specify the individual or entity required to provide notice and further fails to define
the phrase "parties of record." Because "parties of record" is not
defined, we cannot ascertain whether notice to a party's lawyer is sufficient to comply
with the rule, or whether notice to the actual party, individually, is required.
Fortunately, our resolution of this issue does not depend upon an interpretation of this
rule.
The BCBSWV liquidation proceedings are governed by
W. Va. Code §§ 33- 24-14 to -44. Among this series of statutes governing the
liquidation of health service corporations is W. Va. Code § 33-24-25(d) (1990)
(Repl. Vol. 1996). W. Va. Code §33- 24-25(d) specifically states, in relevant part
regarding the resolution of disputes over the Receiver's determination of proofs of
claims:
The matter may be heard by the court or by a court-appointed
referee who shall submit findings of fact along with his recommendation. Upon receipt of
such report, the court shall fix a time for hearing the claim and shall
direct that the claimant or the receiver, as the court shall specify, shall give
such notice as the court shall determine to such persons as shall appear to the
court to be interested therein. All such notices shall specify the time and place of
the hearing and shall concisely state the amount and nature of the claim, the priorities
asserted, if any, and the recommendation of the receiver with reference thereto.
(Emphasis added).
The above-quoted statute repeatedly utilizes the
word "shall." In this regard, we have previously held that "'"[t]he
word 'shall', in the absence of language in the statute showing a contrary intent on the
part of the legislature, should be afforded a mandatory connotation." Point 2
Syllabus, Terry v. Sencindiver, 153 W. Va. 651[, 171 S.E.2d 480 (1969)].' Syl.
pt. 3, Bounds v. State Workmen's Compensation Comm'r, 153 W. Va. 670, 172
S.E.2d 379 (1970)." Syl. pt. 9, State ex rel. Goff v. Merrifield, 191
W. Va. 473, 446 S.E.2d 695 (1994) (citation alteration in original). Thus,
W. Va. Code § 33-24-25(d) imposes a mandatory duty upon the circuit court to
schedule a hearing and to dictate the specifics of notification, including naming the
individual who will be responsible for providing notice and the parties to receive notice.
In addition, the statute specifically details the information to be contained in such
notice.
There is nothing in the record before this Court indicating that the mandatory procedures outlined in W. Va. Code § 33-24-25(d) were followed by the circuit court.
Furthermore, the form of notice ventured by the Referee, by virtue of his
attempt to serve local counsel with copies of the recommended orders, was inadequate in
that it failed to provide information regarding the scheduled time and place of a hearing
on each claim, which would have been impossible to include in these two instances since
the court failed to schedule such hearings.
With regard to the statutory procedures for
liquidating a health service corporation, we have held, in an earlier case involving the
liquidation of BCBSWV, that "[s]trict adherence must be given to the express
legislative procedures governing the liquidation of health service corporations found in
West Virginia Code §§ 33-24-14 to -44 (1992 & Supp. 1995)." Syl. pt. 1, in
part, State ex rel. Clark v. Blue Cross Blue Shield of West Virginia, Inc., 195
W. Va. 537, 466 S.E.2d 388 (1995). Because the circuit court failed to adhere to the
mandatory provisions contained in W. Va. Code § 33-24-25(d), requiring the court to
schedule a hearing and to dictate the specifics of notification, including naming the
individual responsible for providing notice and the parties to receive such notice, we
conclude that PBS and BCWP did not receive proper notice of the Referee's recommended
orders. Consequently, as the interested parties did not receive proper notice of, and an
opportunity to express their objections to, the respective recommended orders, we find
that the circuit court erred in entering its final orders adopting the same.See footnote 13 13 In accordance with
this conclusion, we remand the two cases involving PBS and BCWP for hearings in compliance
with W. Va. Code § 33-24-25(d).See footnote
14 14
B.
The United States of AmericaSee footnote 15 15
The United States has raised two issuesSee footnote 16 16 that are within our appellate
jurisdiction,See footnote 17 17 the
lower court's resolution of the classification of the United States' late- filed claims
and the lower court's finding that OPM was not a party to a contract with BCBSWV. First,
while the lower court's resolution of the classification of the late-filed claims did not
completely and finally resolve a cause of action arising in the liquidation proceedings,
leaving this issue unresolved until a later time may have a substantial impact on the
ultimate disposition of the litigation by further delaying the already overdue
distribution of funds to claim holders. Second, the lower court's finding that the OPM
could not pursue its claim against the liquidated estate of BCBSWV, as there was no
contract between the OPM and BCBSWV, conclusively terminated the litigation as to the OPM.
1. Late-Filed Claims
The law of this State requires that, in liquidation proceedings
conducted under W. Va. Code §§ 33-24-14 through -44, proofs of claim must be filed
within four months of the circuit court's order declaring the corporation to be insolvent,
unless a longer time is prescribed upon certification by the Insurance Commissioner that
such additional time is necessary. W. Va. Code § 33-24-37(a) (1990) (Repl. Vol.
1996).See footnote 18 18 This
deadline for filing proofs of claim is commonly referred to as the "bar" date.
In West Virginia, claims filed after the bar date do not share in the distribution of
assets of a company in liquidation until all allowed, timely-filed claims have been paid
in full with interest. W. Va. Code § 33-24-37(b) (1990) (Repl. Vol. 1996). See
also W. Va. Code § 33-24-27(g) (1996) (Supp. 1998) (assigning Class VII to
late-filed claims for purposes of distribution). Thus, the West Virginia bar date does not
serve to absolutely prohibit late-filed claims. Rather, it simply assigns late-filed
claims to a distribution classification that is subordinate to all timely-filed claims.
W. Va. Code § 33-24-27(g). Because the commonly used term "bar" date is
somewhat misleading in the context of the West Virginia law in question, since it implies
that claims may not be filed after that date, we will heretofore refer to this date as the
"timely-claim" date.
During the proceedings underlying this appeal, claims of the United States that were filed after the timely-claim date were delegated by the Receiver to Class VII in the order of distribution, in accordance with W. Va. Code §§ 33-24-37(b) and 33-24-27(g). The United States objected to this classification, and the dispute was referred to the court- appointed Referee. The Referee issued a recommended order affirming the classification assigned by the Receiver. Thereafter, the circuit court affirmed the conclusion of the Referee on this issue.See footnote 19 19
The United States presents this Court with two arguments urging us
to reverse the lower court's disposition of the federal government's late-filed claims. We
address these two arguments in turn.
a. State-Imposed Statute of Limitation. Before
this Court, the United States first argues that the imposition of any limitation date on
federal claims is prohibited by the principle that the United States is not bound by state
statutes of limitation in actions in which it seeks to enforce its rights as sovereign. See
United States v. Summerlin, 310 U.S. 414, 60 S. Ct. 1019, 84 L. Ed.
1283(1940).
In response to the United States' argument that it
is not subject to a state- imposed statute of limitation, the Receiver replies that United
States v. Summerlin, the case primarily relied upon by the United States, is
distinguishable from the case at hand because Summerlin did not involve an
insurance liquidation proceeding. Moreover, the Receiver argues that West Virginia law
regarding the priority of late-filed federal claims is enforceable because it does not
invalidate, void and make totally unenforceable the federal claims. Next, the Receiver
argues that this issue involves the business of insurance and, thus, falls within the
McCarran-Ferguson Act, 15 U.S.C. §§ 1011 et seq. (1994 ed.).See footnote 20 20
We have reviewed the arguments presented by the parties, and the statutory and decisional law relevant to their arguments. For the reasons that follow, we conclude that a state may impose a limitation date on federal claims against an insolvent insurance company or health service corporation when that date merely subordinates the priority of late-filed federal claims rather than causing them to be absolutely invalidated.
We begin by analyzing United States v. Summerlin, the only
United States Supreme Court case cited by the United States in support of its argument. Summerlin
involved a United States claim against the estate of a deceased individual. The United
States filed its claim in a county court in the state of Florida, after the eight-month
state- established period for filing such claims had expired. A judge of the county court
wherein the claim was filed disallowed the late-filed claim of the United States. On
appeal to the county circuit court, the claim was declared void. The Supreme Court of
Florida affirmed the circuit court judgment, and the case was appealed to the United
States Supreme Court. The Supreme Court stated "[i]t is well settled that the United
States is not bound by state statutes of limitation or subject to the defense of laches in
enforcing its rights." Summerlin at 416, 60 S. Ct. at 1020, 84
L. Ed. at 1285. The high court went on to explain:
If this were a statute merely determining
the limits of the jurisdiction of a probate court and thus providing that the County Judge
should have no jurisdiction to receive or pass upon claims not filed within the eight
months, while leaving an oportunity [sic] to the United States otherwise to enforce its
claim, the authority of the State to impose such a limitation upon its probate court might
be conceded. But if the statute, as sustained by the state court, undertakes to
invalidate the claim of the United States, so that it cannot be enforced at all,
because not filed within eight months, we think the statute in that sense transgressed the
limits of state power.
Summerlin at 417, 60 S. Ct. at 1021, 84 L. Ed. at 1286 (emphasis added)
(citation omitted). Unlike the Florida statute at issue in Summerlin, the West
Virginia statute does not invalidate late-filed claims of the United States. It merely
provides them a subordinate classification so that the liquidation proceeding may advance.
In addition to Summerlin, the United States cites a federal circuit court of appeals case and a federal district court case on the topic of the applicability of state statutes of limitation to suits filed by the United States. However, as with Summerlin, these two cases involved a state law that completely abrogated the government's claim or suit.See footnote 21 21 The United States has cited no case rendered by the Supreme Court of the United States, or by any other court, involving a time limitation that merely subordinated the interests of the United States.See footnote 22 22
Absent specific authority on this issue, we believe a review of
the definition of the term "statute of limitation" aids our determination.
Generally, statutes of limitation are recognized as
[s]tatutes of the federal government and various states setting
maximum time periods during which certain actions can be brought or rights enforced. After
the time period set out in the applicable statute of limitations has run, no legal
action can be brought regardless of whether any cause of action ever existed.
A statute prescribing limitations to the
right of action on certain described causes of action or criminal prosecutions; that is, declaring
that no suit shall be maintained on such
causes of action, nor any criminal charge be made, unless brought within a
specified period of time after the right accrued.
Black's Law Dictionary 927 (6th ed. 1990) (emphasis added) (citation omitted). Unlike a
statute of limitation, the time limitation and claim subordination imposed by W. Va.
Code §§ 33-24-37(b) and 33-24-27(g) do not prohibit the United States from bringing its
claim. These two statutes merely diminish the priority of any late-filed claim in favor of
timely-filed claims. Thus, these provisions do not create a statute of limitation as that
term is generally understood.
Another important concern in liquidation
proceedings is that available assets be timely distributed.See footnote 23 23 Imposing a limit on the timely filing
of proofs of claim in liquidation proceedings promotes an expedient distribution of assets
to those with valid claims against the liquidated estate:
The assets of an insolvent insurer should
be distributed as soon as practicable, at the same time that the insurer's policyholders
have a strong interest in stating their claims against the insurer's assets. In attempting
to balance these interests, a reasonable time may be prescribed within which claims must
be filed; and, when a time limit is specified in the
relevant statutory scheme, the court has only such authority to allow late
claims as may be granted by the statute.
1 Lee R. Russ and Thomas F. Segalla, Couch on Insurance 3d § 6:5 (1997). See also
43 Am. Jur. 2d Insurance § 98, at 178 (1982) ("When an insurance company
becomes insolvent, its funds are to be distributed among its creditors as their claims
then exist, and the distribution of such assets at an early date is important because it
prevents postponing the settlement to await the determination of every contingency on
which its policy engagements may be suspended. Accordingly, a court having charge of the
affairs of an insolvent insurance company may fix a reasonable time within which claims
must be filed in order to participate in the distribution of assets, and may fix a date
beyond which no claims shall be presented or allowed, with the consequence that claims not
so presented and allowed are barred [or, as in West Virginia, subordinated], unless the
court sees fit, as it has power to do, to extend the time for good cause shown."
(footnotes omitted)).
The West Virginia statutory scheme for liquidating an insolvent insurance company plainly attempts to accomplish this timely resolution of claims against the liquidated estate of the company in receivership, while at the same time assuring that all claims, even those filed late, will be paid where the liquidated estate is large enough to fulfill lower classified claims. Under the operation of W. Va. Code §§ 33-24-37(b) and 33-24-37(a), no proofs of claim are rendered void or invalid due to their untimely filing.
Consequently, we hold that W. Va. Code § 33-24-37(b) (1990) (Repl.
Vol. 1996), which directs that proofs of claim filed after the time prescribed by the
circuit court pursuant to W. Va. Code § 33-24-37(a) (1990) (Repl. Vol. 1996) shall
not share in the distribution of assets of the company in liquidation until all allowed
claims that were timely filed have been paid in full with interest, and W. Va. Code
§ 33-24-27(g) (1996) (Supp. 1998), which assigns late-filed proofs of claim to Class VII
for purposes of distribution, do not violate the principle that the United States is not
bound by state statutes of limitation when enforcing its rights as sovereign.See footnote 24 24
b. Federal Preemption. We turn now to the United States' argument that W. Va. Code § 33-24-27 (1996) (Supp. 1998), which specifies the order of distribution for claims against the liquidated estate of an insolvent company, is preempted by the federal priority statute found at 31 U.S.C. § 3713 (1982) (1994 ed.).See footnote 25 25
The United States acknowledges that there is an exception to
federal preemption of a state law in circumstances where the state law regulates the
business of insurance. See McCarran-Ferguson Act, 15 U.S.C. §§ 1011 and 1012.
Furthermore, the United States concedes that the question of whether state laws pertaining
to insurance liquidation regulate the business of insurance has been addressed by the
United States Supreme Court. See United States Dep't of the Treasury v. Fabe,
508 U.S. 491, 113 S. Ct. 2202, 124 L. Ed. 2d 449. The United States
explains, however, that the Fabe Court concluded that state laws governing the
liquidation of an insurance company regulate the business of insurance only to the extent
that such laws protect policyholders. The United States argues that, because West Virginia
law permits priority diminution of late- filed federal claims to place the interests of
general creditors ahead of the federal government, it does not sufficiently protect
policyholders and, thus, is subject to federal preemption. See Garcia v. Island
Program Designer, Inc., 4 F.3d 57 (1st Cir. 1993) (applying Fabe and concluding
state priority law was preempted).
To the contrary, the Receiver contends that, under
Fabe and the McCarran- Ferguson Act, the West Virginia priority statute is not
preempted. The Receiver submits that Garcia has been twice rejected as reading Fabe
too narrowly. See Boozell v. United States, 979 F. Supp. 670 (N.D. Ill.
1997); Stephens v. American Int'l Ins. Co., 66 F.3d 41, 45 (2d Cir. 1995).
Moreover, the Receiver explains that without an enforceable timely-claim date, payment of
policyholders' claims cannot occur. According to the Receiver, the position advanced by
the United States, if followed, would convert the liquidation proceeding into a proceeding
of uncertainty. The Receiver, who is personally liable to the United States for
satisfaction of government claims having priority over claims already paid, would be
unable to distribute assets to policyholders without fear of the existence of a
significant, but unfiled, claim of the United States that would have priority over claims
already paid. Thus, the priority statute regulates the business of insurance by protecting
policyholders and is not preempted by federal law. For the reasons explained below, we
agree with the Receiver's conclusion.
We begin our analysis with a brief review of the
history of the McCarran - Ferguson Act. Prior to 1944, "'the States enjoyed a
virtually exclusive domain over the insurance industry.'" United States Dep't of
the Treasury v. Fabe, 508 U.S. 491, 499, 113 S. Ct. 2202, 2207, 124
L. Ed. 2d 449, 458 (quoting St. Paul Fire & Marine Ins. Co. v. Barry,
438 U.S. 531, 539, 98 S. Ct. 2923, 2928, 57 L. Ed. 2d 932, 939 (1978)). In
1944, this nearly exclusive domain was called into question by a decision of the United
States Supreme Court rendered in United States v. South-Eastern Underwriters
Association, 322 U.S. 533, 64 S. Ct. 1162, 88 L. Ed. 1440 (1944). The Court
has since explained:
South-Eastern Underwriters . . . held
that an insurance company that conduced a substantial part of its business across state
lines was engaged in interstate commerce and thereby was subject to the antitrust laws.
This result, naturally, was widely perceived as a threat to state power to tax and
regulate the insurance industry. To allay those fears, Congress moved quickly to restore
the supremacy of the States in the realm of insurance regulation. It enacted the
McCarran-Ferguson Act within a year of the decision in South-Eastern Underwriters.
Fabe at 499-500, 113 S. Ct. at 2207, 124 L. Ed. 2d at 458.
The McCarran-Ferguson Act, codified at 15 U.S.C.
§ 1011 et seq., states in relevant part:
§ 1011. Declaration of policy
Congress hereby declares that the
continued regulation and taxation by the several States of the business of insurance is in
the public interest, and that silence on the part of the Congress shall not be construed
to impose any barrier to the regulation or taxation of such business by the several
States.
§ 1012. Regulation by State law; Federal law relating
specifically to insurance. . . .
(a) State regulation
The business of insurance, and every
person engaged therein, shall be subject to the laws of the several States which relate to
the regulation or taxation of such business.
(b) Federal regulation
No Act of Congress shall be construed
to invalidate, impair, or supersede any law enacted by any State for the purpose of
regulating the business of insurance, or which imposes a fee or tax upon such business,
unless such Act specifically relates to the business of insurance . . . .
(Emphasis added).
While the United States argues that West Virginia
law is preempted by 31 U.S.C. § 3713,See footnote
26 26 there is nothing in that provision specifically relating to the
business of insurance. Thus, as the above quote demonstrates, if W. Va. Code §
33-24-27 (1996) (Supp. 1998) was enacted "for the purpose of regulating the business
of insurance," then it reverse preemptsSee
footnote 27 27 31 U.S.C. § 3713. 15 U.S.C. §1012(b).
In determining whether W. Va. Code § 33-24-27 was enacted to regulate the business of insurance, we find much guidance in United States Department of the Treasury v. Fabe, 508 U.S. 491, 113 S. Ct. 2202, 124 L. Ed. 2d 449. In Fabe, the United States Supreme Court considered whether an Ohio statute assigning priorities for claims against an insolvent insurance company qualified as a statute that regulated the business of insurance. The Fabe Court first noted its previous decision in Securities and Exch. Comm'n v. National Securities, Inc., 393 U.S. 453, 460, 89 S. Ct. 564, 568, 21 L. Ed. 2d 668, 676 (1969), wherein it construed the phrase "'for the purpose of regulating the business of insurance.'" Fabe at 501, 113 S. Ct. at 2208, 124 L. Ed. 2d at 459. The Court noted that the National Securities opinion "emphasized that the focus of McCarran- Ferguson is upon the relationship between the insurance company and its policyholders."
Id. The Fabe Court then explained that "'[s]tatutes
aimed at protecting or regulating this relationship [between insurer and insured],
directly or indirectly, are laws regulating the "business of insurance"' within
the meaning of the phrase." Id. (quoting Securities and Exch. Comm'n v.
National Securities, Inc. at 460, 89 S. Ct. at 568, 21 L. Ed. 2d at
676).
Further considering the insurance
company/policyholder relationship and its correlation to the concept of "regulating
the business of insurance," the Fabe Court analyzed its decisions in Union
Labor Life Insurance Co. v. Pireno, 458 U.S. 119, 102 S. Ct. 3002, 73
L. Ed. 2d 647 (1982), and Group Life & Health Insurance Co. v. Royal Drug
Co., 440 U.S. 205, 99 S. Ct. 1067, 59 L. Ed. 2d 261 (1979),See footnote 28 28 and concluded that
"[t]here can be no doubt that the actual performance of an insurance contract
falls within the 'business of insurance,' as we understood that phrase in Pireno
and Royal Drug." Fabe at 503, 113 S. Ct. at 2209, 124
L. Ed. 2d at 461 (emphasis added). The Court then reasoned that the Ohio
priority statute was "designed to carry out the enforcement of insurance contracts by
ensuring the payment of policyholders' claims despite the insurance company's intervening
bankruptcy. Because it is integrally related to the performance of insurance contracts
after bankruptcy, Ohio's law is one 'enacted by any State for the purpose of regulating
the business of insurance.' 15 U.S.C. § 1012(b)." Id. at 504, 113 S. Ct.
at 2209, 124 L. Ed. 2d at 461. The Court stated further
[t]he broad category of laws enacted
"for the purpose of regulating the business of insurance" consists of laws that
possess the "end, intention, or aim" of adjusting, managing, or controlling the
business of insurance. Black's Law Dictionary 1236, 1286 (6th ed. 1990). This category
necessarily encompasses more than just the "business of
insurance." . . . [W]e believe that the actual performance of an
insurance contract is an essential part of the "business of insurance." Because
the Ohio statute is "aimed at protecting or regulating" the performance of an
insurance contract, . . . it follows that it is a law "enacted
for the purpose of regulating the business of insurance," within the meaning of the
first clause of [15 U.S.C. § 1012(b)].
Id. at 505, 113 S. Ct. at 2210, 124 L. Ed. 2d at 462 (internal
citation omitted).
However, the Court did not end its analysis here,
but continued to explain that "[t]he primary purpose of a statute that distributes
the insolvent insurer's assets to policyholders in preference to other creditors is
identical to the primary purpose of the insurance company itself: the payment of claims
made against policies." Id. at 505-06, 113 S. Ct. at 2210, 124
L. Ed. 2d at 462.
The Fabe Court held that "the Ohio
priority statute, to the extent that it regulated policyholders, is a law enacted for the
purpose of regulating the business of insurance. To the extent that it is designed to
further the interests of other creditors, however, it is not a law enacted for the purpose
of regulating the business of insurance." Id. at 508, 113 S. Ct. at 2212,
124 L. Ed. 2d at 464.
Observing that "every preference accorded to
the creditors of an insolvent insurer ultimately may redound to the benefit of
policyholders by enhancing the reliability of the insurance company," the Court noted
"Royal Drug rejected the notion that such indirect effects are sufficient
for a state law to avoid pre-emption under the McCarran-Ferguson Act." Id. at
508-09, 113 S. Ct. at 2212, 124 L. Ed. 2d at 464 (citing Royal Drug,
440 U.S. at 217, 99 S. Ct. at 1076, 59 L. Ed. 2d at 271-72). Finally, the Fabe
Court applied its earlier holding to the Ohio statute, and further held that:
[T]he preference accorded by Ohio to the expenses of administering
the insolvency proceeding is reasonably necessary to further the goal of protecting
policyholders. Without the payment of administrative costs, liquidation could not even
commence. The preferences conferred upon employees and other general creditors, however,
do not escape pre-emption because their connection to the ultimate aim of insurance is too
tenuous.
Id. at 509, 113 S. Ct. at 2212, 124 L. Ed. 2d at 465 (citation
omitted).
Based upon the foregoing, it is clear that in
order to settle whether the priorities imposed by W. Va. Code § 33-24-27(g) on
late-filed claims of the United States are enforceable in the face of conflicting federal
law that is not specifically directed toward regulating insurance, we must ascertain
whether W. Va. Code § 33-24-27(g) regulates the business of insurance. In making
this determination, we must consider whether W. Va. Code § 33-24-27(g) protects or
regulates policyholders either directly, or indirectly so long as the connection to the
regulation of insurance is not too tenuous. We believe that it does.
West Virginia's timely-claim date and associated
priority diminution protect policyholders by assuring their claims will be handled in a
timely and orderly fashion and by reducing the administrative costs of liquidation,
thereby preserving more of the assets of the liquidated estate for distribution to
claimants, particularly policyholders as they must be fully compensated before
distributions are made to lower classified claimants. The timely-claim date and associated
priority diminution are thus integral to the administration of liquidation proceedings.
Without a set date by which all timely claims must be filed, there could be no timely and
orderly distribution of assets. In addition to the difficulty created by the possibility
of additional claims that might be filed at any time, the Receiver has the added concern
that, under 31 U.S.C. § 3713(b), the federal priority statute, "[a] representative
of a person or an estate . . . paying any part of a debt of the person or
estate before paying a claim of the Government is liable to the extent of the payment for
unpaid claims of the Government." Moreover, the unnecessary delays and complications
to the liquidation process that would be caused by the absence of an enforceable
timely-claim date would increase the amount of administrative expenses. Because
administrative expenses must be paid prior to compensating the claims of policyholders,
increases in administrative costs directly harm policyholders by reducing the amount they
are likely to recover on their claims. Due to the substantial benefit of timely and
orderly distribution of assets to policyholders, the fact that claim holders other than
policyholders may also benefit from the enforcement of the timely-claim date and
associated claim diminution is immaterial.
We are aware of only one case where the issue of the subordination of late- filed claims of the United States in insurance liquidation proceedings has been addressed directly. In Garcia v. Island Program Designer, Inc., 4 F.3d 57 (1st Cir. 1993), the United States Court of Appeals for the First Circuit considered whether a Puerto Rico statute that subordinated the priority of late-filed claims in insurance liquidation proceedings was preempted by federal law insofar as it applied to claims of the federal government. The Garcia Court applied Fabe and concluded that the Puerto Rico statute did not regulate the business of insurance, and, therefore, the McCarran-Ferguson Act did not apply. In reaching this conclusion, the Garcia Court reasoned:
The filing deadline (with
its penalty of subordination for late claims) cannot be said to directly "regulate[]
policyholders," for it is neither directed at, nor necessary for, the protection of
policyholders, as the [Fabe] Court required. The provision helps policyholders only
to the extent that (and in the same way as) it helps all creditors. That is to say, by
penalizing late-filers, the Commonwealth provision may bring about more speedy, orderly
liquidation proceedings, thereby (perhaps) reducing the risks (and costs) of extending
credit to the company.
Nor can one say that the
Commonwealth's filing deadline provision is necessary for the protection of
policyholders. . . . The Commonwealth's filing deadline at issue here
. . . is not necessary for a liquidation. Without it, liquidation would
still prove manageable. At worst, the trustee's job would become slightly more difficult.
He would have to provide, for example, the United States with a first priority as long as
he had, say, actual notice (or "constructive" notice through recording) of the
claim, even if he did not have formal notice through a "proof of claim" filed
directly in the liquidation proceedings.
Garcia, 4 F.3d at 62.
The decision of the Garcia Court with
respect to the application of Fabe on the issue of federal preemption has not been
followed by any other court. In fact, the decision has been criticized as interpreting Fabe
too narrowly. See Boozell v. United States, 979 F. Supp. 670 (N.D. Ill.
1997).
In Boozell, the United States District
Court for the Northern District of Illinois was asked to determine whether an Illinois
insurance liquidation priority statute violated Fabe by requiring policyholders to
"compete on an equal basis with state guaranty funds for payment of claims." 979
F. Supp. at 678. The Boozell Court expressly rejected Garcia as
interpreting Fabe too narrowly, and commented:
The Fabe holding, as appropriately noted in Stephens
[v. American International Insurance Co., 66 F.3d 41 (1995)], is a broader
interpretation of the Supreme Court's prior holding in SEC v. National Securities, Inc.
Thus, the Fabe holding attempts to give meaning to the plain wording of the
McCarran-Ferguson Act by exempting any state law which directly or indirectly assists
policyholders from federal preemption.
Id. In reaching the conclusion that the Illinois statute was not preempted, the Boozell
Court reasoned that the guaranty association was designed to protect policyholders of an
insolvent insurer by continuing coverage and paying claims to any policyholders of an
insolvent insurer in exchange for "a limited priority recovery of assets from the
insolvent insurer." Id. Moreover, the Court noted that "[p]olicyholders
who receive payments on other benefits from a guaranty association are deemed to have
assigned their rights under the covered policies to the association to the extent of the
benefits provided," and, thus, the guaranty association was "entitled to the
same priority as the policyholders would have had with respect to the assigned
claims." Id.
While other courts have not expressly criticized Garcia,
they have afforded Fabe a much broader interpretation than did the Garcia
court. See Stephens v. American Int'l Ins. Co., 66 F.3d 41 (2d Cir. 1995).
In Stephens v. American International Insurance Co., the
United States Court of Appeals for the Second Circuit considered whether an
anti-arbitration clause contained in a Kentucky statute governing liquidation of insurers
was preempted by the Federal Arbitration Act. The Court of Appeals reasoned that the
anti-arbitration clause "regulate[d] the performance of insurance contracts once an
insurance company . . . is declared insolvent and enters liquidation.
It is crucial to the 'relationship between [an] insurance company and [a] policyholder'
that both parties know that in the case of insolvency, the insurance company will be
liquidated in an organized fashion." Stephens at 44-45 (citation omitted).
Relying on Fabe, the Court concluded that the statute in question was protected
from preemption by the McCarran-Ferguson Act, and stated:
The Kentucky Liquidation Act has the "end, intention, or aim
of adjusting, managing or controlling the business of insurance," in that it
regulates the winding up of an insolvent insurance company. The Liquidation Act
"protects" policyholders . . . by assuring that an insolvent
insurer will be liquidated in an orderly and predictable manner and the anti- arbitration
provision is simply one piece of that mechanism.
Id. at 45 (citation omitted). See also Munich Am. Reinsurance Co. v.
Crawford, 141 F.3d 585, 592-94 (5th Cir. 1998) (addressing whether an Oklahoma state
court had the
authority, under state law governing insurance delinquency proceedings, to enjoin an action in federal court to enforce the Federal Arbitration Act, where such action violated an earlier entered state court injunction prohibiting any actions against the insolvent insurance company or the Receiver; observing that while Fabe suggested "that a statute may require parsing to determine the extent of its pre-emptive power under the McCarran- Ferguson Act," the Court did not preclude, in some circumstances, the determination that a state insurance liquidation act, as a whole, was enacted to regulate insurance and, thus, reverse preempts federal law; commenting further that "it is crucial to the relationship between the insurance company and its policyholders for both parties to know that, in the event of insolvency, the insurance company will be liquidated in an organized fashion" (citing Stephens v. American Int'l Ins. Co.); and concluding that Oklahoma state laws were "reasonably necessary to further the goal of protecting policyholders, even though they may also benefit other creditors"); Murff v. Professional Med. Ins. Co., 97 F.3d 289, 291 (8th Cir. 1996) (conducting Fabe analysis and deciding, in part, that the portion of a Missouri insurers' insolvency act instituting a stay of all actions against an insolvent insurer inverse preempted the Federal Age Discrimination in Employment Act, as state statute is "'a law regulating the business of insurance,'" which "protects policyholders because it preserves the assets of the insolvent insurer's estate, thereby enhancing the ability of an insolvent insurance company to perform its contractual obligations" (footnote omitted)).
We believe that the courts affording a broader interpretation of Fabe
have chosen the better course. Similarly, we find that the claim priority diminution of
W. Va. Code § 33-24-27 sufficiently protects policyholders so that, under the
McCarran-Ferguson Act, it reverse preempts the federal priority statute found at 31 U.S.C.
§ 3713. Accordingly, for the foregoing reasons, we hold that W. Va. Code § 33-24-27
(1996) (Supp. 1998), which specifies the order of distribution for claims against the
liquidated estate of certain insolvent insurance companies and assigns late-filed claims
to distribution priority VII, is a law that was enacted for the purpose of regulating the
business of insurance in that it operates to protect the claims of policyholders. Thus,
under the operation of the McCarran-Ferguson Act, 15 U.S.C. §§ 1011, 1012 (1994 ed.),
W. Va. Code § 33-24-27 reverse preempts the federal priority statute found at 31
U.S.C. § 3713 (1982) (1994 ed.).
2. OPM Contract
The United States also argues that the circuit court erred in
concluding that Contract No. C.S. 1039 was not a contract between OPM and BCBSWV.See footnote 29 29 Specifically, the
United States contends that the circuit court ignored uncontradicted documentary evidence
that BCBSWV authorized the Association to act on its behalf, as its agent, in entering the
contract. Although BCBSWV did not individually execute the contract, the United States
asserts that BCBSWV is bound thereto by operation of the law of agency as though it had
executed the contract.
The Receiver responds that there was no privity of contract between OPM and BCBSWV, as there is no contract that OPM and BCBSWV entered into together. Additionally, the Receiver contends that the OPM and the Association were the only parties to the contract in question, and that BCBSWV simply acted as a third-party administrator of that contract.
After considering the parties' arguments, and examining the
relevant contractual agreements, we find that the Association was, in fact, acting as an
agent for BCBSWV when it executed Contract No. C.S. 1039 with the OPM. Contract No. C.S.
1039 expressly states: "This Contract . . . is now by and between the
United States Office of Personnel Management . . . and the following
party: (1) Blue Cross and Blue Shield Association, an Illinois not-for-profit Corporation,
acting pursuant to authority specified in Exhibit A for and in behalf of the
organization specified in Exhibit A . . . ." (Emphasis
added). Exhibit A, as referred to in Contract No. C.S. 1039, is an agreement between the
Association and BCBSWV. "ARTICLE I" of Exhibit A provides:
The Association is hereby authorized
and directed by the undersigned Plan to execute on behalf of the Plan the necessary
documents, including any amendments thereof, with the United States Office of Personnel
Management . . . to furnish health benefits through the undersigned
Plan and other similar Plans as provided by the Government-wide Service Benefit Plan, to
those employees and annuitants, including their dependents, if any, enrolled under the
Contract between the Association and the Agency.
(Emphasis added). Finally, a plan participation agreement entered between the Association
and BCBSWV to set forth their respective obligations under Contract No. C.S. 1039 begins
by stating:
WHEREAS, the undersigned Plan has
executed an agreement authorizing the Blue Cross and Blue Shield
Association . . . to obligate the Plan to provide benefits under Title 5,
Chapter 89, United States Code (hereinafter referred to as the "Federal Employee
Program" or "FEP"); and
WHEREAS, the Association
and the U.S. Office of Personnel Management have entered into a Contract for the Provision
of health care benefits under FEP . . .
(Emphasis added).
When considering questions of contract, we have frequently held that:
"'It is not the right or province of a court to alter, pervert or destroy the clear meaning and intent of the parties as expressed in unambiguous language in their written contract or to make a new or different contract for them.' Cotiga Development Co. v. United Fuel Gas Co., 147 W. Va. 484, 128 S.E.2d 626 (1962), Syllabus Point 3." Syllabus Point 2, Bennett v. Dove, 166 W. Va. 772, 277 S.E.2d 617 (1981).
Syl. pt. 1, Fraternal Order of Police, Lodge No. 69 v. City of Fairmont, 196 W. Va. 97, 468 S.E.2d 712 (1996). See also Syl. pt. 1, Bennett v. Dove, 166 W. Va. 772, 277 S.E.2d 617 (1981) ("'A valid written instrument which expresses the intent of the parties in plain and unambiguous language is not subject to judicial construction or interpretation but will be applied and enforced according to such intent.' Cotiga Development Co. v. United Fuel Gas Co., 147 W. Va. 484, 128 S.E.2d 626 (1962), Syllabus Point 1.").
The above-quoted language from the various
contracts is clear and unambiguous, and expresses that the Association was authorized and
directed by BCBSWV to executed Contract No. C.S. 1039 with OPM on behalf of BCBSWV. When a
person or entity is authorized and directed to act on behalf of another, that person or
entity is generally recognized as acting in the capacity of an agent. We have held that
"'"[a]n agent in the restricted and proper sense is a representative of his
principal in business or contractual relations with third
persons . . . ." Syllabus Point 3, [in part,] State ex rel.
Key v. Bond, 94 W. Va. 255, 118 S.E. 276 (1923).' Syl. Pt. 2, [in part,] Teter
v. Old Colony Co., 190 W. Va. 711, 441 S.E.2d 728 (1994)." Syl. pt. 3, in
part, Thomson v. McGinnis, 195 W. Va. 465, 465 S.E.2d 922 (1995). See
generally 3 Am. Jur. 2d Agency § 1, at 509-10 (1986) ("The term
'agency' means a fiduciary relationship by which a party confides to another the
management of some business to be transacted in the former's name or on his account, and
by which such other assumes to do the business and render an account of it. It has also
been defined as the fiduciary relationship which results from the manifestation of consent
by one person to another that the other shall act on his behalf and subject to his
control, and consent by the other so to act. Thus, the term 'agency,' in its legal sense,
always imports commercial or contractual dealings between two parties by and through the
medium of another. In an agency relationship, . . . the one who acts for
and represents the principal, and acquires his authority from him, is known and referred
to as an 'agent.'" (footnotes omitted)); 2A C.J.S. Agency § 4, at 552, 554-55
(1972) (stating that "[a]gency is succinctly defined as a relation created by an
agreement between the parties; relationship between a principal and his agent; the
representation of one called the principal by another called the agent in dealing with
third persons; the relation resulting where one person authorizes another to act for him
in business dealings with others," and defining agent as "one who acts for or in
the place of another by authority from him; a person having express or implied authority
to represent or act on behalf of another person who is called his principal; a person
employed or authorized by another to act for him, or to transact business for
him . . . ." (footnotes omitted)); 1A Michie's Jurisprudence Agency
§ 2, at 666 (1993) ("An agent is one who represents another, called the principal,
in dealings with third persons. He is one who undertakes some business or to manage some
affair for another by authority of or on account of the latter and to render an account of
it." (footnotes omitted)).
Because the Association was acting as an agent for
BCBSWV, with express authority to enter a contract obligating BCBSWV to furnish health
benefits to certain federal employees, BCBSWV is bound by the contract as if it had
executed the contract on its own behalf rather than through the Association. See
Syl. pt. 1, Bank of White Sulphur Springs v. Lynch, 93 W. Va. 382, 116 S.E.
685 (1923) ("A principal is liable for the contract of his agent made within the
scope of his Authority."). See also 3 Am. Jur. 2d Agency § 270,
at 771-72 (1986) ("[A] principal is bound by, and is liable upon, a contract executed
properly as to form by his agent, within the actual or apparent authority of the agent,
and with the understanding that the agent is contracting on behalf of the
principal."); 3 C.J.S. Agency § 406, at 245 (1973) ("Since an agent acts
for his principal in a representative capacity, the principal, rather than the agent, is
ordinarily bound by contracts entered into on his behalf by his agent when the making of
such contracts is within the scope of the agent's actual or apparent authority."); 1A
Michie's Jurisprudence Agency § 81, at 734 (1993) ("Where an agent's
authority is proved, no question of privity can arise. The doctrine of principal and
agent, whether disclosed or undisclosed, recognizes that privity of contract exists
between the principal and one dealing with the agent. The act of the agent is the act of
the principal.") (footnote omitted).
For the foregoing reasons, we conclude that BCBSWV
was a party to Contract No. C.S. 1039. Therefore, OPM, as a party to a contract with
BCBSWV, is entitled to assert any claims it may have arising from that contract.
Consequently, we remand this case for further consideration of OPM's claims.
3. Classification of the United States' Claims
Lastly, the United States asserts that the circuit court erred in finding that:
21. The claims of the USA relating to the treatment of veterans, and of the Health and Human Services, are claims which arise out of the USA's providing of medical services either directly or through third parties, and not through policies of insurance issued to such beneficiaries by Blue Cross Blue Shield West Virginia.
In this regard, the United States first argues
that the circuit court misinterpreted the basis for the VA's and HCFA's claims. These
claims, the United States asserts, represent payment by a federal agency of costs that
should have been paid by BCBSWV under policies held by individual veterans, Medicare
beneficiaries or military dependents. Thus, they are derivative of policyholder claims
because the agencies are subrogated to the right of the policyholders to be paid.
Next, the United States contends that the circuit
court erred by excluding the United States' subrogation claims from Class II when the
Receiver's Plan of Distribution places the subrogation claims of private providers in that
class. The United States also complains that the Plan of Distribution proposed a
two-tiered scheme of distribution, which impermissibly elevates individual subscribers'
claims above the claims of the United States and violates the West Virginia priority
statute, which prohibits creating any subclass within any class.
Finally, the United States argues in the
alternative that the circuit court erred in entering Finding 21 as that finding exceeded
the limited scope of the issues presented to the court in preliminary briefs.
The Receiver responds that the complained
of finding of the circuit court is simply a correct factual statement that the claims of
the VA and HCFA are not claims of policyholders of BCBSWV. Furthermore, the Receiver
asserts, the finding does not assign a particular priority class to the claims of the VA
or HCFA. Thus, the Receiver is uncertain as to how this finding adversely affects the VA,
since timely filed VA claims have been assigned Class II priority. The Receiver also
states that the facts surrounding this issue have yet to be developed in the circuit
court. Thus, the Receiver suggests, the United States is premature in asserting that
Finding 21 adversely affects the claims of the VA or HCFA. Finally, the Receiver submits
that the United States failed to complain of a two-tiered scheme of distribution in its
objections to the Receiver's proposed plan of distribution.
On its face, Finding 21 appears to state simply
that the claims of the VA and HCFA are not policyholder claims. As the Receiver notes,
there is nothing in the finding that assigns a classification to those claims. Moreover,
the Receiver's assertion that the facts must be further developed in the circuit court
before this issue can be resolved is undisputed, and finally, we note that the United
States failed to complain of a two-tiered scheme of distribution before the court below.
Thus, because the issues herein raised by the United States have not been decided by the
lower court, we adhere to our general practice and decline to address them on appeal.
See Hartwell v. Marquez, 201 W. Va. 433, 442, 498 S.E.2d 1, 10 (1997)
("'It is a well established principle that this Court will not decide
nonjurisdictional questions which have not been raised in the court below.'" (quoting
Stonebraker v. Zinn, 169 W. Va. 259, 266, 286 S.E.2d 911, 915 (1982)
(additional citations omitted))); Syl. pt. 2, Trent v. Cook, 198 W. Va. 601,
482 S.E.2d 218 (1996) ("'[T]he Supreme Court of Appeals is limited in its authority
to resolve assignments of nonjurisdictional errors to a consideration of those matters
passed upon by the court below and fairly arising upon the portions of the record
designated for appellate review.' Syl. Pt. 6, in part, Parker v. Knowlton Const . Co.,
Inc., 158 W. Va. 314, 210 S.E.2d 918 (1975)."); Syl. pt. 3, Voelker v.
Frederick Bus. Properties Co., 195 W. Va. 246, 465 S.E.2d 246 (1995)
("'"In the exercise of its appellate jurisdiction, this Court will not decide
nonjurisdictional questions which were not considered and decided by the court from which
the appeal has been taken." Syllabus Point 1, Mowery v. Hitt, 155 W. Va.
103[, 181 S.E.2d 334] (1971).' Syl. pt. 1, Shackleford v. Catlett, 161 W. Va.
568, 244 S.E.2d 327 (1978)").
IV.
CONCLUSION
For the reasons set forth in this opinion, the two final orders of
the Circuit Court of Kanawha County, entered on January 13, 1997, and January 21, 1997,
pertaining to Blue Cross of Western Pennsylvania and Pennsylvania Blue Shield
respectively, are reversed and remanded for further proceedings consistent with this
opinion. The final order entered by the circuit court on January 21, 1997, concerning the
United States of America, is affirmed in part, reversed in part and is also remanded for
further proceedings consistent with this opinion.
1 Highmark, Inc., appears before this Court as successor-in-interest to Pennsylvania Blue Shield. However, for clarity and ease of reference, we will refer to this
appellant as Pennsylvania Blue Shield or PBS.
Footnote: 2
2 Highmark, Inc., also appears before this Court as successor-in-interest to Blue Cross of Western Pennsylvania. For clarity and ease of reference, we will similarly refer to this appellant as Blue Cross of Western Pennsylvania or BCWP.Footnote: 3
3 The parties dispute the nature of these advance deposits and the priority classification assigned to them by the Receiver for purposes of liquidation.Footnote: 4
4 See W. Va. Code § 33-24-25 (1990) (Repl. Vol. 1996) for the statutory requirements for processing proofs of claims.Footnote: 5
5 The Receiver actually, and properly, applied the statute in effect at the time of his decision, W. Va. Code § 33-24-27 (1990) (Repl. Vol. 1996). Under this version of the statute, the category assigned to the claims of PBS and BCWP was Priority Class IV. However, following the issuance of the Receiver's notices of determination to PBS and BCWP, W. Va. Code § 33-24-27 was amended. The amended statute became effective on March 9, 1996, and was made to apply retrospectively to "all claims filed in any proceeding to liquidate a corporation which [were] pending on the effective date of thissection . . . ." For the sake of clarity and to avoid confusion, throughout this opinion all references to classifications assigned by the Receiver are translated into the associated classification under the revised version of W. Va. Code § 33-24-27, unless otherwise noted.
Footnote: 6
6 By letter dated January 21, 1997, McKowen sent notices of his new address to lawyers for the various parties, including counsel for the Receiver. However, the letter does not indicate that it was sent to the circuit court or to the Referee.Footnote: 7
7 In its appellate brief, the United States indicated that it was also appealing a claim against the BCBSWV liquidated estate asserted by the Office of Civilian Health and Medical Program of the Uniformed Services [hereinafter CHAMPUS]. However, the United States has failed to present an argument describing any alleged error involving the circuit court's disposition of the CHAMPUS claim. Moreover, the United States has acknowledged that the Receiver's notice of determination placed the CHAMPUS claim into the equivalent of priority Class II under W. Va. Code § 33-24-27, as amended. See supra note 5. As this is the highest class that may be assigned to any claimant, priority Class I being reserved for administrative expenses, we conclude that the United States has failed to designate an error in connection with the CHAMPUS claim.Footnote: 8
8 See supra note 5.Footnote: 9
9 See supra note 5.Footnote: 10
10 Presumably, the contract between BCBSWV and HCFA was terminated when BCBSWV was placed into receivership.Footnote: 11
11 See supra note 5.Footnote: 12
12 W. Va. Code § 58-5-1 was amended in 1998; however, the earlier version of the statute was in effect at the time relevant to this appeal. The current version of W. Va. Code § 58-5-1 adopts language similar to that contained in W. Va. R. Civ. P., Rule 54(b).Footnote: 13
13 Although the circuit court's failure to follow mandatory statutory procedures requires the remand of this case, we note that the notice problem experienced in this instance could easily have been avoided without the necessity of appeal if McKowen had promptly corrected his address on the court pleadings. It is a lawyer's responsibility to assure that his correct address appears on pleadings. See W. Va. R. Civ. P., Rule 11 ("Every pleading, motion and other paper of a party represented by an attorney shall be signed by at least one attorney of record in his individual name, whose address shall be stated." (emphasis added)). Moreover, parties giving notice have the right to rely on addresses provided on pleadings, and are not required to search for the correct address. See W. Va. R. Civ. P., Rule 5(b) ("Whenever under these rules service is required or permitted to be made upon a party represented by an attorney of record the service shall be made upon the attorney unless service upon the party himself or herself is ordered by the court. Service upon the attorney or upon a party shall be made by delivering a copy to him or her, or by mailing it to him or her at his or her last-known address . . . ." (emphasis added)). Additionally, we note that Rule 18 of the Local Rules for Kanawha County Civil Courts requires that: All proposed orders
shall be submitted to opposing counsel, if known, before the presentation thereof to the
court for entry, or reasonable written notice of intention to present a particular order
or decree shall be given to opposing counsel, if known, and the court shall be fully
advised in the premises contemporaneously with the motion for the entry of any such order
or decree.
At the bottom of the
order space shall be provided for each attorney to whom the order is presented to sign his
name to evidence the fact that such attorney has inspected the order, but such signature
shall not constitute approval of the order unless so stated in writing by the attorney
signing. Each attorney to whom any order is presented for inspection shall sign the
same at the bottom to evidence the fact that such attorney has had notice of such order
and inspected the same.
(Emphasis added). The necessity for appeal in this case may also have been avoided had this local rule been followed.
Footnote: 14
14 PBS and BCWP raise other issues on appeal. However, because we remand these cases for hearings in the circuit court, the additional issues are not ripe for appeal, and should be first addressed by the circuit court. See supra Section II.A. at 15-16.Footnote: 15
15 See supra pages 9-14 for a discussion of the facts relevant to the appeal of the Untied States.Footnote: 16
16 For the reasons explained in Section III.B.3. infra, we decline to address a third issue raised by the United States.Footnote: 17
17 See supra Section II.A. for a discussion of our jurisdiction to consider the appeal of the United States.Footnote: 18
18 The order of liquidation entered by the circuit court on October 26, 1990, directed the Receiver to notify all persons who may have claims against BCBSWV to file their proofs of claim "within four months from the entry of [the] order." Thereafter, by order entered February 22, 1991, the circuit court extended the deadline for timely filing proofs of claim by an additional four months at the request of the Insurance Commissioner/Receiver.Footnote: 19
19 Following are the particular findings and conclusions of the circuit court that the United States contends are erroneous: 46. The
West Virginia Legislature, in amending West Virginia Code, §33-24-27, to
specifically address the clash of priorities addressed in [United States Dep't of the
Treasury v. Fabe, 508 U.S. 491, 113 S. Ct. 2202, 124 L. Ed. 2d 449
(1993)], elevated the priority of federal claims so long as they otherwise complied with
the procedural requirements of the statutory scheme. However, the Legislature adhered to
existing law which allows for a diminishment in priority, but not elimination of the
claim, if the procedural requirements of the statute were not met.
48. "Where
a proof of claim complies with the statutory requirements of West Virginia Code §
33-24-25 (1992)[,] but is filed after the claims bar date provided for by statute [or any
court-ordered extensions thereof] has elapsed, the proof of claim is properly classified
as a Class [VII] late- filed claim as directed by West Virginia Code § 33-24-27(f)
(1992)". [Syl. pt. 2, State ex rel. Clark v. Blue Cross Blue Shield of West
Virginia, Inc., 195 W. Va. 537, 466 S.E.2d 388 (1995)].
49. The priority statute does not operate to void or invalidate the claims of the [United States of America] so that they cannot be enforced at all because of being filed after the bar date [timely-claim date], but simply assigns the late-filed claims to a lower class in the order of distribution. Therefore, the statute does not exceed the limits of state powers.
Footnote: 20
20 Contrary to the Receiver's contention that this portion of the United States' argument is disposed of by operation of the McCarran-Ferguson Act, 15 U.S.C. §§ 1011 et. seq., we find it necessary to address the state-imposed statute of limitation issue independently of the Act. McCarran-Ferguson states, in relevant part, "[n]o Act of Congress shall be construed to invalidate, impair, or supersede any law enacted by any State for the purpose of regulating the business of insurance." (Emphasis added). Because the principle relied upon by the United States in this portion of its argument does not arise from an Act of Congress, we believe that the McCarran-Ferguson Act does not operate to prevent its application. For further discussion of the McCarran-Ferguson Act, see text infra, Section III.B.1.b.Footnote: 21
21 See United States v. Morgan, 298 F.2d 255 (4th Cir. 1962) (affirming district court decision that rejected defendant lessees' assertion of state statute of limitation as a defense to an action by the United States to recover rent); United States v. Polan Indus., Inc., 196 F. Supp. 333 (S.D.W. Va. 1961) (rejecting defendant's attempt to assert state statute of limitation as defense against suit filed by United States to collect tax assessment from third-party debtor of the taxpayer).Footnote: 22
22 Our research has revealed one case decided by the United States Supreme Court, United States v. John Hancock Mut. Life Ins. Co., 364 U.S. 301, 81 S. Ct. 1, 5 L. Ed. 2d 1 (1960), wherein the Supreme Court was faced with an issue somewhat similar to the question before us. John Hancock involved foreclosure proceedings. A note, which was secured by a mortgage on real estate, and which was held by John Hancock Mutual Life Insurance Company, was in default. The United States held a second note secured by a mortgage on the same real estate. The United States' note was junior to the note held by John Hancock. At a foreclosure sale, John Hancock bought the real estate for an amount equal to the amount of the note it held. Under the relevant state law, the debtor/property owner had the exclusive right to redeem the foreclosed property for a period of twelve months. If the debtor/property owner failed to redeem during the twelve-month period, the lien creditors then had a three-month period within which to redeem. Under the applicable federal law, the United States had one year from the date of sale within which to redeem the property. Thus, there was a conflict between the state and federal law. The United States attempted to redeem the property pursuant to federal law, and the attempt was rejected by the state courts. Thereafter, the debtor/property owner redeemed the property as permitted by state law. On appeal to the Supreme Court of the United States, the conflict was resolved in favor of the United States on grounds not involving the federal government's immunity to state-imposed statutes of limitation. After reaching its conclusion, however, the Court noted that John Hancock advanced several other arguments, one being that "the United States, by seeking affirmative relief in a state court, subjects itself to all the incidents of state law which govern other suitors." John Hancock at 308, 81 S. Ct. at 6, 5 L. Ed. 2d at 6. The Court explained that this contention was easily resolved by one of "the several special rules which favor the United States in preference to other plaintiffs -- the rule that the United States is not subject to local statutes of limitations." Id. (citing United States v. Summerlin, 310 U.S. 414, 60 S. Ct. 1019, 84 L. Ed. 1283 (1940)). Because the debtor/property owner in John Hancock redeemed the foreclosed property, the application of state law would have forever barred the United States' right to redeem the real estate, and thus, its right to recover any of the funds due it. Contrariwise, the West Virginia statute in question merely subordinates the United States' claims, and does not operate as a total bar. Consequently, we find the John Hancock case, like those mentioned above, is factually and legally distinguishable from the issue before us.
Footnote: 23
23 As the BCBSWV liquidation proceedings demonstrate, speedy resolution is not always possible or practicable in complex liquidations involving large numbers of claimants and complicated legal issues. However, we do not believe that time-consuming complex cases should be further delayed through the abandonment of administrative aids such as West Virginia's imposition of a timely-claim date.Footnote: 24
24 But see United States v. Middle States Oil Corp., 18 F.2d 231 (8th Cir. 1927) (concluding that priority of late-filed claims of United States in bankruptcy proceeding could be subordinated only when the assets of the bankruptcy estate were sufficient to satisfy all claims against the estate, including those of the United States); United States v. Vellalos, 780 F. Supp. 705, 707 (D. Haw. 1992) (stating in dicta that a "state may not limit the federal government's general common law right to collect debts owed to it").Footnote: 25
25 31 U.S.C. § 3713 (1982) (1994 ed.) states:(a)(1) A claim of the United States Government shall be paid first when --
(A) a
person indebted to the Government is insolvent and--
(i) the
debtor without enough property to pay all debts makes a voluntary assignment of property;
(ii) property
of the debtor, if absent, is attached; or
(iii) an
act of bankruptcy is committed; or
(B) the
estate of a deceased debtor, in the custody of the executor or administrator, is not
enough to pay all debts of the debtor.
(2) This
subsection does not apply to a case under title 11.
(b) A representative of a person or an estate (except a trustee acting under title 11) paying any part of a debt of the person or estate before paying a claim of the Government is liable to the extent of the payment for unpaid claims of the Government.
Footnote: 26
26 See supra note 25 for the text of 31 U.S.C. § 3713.Footnote: 27
27 By the term "reverse preempt" we mean that, under the McCarran- Ferguson Act, state law regulating the business of insurance will be enforced over conflicting federal law that does not specifically relate to the business of insurance. In other words, the normal course of preemption is reversed in that state law will preempt federal law. See, e.g., Munich Am. Reinsurance Co. v. Crawford, 141 F.3d 585, 592-94 (5th Cir. 1998) ("Ordinarily, federal law pre-empts conflicting state law by virtue of the Supremacy Clause. See U.S. Const. art. VI, cl. 2. The McCarran-Ferguson Act reverses that effect in the narrow range of cases involving state regulation of the insurance industry. By its terms, the Act permits a state law to reverse pre-empt a federal statute . . . .")Footnote: 28
28 In Union Labor Life Insurance Co. v. Pireno, 458 U.S. 119, 102 S. Ct. 3002, 73 L. Ed. 2d 647 (1982), and Group Life & Health Insurance Co. v. Royal Drug Co., 440 U.S. 205, 99 S. Ct. 1067, 59 L. Ed. 2d 261 (1979), the United States Supreme Court identified three factors to be considered in determining what constitutes the "business of insurance." Those three factors are: "first, whether the practice has the effect of transferring or spreading a policyholder's risk; second, whether the practice is an integral part of the policy relationship between the insurer and the insured; and third, whether the practice is limited to entities within the insurance industry." Pireno at 129, 102 S. Ct. at 3009, 73 L. Ed. 2d at 656.Footnote: 29
29 The following findings of fact and conclusions of law are identified by OPM as erroneous:20. The USA asserts that the Office of Personnel Management claims arise on behalf of subscribers to the USA's own health care program, while the Receiver asserts
[and the Referee agrees] that Blue Cross Blue Shield West Virginia was a
third party administrator
27. The
USA's claim, including that asserted on behalf of the Office of Personnel Management, is
not the claim of a policyholder of Blue Cross Blue Shield West Virginia within the meaning
of West Virginia Code § 33-24-27(b).
28. The USA's claim
is not a claim for refund of unearned premiums or of a policyholder within the meaning of West
Virginia Code § 33-24-27(b).
29. The claims of the USA are not losses incurred as a policyholder within the meaning of West Virginia Code § 33- 24-27(b).