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All opinions are subject to modification and technical correction prior to official publication in the North Carolina Reports and North Carolina Court of Appeals Reports. In the event of discrepancies between the electronic version of an opinion and the
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STATE OF NORTH CAROLINA EX REL. COMMISSIONER OF INSURANCE,
Appellee, v. NORTH CAROLINA RATE BUREAU, Appellant
IN THE MATTER OF THE FILING DATED MAY 1, 2001 BY THE NORTH
CAROLINA RATE BUREAU FOR REVISED AUTOMOBILE INSURANCE RATES _
PRIVATE PASSENGER CARS AND MOTORCYCLES
NO. COA02-891
Filed: 7 October 2003
1. Insurance--ratemaking process--automobile and motorcycle liability insurance--
investment income from capital and surplus funds--return on insurance operations
The Commissioner of Insurance did not improperly consider investment income from
capital and surplus funds while calculating the ordered automobile and motorcycle liability
insurance rates, because: (1) the Commissioner focused on the return on insurance operations as
the appropriate target for his calculations; (2) the evidence regarding the eighteen year average
return on insurance operations is more than a scintilla or a permissible inference that sufficiently
supports the Commissioner's setting of rates; and (3) the Commissioner is not required to set his
target as the total rate of return.
2. Insurance--ratemaking process--automobile and motorcycle liability insurance--
policyholder dividends--rate deviations
The Commissioner of Insurance did not fail to give due consideration to the impact of
policyholder dividends and rate deviations in his ratemaking calculations for the ordered
automobile and motorcycle liability insurance rates, because: (1) the ratemaking formula is not
required to contain an explicit adjustment for dividends and deviations in order to prove due
consideration was given to them; (2) dividends and deviations should not be added to the rate
since they are already included within the computation of the average rate; (3) dividends and
deviations are part of profit and a provision for profit already exists; and (4) although the
Commissioner analyzed this issue from the average insurance company, his conclusions and
findings also discussed the effect of the average rate on the industry and the overall aggregate
profit of the industry.
3. Insurance--ratemaking process--automobile and motorcycle liability insurance--
investment income from policyholder-supplied funds
The Commissioner of Insurance did not improperly calculate the investment income
available from policyholder-supplied funds in its ratemaking calculations for the ordered
automobile and motorcycle liability insurance rates, because: (1)if rate deviations were also
considered within the investment income from policyholder-supplied funds portion of the
equation, deviations would be counted twice; and (2) agents' balances and prepaid expenses were
within the control of the individual insurance companies and should not impact the ratemaking
process in a way that disadvantages consumers.
4. Insurance--ratemaking process--automobile and motorcycle liability insurance--
excessive, inadequate, or unfairly discriminatory rates
The Commissioner of Insurance did not err by substituting its ratemaking procedure
without first finding that the North Carolina Rate Bureau's procedure would produce excessive,
inadequate, or unfairly discriminatory automobile and motorcycle liability insurance rates,because: (1) the Commissioner is not required to find each portion of the Bureau's filing
improper before he can substitute his own ratemaking structure; and (2) in order to use his own
data or calculations or to set rates, the Commissioner must only conclude that the Bureau's filing
as a whole would result in excessive, inadequate, or unfairly discriminatory rates.
Judge TYSON dissenting.
Appeal by North Carolina Rate Bureau from order entered 14
December 2001 by the North Carolina Commissioner of Insurance.
Heard in the Court of Appeals 10 June 2003.
Young, Moore and Henderson, P.A., by R. Michael Strickland,
William M. Trott, Marvin M. Spivey, Jr. and Terryn D. Owens,
for appellant.
North Carolina Department of Insurance, by Sherri L. Hubbard
and Stewart L. Johnson, for appellee.
EAGLES, Chief Judge.
The North Carolina Rate Bureau (Bureau) appeals from an
order entered by the North Carolina Commissioner of Insurance
(Commissioner) that denied the Bureau's request for an adjustment
in automobile insurance rates. The Bureau asserts four arguments
on appeal: (1) the Commissioner improperly considered investment
income on capital and surplus funds while deriving his underwriting
profit provisions; (2) the Commissioner did not give due
consideration to dividends and deviations; (3) the Commissioner
overstated the amount of investment income generated from
policyholder-supplied funds; and (4) the Commissioner improperly
substituted his own ratemaking procedure. After careful review of
the record, briefs and arguments of counsel, we discern no error
and affirm the Commissioner's order.
The Bureau is a statutorily created entity. The Bureau was
created by the General Assembly to replace and assume the duties ofthe North Carolina Automobile Rate Administrative Office, the North
Carolina Fire Insurance Rating Bureau, and the Compensation Rating
and Inspection Bureau of North Carolina. G.S. § 58-36-1(1) (2001).
The Bureau is not an agency of the State. See Allstate Ins. Co. v.
Lanier, 242 F. Supp. 73 (E.D.N.C. 1965), aff'd, 361 F.2d 870 (4th
Cir.), cert. denied, 385 U.S. 930, 17 L. Ed. 2d 212 (1966). It
represents the companies that sell automobile insurance in North
Carolina, along with other types of insurers. See G.S. § 58-36-
1(1).
The Commissioner of Insurance is an elected official of the
State of North Carolina. G.S. § 58-2-5 (2001). The Commissioner's
duties as chief officer of the Department of Insurance are broadly
described as the execution of laws relating to insurance. G.S. §
58-2-1 (2001). The North Carolina Supreme Court has listed the
Commissioner's duties as follows:
[F]aithfully executing all laws governing
insurance companies and the authority to adopt
rules to enforce that law; preventing
practices injurious to the public; furnishing
the necessary forms for statements required by
companies, associations, orders, or bureaus;
reporting to the Attorney General any
violations of law relating to insurance
companies; instituting civil actions or
criminal prosecutions for violations of the
insurance statutes; giving a statement or
synopsis of any insurance contract upon proper
application by any citizen; administering all
oaths required in the discharge of his
official duty; compiling and making available
to the public the lists of rates charged,
including explanations of coverages provided
by insurers; and adopting rules governing what
constitutes an uninsurable facility.
State ex rel. Comm'r of Ins. v. N.C. Rate Bureau, 350 N.C. 539,
541, 516 S.E.2d 150, 151 (1996 Auto)(citing G.S. § 58-2-40),
reh'g denied, 350 N.C. 852, 539 S.E.2d 11 (1999).
An insurance company may write insurance in North Carolina
only after it has become a member of the Bureau. G.S. § 58-36-5
(2001). The Bureau files a rate change proposal with the
Commissioner on behalf of its member companies. G.S. § 58-36-1(3)
(2001). Any rate change must be approved by the Commissioner.
G.S. § 58-36-70(a) (2001). If the Commissioner does not approve
the Bureau's proposed rates, the Commissioner may set the insurance
rates according to statute. G.S. § 58-36-70(d)(2001); see G.S. §
58-36-10 (2001).
After the Commissioner enters an order that rejects the
Bureau's ratemaking structure, the Bureau may appeal to this Court.
G.S. §§ 58-2-80, 58-36-25 (2001). The two most recent filings by
the Bureau have resulted in appeals to this Court and the Supreme
Court. The disagreement between the Bureau and the Commissioner
regarding the legal significance of the two previous appeals forms
the basis for the current appeal.
The Bureau filed a rate adjustment request for automobile
insurance on 1 February 1994. The Commissioner entered an order on
28 September 1994 rejecting the Bureau's rates and substituting a
different schedule of rates. The Bureau appealed to this Court.
In an opinion dated 17 December 1996, this Court remanded the case
to the Commissioner with instructions to modify his order. The
Commissioner issued a new, modified order on 10 September 1997. The 10 September 1997 order was reversed on appeal to this Court on
29 December 1998.
While the 1994 filing proceeded on appeal, the Bureau filed
for another rate change on 1 May 1995. The Bureau amended its
filing on 1 April 1996. After hearings in July and August 1996,
the Commissioner disapproved the Bureau's rate proposal. By orders
issued on 4 October 1996 and 31 October 1996 the Commissioner
lowered rates for car insurance by 8.3% and raised the motorcycle
insurance rates by 3.2%. In an opinion filed on 16 June 1998, this
Court reversed the Commissioner's orders in part and affirmed in
part. The Supreme Court affirmed the Court of Appeals' opinion on
25 June 1999. Both the 1994 and 1996 rate filing disputes were
eventually settled by the parties.
The Bureau filed the requested rate change at issue here on 1
May 2001. The filing requested an increase of 10.6% for private
passenger automobile rates and a decrease of 2.4% for motorcycle
rates. The Commissioner held a hearing on the matter from 25
September 2001 until 31 October 2001. The Bureau's filing was over
1,000 pages in length. The evidence included nearly seventy
exhibits, testimony from nine expert witnesses and four additional
witnesses. The Commissioner rejected the Bureau's requested rates
in his order dated 14 December 2001. Instead, the Commissioner
ordered a rate reduction of 13.0% for automobile rates and a
reduction of 15.9% for motorcycles. The Bureau appeals from this
order.
When reviewing an order by the Commission, this Court must
examine the whole record and determine whether the Commissioner'sconclusions of law are supported by material and substantial
evidence. State ex rel. Comm'r of Ins. v. N.C. Rate Bureau, 129
N.C. App. 662, 664, 501 S.E.2d 681, 684 (1998)(1996 Auto-COA),
aff'd, 350 N.C. 539, 516 S.E.2d 150 (1999). The whole record
test requires the reviewing court to consider the record evidence
supporting the Commissioner's order, to also consider the record
evidence contradicting the Commissioner's findings, and to
determine if the Commissioner's decision had a rational basis in
the material and substantial evidence offered. State ex rel.
Comr. of Ins. v. Rate Bureau, 124 N.C. App. 674, 678, 478 S.E.2d
794, 797 (1996)(1994 Auto)(quoting State ex rel. Comr. of
Insurance v. N.C. Rate Bureau, 75 N.C. App. 201, 208, 331 S.E.2d
124, 131, disc. rev. denied, 314 N.C. 547, 335 S.E.2d 319
(1985)(1983 Farm)), disc. rev. denied, 346 N.C. App. 184, 486
S.E.2d 217 (1997). Substantial evidence is 'such relevant
evidence as a reasonable mind might accept as adequate to support
a conclusion.' It is 'more than a scintilla or a permissible
inference.' 1994 Auto, 124 N.C. App. at 678, 478 S.E.2d at 797
(citations omitted)(quoting Comr. of Insurance v. Automobile Rate
Office, 287 N.C. 192, 205, 214 S.E.2d 98, 106 (1975)).
The Commissioner determines the weight and sufficiency of the
evidence presented during the hearing, including the credibility of
any witnesses. See State ex rel. Comr. of Insurance v. N. C. Rate
Bureau, 96 N.C. App. 220, 221, 385 S.E.2d 510, 511 (1989)(1987
Workers' Compensation). [I]t is not our function to substitute
our judgment for that of the Commissioner when the evidence is
conflicting. 1987 Workers' Compensation, 96 N.C. App. at 221, 385S.E.2d at 511. Instead, the Commissioner's order is presumed
correct if it is supported by substantial evidence. G.S. §§ 58-2-
80 and 58-2-90(e)(2001). The order must conform to the guidelines
set out in G.S. § 58-36-10:
(1) Rates or loss costs shall not be
excessive, inadequate or unfairly
discriminatory.
(2) Due consideration shall be given to actual
loss and expense experience within this State
for the most recent three-year period for
which that information is available; to
prospective loss and expense experience within
this State; to the hazards of conflagration
and catastrophe; to a reasonable margin for
underwriting profit and to contingencies; to
dividends, savings, or unabsorbed premium
deposits allowed or returned by insurers to
their policyholders, members, or subscribers;
to investment income earned or realized by
insurers from their unearned premium, loss,
and loss expense reserve funds generated from
business within this State; and to all other
relevant factors within this State: Provided,
however, that countrywide expense and loss
experience and other countrywide data may be
considered only where credible North Carolina
experience or data is not available.
G.S. § 58-36-10. As long as the Commissioner's order meets the
criteria of G.S. § 58-36-10 and is supported by material and
substantial evidence, the order should be upheld.
I.
[1] The Bureau first argues that the Commissioner improperly
considered investment income from capital and surplus funds while
calculating the ordered insurance rates. In order to analyze the
Bureau's argument, we must first look at the structure of the
insurance industry and the holdings of the
1994 Auto and
1996 Auto
cases.
See 1996 Auto, 350 N.C. 539, 516 S.E.2d 150 (1999);
1994
Auto, 124 N.C. App. 674, 478 S.E.2d 794 (1996). An insurance company's total profit is derived from two
distinct parts of the insurance business -- (1) profit earned by
the insurance operations and (2) profits earned by investing
capital and surplus funds. The profit from insurance operations
includes both the underwriting profit and investment income from
policyholder-supplied funds. The underwriting profit can be
defined as the difference between insurance premiums collected and
the amount the company pays out for losses and expenses.
Policyholder-supplied funds are the amount of premiums paid to the
insurance company. Policyholder-supplied funds are usually
invested during the insurance coverage period.
The investment income produced by policyholder-supplied funds
should be given due consideration during the ratemaking process.
See G.S. § 58-36-10(2). The underwriting profit portion has been
the traditional focus of the dispute between the Commissioner and
the Bureau. In past orders, the Commissioner improperly considered
investment income from capital and surplus funds.
See 1996 Auto,
350 N.C. 539, 516 S.E.2d 150 (1999);
1994 Auto, 124 N.C. App. 674,
478 S.E.2d 794 (1996).
In addition to the statutory structure, this Court and the
Supreme Court have placed additional requirements upon the
ratemaking process:
Three basic principles of law pertain to the
setting of insurance rates: (1) the
Commissioner must set rates that will produce
a fair and reasonable profit and no more; (2)
what constitutes a fair and reasonable profit
'involves consideration of profits accepted by
the investment market as reasonable in
business ventures of comparable risk'; and (3)
the underwriting business, which includes the
collection and investment of premiums, is theonly basis for calculating the profit
provisions.
1996 Auto, 350 N.C. at 541, 516 S.E.2d at 151 (citations omitted)
(quoting
In re N.C. Fire Ins. Rating Bureau, 275 N.C. 15, 39, 165
S.E.2d 207, 224 (1965)). In the orders that gave rise to the
1994
Auto and
1996 Auto appeals, the Commissioner defined business
ventures of comparable risk as the total profit of the insurance
industry. In order to set a rate equal to comparable businesses in
those orders, the Commissioner subtracted capital investment income
and investment income from policyholder-supplied funds from total
returns to reach the underwriting profit:
Total profits of the industry
- capital/surplus investment income
= profits from insurance operations.
Profits from insurance operations
- income from policyholder-supplied funds
= underwriting profit.
Both orders (1994 and 1996) were reversed because the Commissioner
improperly considered the investment income on capital and surplus
funds. See 1996 Auto, 350 N.C. at 545, 516 S.E. 2d at 153-54
(This Court has made it clear that unless the legislature changes
the law, investment income from capital and surplus cannot be
considered when setting insurance rates.) and 1994 Auto, 124 N.C.
App. at 686, 478 S.E.2d at 802 (The formula used must exclude
investment income earned on capital and surplus.). The Supreme
Court prohibited the Commissioner from including capital and
surplus income in the ratemaking formula because [i]n determining
whether an insurer has made a reasonable profit, the amount of
business done rather than its capital should be considered . . . .Comr. of Insurance v. Rate Bureau, 300 N.C. 381, 444, 269 S.E.2d
547, 586 (1980)(1977 Auto)(quoting 2 Ronald A. Anderson, Couch
Cyclopedia of Insurance Law § 21:38 (2d ed. 1959)). Here, the
Bureau argues that the Commissioner has committed the same error in
his 2001 order as he did in the 1994 and 1996 orders. We disagree.
In the 2001 order, the Commissioner altered his ratemaking
formula in one significant way. Rather than attempting to find a
total return, the Commissioner set the return on insurance
operations as his target. The Commissioner made the following
pertinent findings of fact:
150. The Bureau proposes a return on
operations equivalent to a target total
return. A target total return is an
appropriate return for the whole of an
insurance company taking into account
investment income from capital and surplus.
151. The Bureau's target total return is
a range of 13.1% to 15.3% and is based upon
the cost of capital with the addition of a
.49% market to book conversion factor. [Expert
witness] Appel indicates that the law in North
Carolina allows for a return on operations in
this range.
152. The Bureau uses a cost of capital
as a measure of the returns that other
businesses of comparable risk can earn in the
market. However, the returns that the cost of
capital measures are the returns those other
businesses earn from all sources of income.
Thus, the cost of capital is a total return,
which in the insurance industry includes
consideration of income from capital and
surplus.
153. Department witnesses Cohn, Schwartz
and D'Arcy testify that the Bureau's total
return includes investment income on capital
and surplus by virtue of the cost of capital
calculation, described more fully below.
. . . .
156. In other jurisdictions, setting the
cost of capital as the target return is
appropriate; however, other jurisdictions may
consider all sources of income in calculating
profit. In North Carolina, only one source of
income, the insurance operations, may be
considered, while the investment income from
capital and surplus may not.
. . . .
159. Miller indicates that the law in
North Carolina is unique in that insurers are
allowed a return on operations which, in other
States, would be equivalent to the return on
operations plus the return on capital and
surplus. Miller's statement, thus,
substantiates the Department's claims that the
Bureau's return includes consideration of
investment income on capital and surplus.
. . . .
161. In addition to the Bureau's
consideration of investment income from
capital and surplus in setting the target
return, the Bureau's target return is
excessive. In calculating the total return as
the target, the Bureau is setting the return
for the insurance operations alone (which is a
partial return) commensurate with the total
returns of other businesses, including the
insurance business. This is simply not
comparable as required by law.
162. The lack of comparability is
evidenced by the Bureau's prospective range of
returns of 13.1% to 15.3% compared to the
average pre-tax historical returns on
insurance operations during an eighteen year
period of the countrywide property/casualty
industry of approximately 3.7% and the ten
year average pre-tax returns in competitive
rating states of 4.3% liability and 6.4%
physical damage. This lack of comparability
is further evidenced by the resulting profit
provisions of 9.5% and 14.0%, which are higher
than several of the witnesses have ever
encountered in any jurisdiction and certainly
higher than the profit provisions recently
utilized by the top ten writers in three
neighboring states.
163. In contrast to the Bureau, the
Department witnesses calculate a return on
operations taking into consideration only the
income generated by the insurance activity.
164. The Department witnesses'
recommended returns are compared to the risk
or operational returns (partial returns) of
businesses of comparable risk.
165. The returns which the Department
witnesses propose range from pre-tax returns
of 4.3% to 4.5% for liability and 3.5% to 6.4%
for physical damage to post tax returns of
3.7% to 6.8% for liability and 4.3% to 6.8%
for physical damage.
166. The Department witnesses recommend
a return on operations that is not a total
return because North Carolina law requires
that profit be set on the insurance operations
only and that profit from the investment
business not be considered. Furthermore, a
return on operations that is not a total
return provides the proper comparison to
businesses of comparable risk.
167. Unlike the Bureau, the Department
witnesses did not recommend a target total
return because: (1) a total return includes
consideration of investment income from
capital and surplus; (2) calculating a return
for only one source of insurance industry
income based upon the returns generated by all
sources of income of other businesses does not
constitute comparable risk, as required by
the law of this State.
168. The evidence in this case is
overwhelming that it is impossible to
calculate a target total return without
considering investment income on capital and
surplus.
169. In an attempt to circumvent the
illegality of including investment income from
capital and surplus in the calculation of the
target rate of return, Bureau witness Appel
states that the prohibition against
considering investment income from capital and
surplus applies only to the calculation of the
profit provisions, not to the establishment of
a target rate of return. However, there is
absolutely no legal foundation for thiscontention and the recent North Carolina
Supreme Court decision in the 1996 case states
otherwise.
170. Based upon the material and
substantial evidence in this case, the
Commissioner finds that the appropriate target
rate of return in this case is a return on
operations which is not equivalent to a total
return. A total return requires consideration
of investment income from capital and surplus
which violates the ratemaking laws of this
State. Furthermore, a total return makes an
inappropriate comparison to businesses that
are not of comparable risk, which leads to
excessive returns. For those reasons, the
Bureau's target range of returns is herein
rejected.
(Internal citations omitted.) In this order, the Commissioner
focused on the return on insurance operations as the appropriate
target for his calculations. In order to compare the insurance
operations return to an industry of comparable risk, the
Commissioner relied upon an expert opinion by Department witness
Allan I. Schwartz. Schwartz testified that the eighteen year
average return on insurance operations for the property and
casualty insurance industry was 3.7%. Schwartz adjusted his
estimate of the return on operations in order to account for the
slight difference in risk between the property and casualty
industry and the private passenger automobile insurance industry.
The Bureau has not argued that this property and casualty industry
information is not indicative of an industry of comparable risk.
Indeed, we note that the Bureau's own expert, Dr. James H. Vander
Weide, used property and casualty industry information when
formulating his expert opinion. G.S. § 58-36-10(2) does not
require the Commissioner or any expert witness to use only three
years of North Carolina data when calculating the reasonable marginof underwriting profit. Those geographical and temporal
restrictions only apply to the consideration of the loss and
expense experience, which is not in dispute here. As a result, we
hold that the evidence regarding the eighteen year average return
on insurance operations is more than a scintilla or a permissible
inference that sufficiently supports the Commissioner's setting of
rates.
In addition, we find the Bureau's argument that the
Commissioner must set his target as the total rate of return to be
unpersuasive. No statute or any case has required the Commissioner
to focus on the total rate of return for the insurance industry.
Instead, previous appellate court opinions have declared that the
return on operations is the only portion of income the Commissioner
can consider during the ratemaking process. If the Commissioner
had compared total returns here, as he did in previous ratemaking
orders, the Commissioner would have been required to add capital
and surplus funds somehow. By using insurance operations as the
comparable industry, the Commissioner did not need to consider
investment income on capital and surplus funds. Accordingly, the
investment income on capital and surplus funds has not been used in
the 2001 ratemaking calculation. The Commissioner's underwriting
profit provision comports with the requirements of G.S. § 58-36-10
as well as the holdings of 1994 Auto and 1996 Auto. We conclude
there is substantial evidence to support the Commissioner's
findings of fact and conclusions of law on this issue. Therefore
this assignment of error is denied.
II.
[2] The Bureau next argues that the Commissioner failed to
give due consideration to the impact of policyholder dividends and
rate deviations in his ratemaking calculations. We disagree.
Policyholder dividends are a return of premiums to insurance
purchasers, much like a rebate. Policyholders pay premiums at the
manual rate, then receive a rebate or dividend at the end of the
policy term. See G.S. § 58-36-60 (2001). The manual rate is set
by the Commissioner through the ratemaking process and is the rate
insurance companies must charge customers unless a deviation is
allowed. Rate deviations occur when a company receives permission
to charge certain policyholders more or less than the manual rate.
See G.S. § 58-36-30 (2001). If a policyholder is given a rate
deviation, the policyholder pays less than the manual rate from the
beginning of the policy period.
The Bureau contends that dividends and deviations are a
necessary tool for competition among insurance companies. Without
deviations or dividends, the Bureau argues that insurance companies
could not attract good risk policyholders. According to its
argument, dividends and deviations are not profits. The Bureau
believes that an adjustment of 5.0% should be included as a
separate term in the ratemaking calculation in order to counteract
the effect of dividends and deviations. Without this provision,
the Bureau argues that a premium shortfall will occur. This
argument is unpersuasive.
Due consideration of policyholder dividends and rate
deviations is required by statute. See G.S. § 58-36-10(2)(Due
consideration shall be given . . . to dividends, savings orunabsorbed premium deposits allowed or returned by insurers to
their policyholders, members, or subscribers.). The 1994 Auto,
1996 Auto-COA, and 1996 Auto cases are also instructive on this
issue because the treatment of dividends and deviations was
considered in those appeals.
The ratemaking formula is not required to contain an explicit
adjustment for dividends and deviations in order to prove due
consideration was given to them. See 1996 Auto, 350 N.C. at 547,
516 S.E.2d at 154-55 ('[D]ue consideration' does not require that
a numerical adjustment of the rates be made in order to reflect the
effects of dividends and deviations.); 1996 Auto-COA, 129 N.C.
App. at 667, 501 S.E.2d at 686; 1994 Auto, 124 N.C. App. at 681,
478 S.E.2d at 799. It has also been held that dividends and
deviations can be treated as profits rather than as expenses. 1996
Auto-COA, 129 N.C. App. at 668, 501 S.E.2d at 686 (citing 1994
Auto, 124 N.C. App. at 682, 478 S.E.2d at 800). The Bureau's
arguments contradict these established guidelines and are therefore
overruled.
The Commissioner made the following pertinent findings of fact
regarding dividends and deviations:
406. The Commissioner finds and
concludes that any margin for the payment of
dividends and deviations in excess of the
margin provided for in the average manual
premium is unreasonable and produces rates
that are excessive and unfairly
discriminatory.
407. Based on the foregoing, the
Commissioner finds that an average manual rate
with profit provisions of -2.8% for liability
and +1.0% for physical damage will provide
approximately 4.5% to 5.0% of manual premiums,
or approximately $120-135 million, as savingsthat may be used to pay dividends and to grant
deviations to insureds, assuming the same book
of business.
408. The approximately 4.5% to 5.0% of
premium or approximately $120-135 million
provided in the manual rate for policyholder
dividends and deviations by the Bureau member
companies is reasonable, adequate and is
provided in the rates, which are adopted and
approved herein by this Order and which are
not inadequate, excessive, or unfairly
discriminatory.
409. Dividends and deviations in excess
of the approximately 4.5% to 5.0% of premium
or approximately $120-135 million may occur,
as in the past. If so, the excess may come
from companies which are prepared to accept,
on an individual basis, less than the average
profit provided in the manual rate, from
accumulated surplus, from lower expenses, from
an excessive rate level implemented by the
Bureau or from sources which are not within
the jurisdiction of the Commissioner.
410. This approximately 4.5% to 5.0% of
premium will become retained earnings, i.e.,
profit, if it is not distributed as dividends
and deviations. Including more than the 4.5%
to 5.0% of premium that comes from savings for
dividends and deviations in the rate
calculation will cause rates to spiral and
become excessive and unfairly discriminatory.
The Commissioner also found that dividends and deviations are
transfer payments or profit. The Commissioner found that including
a specific provision for dividends and deviations was unnecessary
because the use of an average rate implicitly included
consideration of dividends and deviations. After careful review,
we conclude that there is sufficient record evidence to support the
Commissioner's findings.
The Commissioner's reasons for refusing to adjust the
ratemaking formula by adding a provision for dividends and
deviations are twofold. First he states that dividends anddeviations should not be added to the rate because they are already
included within the computation of the average rate. The average
rate takes into account the companies that deviate as well as those
that do not deviate. Similarly, the average is already reduced by
those companies that provide dividends. Any explicit provision
would double-count dividends and deviations, which would lead to
spiraling -- a rise in insurance rates. In addition, the
Commissioner finds that dividends and deviations are part of
profit, instead of an expense for insurance companies. Since a
provision for profit already exists, adding an additional provision
in the ratemaking formula for these types of profit is redundant.
We hold that the Commissioner's findings of fact are based
upon substantial and competent evidence. The Commissioner's
findings of fact indicate that the insurance industry will have
approximately 4.5% to 5.0% profit to use for dividends and
deviations if they choose to do so. The Commissioner's finding
that dividends and deviations are profit is based upon the opinion
that these are monies voluntarily surrendered by the insurance
companies. Treatment of dividends and deviations as profit has
been approved by this Court before. See 1996 Auto-COA, 129 N.C.
App. at 668, 501 S.E.2d at 686 (citing 1994 Auto, 124 N.C. App. at
682, 478 S.E.2d at 800). In addition, designating dividends and
deviations as profit and failure to adjust the ratemaking formula
with a specific provision for them does not mean that the due
consideration required by statute has been denied. Here, the
Commissioner listed each expert witness's treatment of dividends
and deviations in his findings of fact. The Commissioner thenstated why he found one expert's opinion more persuasive than the
others, and why he chose to treat dividends and deviations as he
did. We note again that the Commissioner is not required to
numerically adjust the rates to show that he has provided due
consideration of any of the factors in G.S. § 58-36-10. See 1996
Auto, 350 N.C. at 547, 516 S.E.2d at 154-55. Here, this technique
of analysis indicates that the Commissioner provided due
consideration to dividends and deviations as required by G.S. § 58-
36-10.
The Bureau's arguments regarding competition and premium
shortfalls are essentially arguments that dividends and deviations
should not be treated as profit. We reject these arguments for the
reasons stated above.
The Bureau also argues that the Commissioner's order should
focus on the aggregate industry rather than the average company.
The Bureau cites the following:
The statute contemplates that the rates shall
be fixed with a view of the aggregate earnings
and profits for the insurance business in the
State. Each company may make as much money as
it can. Some may make enormous profits, some
may do a losing business, but the average
profit, that is, the average profit on the
aggregate business, must be reasonable.
1977 Auto, 300 N.C. 381, 444-45, 269 S.E.2d 547, 586 (1980)(quoting
Aetna Ins. Co. v. Hyde, 285 S.W. 65 (Mo. 1926), cert. dismissed,
275 U.S. 440, 72 L.Ed. 357 (1928)). Here, the Commissioner chose
to analyze the issue of dividends and deviations from the
standpoint of an average insurance company. However, his
conclusions and findings also discussed the effect of the average
rate on the industry and the overall aggregate profit of theindustry. Therefore, assuming that the 1977 Auto case requires the
Commissioner to consider the effect of the average rate on the
industry and the overall aggregate profit of the industry, he has
done so according to the order.
After careful review of the record, we hold that the
Commissioner's findings and conclusions were adequately supported
by the evidence and do not produce an excessive, inadequate or
unfairly discriminatory rate. Accordingly, this assignment of
error is overruled.
III.
[3] The Bureau also contends that the Commissioner improperly
calculated the investment income available from policyholder-
supplied funds. The Commissioner found that rate deviations should
not be included in the calculation of the investment of
policyholder-supplied funds. The Commissioner also found that no
reduction in investment income should be included to account for
agents' balances and prepaid expenses. We conclude that sufficient
evidence supports the Commissioner's findings and conclusions.
As the Commissioner stated in his findings, investment income
is dependent upon three factors: (1) the amount of money invested,
(2) the length of time the funds are invested, and (3) the rate of
return. Here, the Bureau disputes the Commissioner's decision
regarding the first two factors -- the amount invested and the
duration of the investment. The Bureau argues that rate deviations
reduce the amount of premiums that insurance companies are able to
invest. The Commissioner calculated the amount of money available
for investment without reducing that amount to account for ratedeviations. The Commissioner based his calculation upon the
testimony of Department of Insurance's expert witness Schwartz.
Also, the Commissioner considered deviations within his calculation
of the underwriting profit provision. If rate deviations were
also considered within the investment income from policyholder-
supplied funds portion of the equation, deviations would be counted
twice. This double-counting would produce an excessively high rate
of return on insurance operations according to the Commissioner's
ratemaking formula. Therefore we hold that the Commissioner's
refusal to reduce investment income from policyholder-supplied
funds in order to consider rate deviations is supported by material
and substantial evidence.
The Bureau also faults the Commissioner's refusal to reduce
the estimated investment income projection as a result of agents'
balances and prepaid expenses. Agents' balances occur when
insurance policyholders pay for their coverage in installment
payments throughout the policy term. Prepaid expenses refers to
the insurance companies' practice of paying expenses from their
reserve funds before the policy premiums are paid by consumers.
The Bureau argues that agents' balances and prepaid expenses
negatively affect overall investment income. Both agents' balances
and prepaid expenses reduce the amount of time policyholder-
supplied funds are invested. The Commissioner based his
calculations on the assumption that the insurance company would
have the full manual rate premium over the entire coverage period.
The Commissioner found that his treatment of agents' balances and
prepaid expenses was consistent with the testimony of expertwitnesses Cohn and Schwartz. In addition, the Commissioner stated
that his calculations were consistent with the calculations used to
set rates that were examined in the 1994 and 1996 Auto opinions.
In 1994 Auto, this Court wrote:
Section F of the Commissioner's order examined
the issue of investment income from unearned
premium, loss, and loss expense reserve funds
[or policyholder-supplied funds]. In this
section, the Commissioner clearly defined the
factors involved in considering investment
income; selected a reasonable rate of return
(7%) on investments; and carefully explained
why he concluded the Bureau's amount of
reserves subject to investment was incorrect.
1994 Auto, 124 N.C. App. at 691, 478 S.E.2d at 805. Here, the
Commissioner summarized the evidence given by the expert witnesses
on both sides of the dispute. The Commissioner noted that two
expert witnesses had adopted his treatment of agents' balances and
prepaid expenses from the 1994 and 1996 Auto cases. Then the
Commissioner summarized his method of calculating investment income
on policyholder-supplied funds in the previous orders. After
finding that the Bureau had not offered new evidence on this
matter, the Commissioner found that his calculation in the 2001
order was identical to the one approved by this Court in the
earlier filing. Adopting the reasoning of this Court in 1994 Auto,
the Commissioner found that:
433. The policy reason for disallowing
deductions for agents' balances and prepaid
expenses is that, unlike the customary
consumer transactions, in an insurance
transaction the policyholder must pay for the
insurance benefit in advance of the service
provided. This pre-payment of premiums allows
the insurance companies to invest this
unearned revenue for profit. For this reason,
policyholders, should, in the ratemaking
process, receive the full benefit of incomethat results from investing policyholder
funds.
Also see 1994 Auto, 124 N.C. App. at 691, 478 S.E.2d at 805. The
Commissioner also repeated this Court's finding that agents'
balances and prepaid expenses were within the control of the
individual insurance companies and should not impact the ratemaking
process in a way that disadvantages consumers. We conclude that
there is substantial evidence in the record to support the
Commissioner's calculation of investment income from policyholder-
supplied funds.
IV.
[4] The Bureau's final argument on appeal is that the
Commissioner erred by substituting his ratemaking procedure without
first finding that the Bureau's procedure would produce excessive,
inadequate or unfairly discriminatory rates. We disagree.
The Bureau takes exception to the Commissioner's rejection of
its data set. The Bureau's calculations were based upon one year
of data that met certain reliability standards. The Bureau had
used the one year data set in previous filings without objection
from the Commissioner. However, here the Commissioner chose to use
a three-year average data set instead. The Commissioner found that
[t]he use of three years of data will produce rates that are
neither inadequate, excessive or unfairly discriminatory. The
Commissioner did not find that the Bureau's data would produce
excessive, inadequate or unfairly discriminatory rates. The Bureau
contends that without this specific finding regarding its data, the
Commissioner could not substitute his own data set. This argument
is not persuasive. G.S. § 58-36-10(1) states that [r]ates or loss costs shall
not be excessive, inadequate or unfairly discriminatory. If the
Commissioner after the hearing finds that the filing does not
comply with the provisions of this Article, he may issue an order
disapproving the filing, determining in what respect the filing is
improper, and specifying the appropriate rate level or levels that
may be used . . . . G.S. § 58-36-70(d). These two statutes focus
upon the propriety of the entire filing instead of specific parts
of the filing. As a result, we hold that the Commissioner is not
required to find each portion of the Bureau's filing improper
before he can substitute his own ratemaking structure. Instead,
the plain language of G.S. § 58-36-70(d) indicates that the
Commissioner must analyze the entire rate filing to determine
whether the overall calculation will result in excessive,
inadequate or unfairly discriminatory insurance rates. Therefore,
it was not necessary for the Commissioner to find that the data set
used by the Bureau would produce a calculation that created rates
that were excessive, inadequate or unfairly discriminatory. The
Commisioner, in order to use his own data or calculations, or to
set rates, must only conclude that the Bureau's filing as a whole
would result in excessive, inadequate or unfairly discriminatory
rates. Here, the Commissioner concluded:
II. Inasmuch as the Bureau has failed to give
due consideration to the factors set forth in
Conclusions of Law, Part I, the Bureau's
proposed rate level increase for private
passenger cars of ten and six tenths percent
(+10.6%) is excessive and unfairly
discriminatory for the reasons set forth in
Findings Part I through Part VI and elsewhere
in this Order, which are incorporated herein
by reference. Accordingly, the Bureau'srequest for a rate increase of ten and six
tenths percent (+10.6%) is denied and the
filing is disapproved.
Because the Commissioner's conclusion was adequately supported by
material and substantial evidence, this assignment of error is
overruled.
V.
After careful review of the record, we hold that the
Commissioner's order establishes a rate level that is not
inadequate, excessive or unfairly discriminatory. The Commissioner
appropriately considered the factors outlined in G.S. § 58-36-10
and applied his discretion according to the limits of the
1994 Auto
and
1996 Auto opinions. The Commissioner's findings of fact are
supported by material and substantial evidence. For the foregoing
reasons, the Commissioner's order setting automobile and motorcycle
liability insurance rates is affirmed.
Affirmed.
Judge STEELMAN concurs.
Judge TYSON dissents.
TYSON, Judge dissenting.
I respectfully dissent from the majority's opinion.
I. Issue
The issue before this court is whether the Commissioner's
order is supported by material and substantial evidence where the
expert witness, whose opinion the Commissioner relied upon to
support his findings of fact, ignored and expressly excluded
consideration of statutorily required factors.
II. Standard of Review
On judicial review, this Court employs the whole record test
to determine whether material and substantial evidence supports the
findings of fact and conclusions of law of the Commissioner. State
ex rel. Comm'r of Ins. v. N.C. Rate Bureau (1996 Auto), 350 N.C.
539, 547, 516 S.E.2d 150, 155, reh'g denied, 350 N.C. 852, 539
S.E.2d 11 (1999). The whole record test requires the reviewing
court to consider the record evidence supporting the Commissioner's
order, to also consider the record evidence contradicting the
Commissioner's findings, and to determine if the Commissioner's
decision had a rational basis in the material and substantial
evidence offered. State ex rel. Comm'r of Ins. v. N.C. Rate
Bureau, 124 N.C. App. 674, 678, 478 S.E.2d 794, 797 (1996). The
Commissioner's order, if supported by substantial and material
evidence, is presumed to be correct and proper. 1996 Auto, 350
N.C. at 547, 516 S.E.2d at 155. This Court should not substitute
its judgment for that of the Commissioner's when the evidence is
conflicting. Id. at 548, 516 S.E.2d at 155.
The record shows that the Commissioner's findings of fact fail
to conform to these requirements and are not supported by
substantial and material evidence in the whole record. The order
failed to meet the requirements of N.C. Gen. Stat. § 58-36-10.
III. Reliance on Countrywide Loss and Expense Experience
The Bureau asserts in their first assignment of error, that
the Commissioner relied on expert testimony that does not compare
returns on insurance operations in North Carolina to industries of
comparable risk in North Carolina.
N.C. Gen. Stat. § 58-36-10 (2001) requires: (2) Due consideration
shall be given to actual
loss and expense experience within
this State
for the most recent
three-year period for
which that information is available . . .
Provided, however, that countrywide expense
and loss experience and other countrywide data
may be considered
only where credible North
Carolina experience or data is not available.
(emphasis supplied).
The statute requires that the Commissioner shall consider
North Carolina data over the most recent three-year period in
making his findings of fact. N.C. Gen. Stat. § 58-36-10(2) (2001).
The Commissioner may consider countrywide data
only if he finds
that the North Carolina data is not credible or available.
Id.
When finding returns on insurance operations, the Commissioner
primarily relied on the expert opinion of the department's witness
Allan I. Schwartz (Schwartz). Schwartz testified that the
eighteen year average return on countrywide insurance operations
for the property and casualty insurance industry was 3.7%. He
further testified that property/casualty risks are lower than the
risks associated with automobile liability. Relying on this
testimony, the Commissioner made the following finding of fact:
162. The lack of comparability is evidenced
by the Bureau's prospective range of returns
of 13.1% to 15.3% compared to the average pre-
tax historical returns on insurance operations
during an
eighteen year period of the
countrywide property/casualty industry of
approximately 3.7% and the
ten year average
pre-tax returns in
competitive rating states
of 4.3% liability and 6.4% physical damage.
This lack of comparability is further
evidenced by the resulting profit provisions
of 9.5% and 14.0%, which are higher than
several of the witnesses have ever encountered
in any jurisdiction and certainly higher than
the profit provisions recently utilized by the
top ten writers in three
neighboring states.
(emphasis supplied). The Commissioner had previously and expressly
found that the North Carolina data required to be considered by the
statute was credible and available. The Commissioner made the
following findings of fact:
85. N.C. Gen. Stat. § 58-36-10 does require
due consideration of the latest three years of
data, that data
is available in the filing for
all three years and, according to the Bureau's
credibility standards, all three years
are
fully credible. There doesn't appear to be
any reason, therefore, for all three years not
to be used. In fact, there appears to be a
number of reasons why three years of data
should be used in the rate calculations . . .
.
86. Therefore, based on the evidence in this
case, the Commissioner finds that use of the
three year unweighted average of the
indications for the years 1997-1999 is the
appropriate way to provide due consideration
of the latest three years of experience for
the bodily injury, property damage, medical
payments, comprehensive and collision
coverages. The use of three years of data
will produce rates that are neither
inadequate, excessive or unfairly
discriminatory.
(emphasis supplied).
In spite of these findings, the Commissioner relied on
countrywide data from the property/casualty industry sector and
data from neighboring states to set the overall return on
operations at Schwartz's calculation of 3.7%. Schwartz admitted in
his testimony that property and casualty risks were lower than
automobile liability risks. Schwartz testified that [p]roperty
and casualty insurance companies are better than average (lower
risk) for beta, safety and price stability, and lower than average
(higher risk) for earnings predictability. Overall, the propertyand casualty insurance industry is of about average or somewhat
below average risk.
The Commissioner also considered data from the past eighteen
years and failed to abide by the statutory time frame requiring
data from the most recent three-year period. N.C. Gen. Stat. §
58-36-10(2) (2001). By relying on countrywide data after finding
that North Carolina data was credible and available and by
relying upon data six times older than the most recent three year
period, the Commissioner's findings of fact failed to comply with
the statutory requirements and do not support his conclusions. Id.
IV. Due Consideration of Dividends and Deviations
A. Zero Percent Factor
The Bureau also contends the Commissioner did not give due
consideration to dividends and deviations.
N.C. Gen. Stat. § 58-36-10 (2001) requires: (1) Rates or
loss costs shall not be excessive, inadequate or unfairly
discriminatory. (2) Due consideration shall be given . . . to
dividends, savings, or unabsorbed premium deposits allowed or
returned by insurers to their policyholders, members, or
subscribers . . . . (emphasis supplied). N.C. Gen. Stat. § 58-
36-10(1) requires the Commissioner to determine whether the
proposed rates will produce a fair and reasonable profit and no
more. 1996 Auto, 350 N.C. at 542, 516 S.E.2d at 151.
In State ex rel. Comm'r of Ins. v. N.C. Rate Bureau, Judge
Johnson found [t]he Commissioner . . . elected to assign a
valuation of zero to dividends returned to policyholders and ratedeviations. 102 N.C. App. 824, 404 S.E.2d 368, slip op. at 7 (May
7, 1991) (No. 9010INS864)(unpublished)(Judges, now Justices, Parker
and Orr concurring); Rule 30(e)(3). This Court held:
[t]he net result of the Commissioner's
decision is that the calculated rates are
completely unaffected by dividends and
deviations. As we have carefully considered
the Commissioner's findings of fact,
calculations and conclusions of law, we are
nonetheless unable to adopt his argument that
by assigning zero values to both dividends and
deviations, he has complied with existing case
law.
Id. (citations omitted).
All evidence was presented to the Commissioner in the form of
expert testimony. The Commissioner again relied on Schwartz's
expert testimony. Schwartz testified that allowing dividends and
deviations to be included as a factor in the rate decision, was
against good public policy and would result in unfairly
discriminatory rates. Schwartz also testified that on public
policy grounds . . . it is not appropriate to build an additional
cost factor for dividends and deviations back into the manual rate
level and that dividends and deviations should not be built back
into the manual rate level . . . since that procedure would
eliminate any savings . . . . Relying on this testimony, the
Commissioner's findings of fact applied a zero percent factor for
dividends and deviations in setting the insurance rates.
Public policy in North Carolina is and has been set by the
North Carolina Legislature. N.C. Gen. Stat. § 58-36-10(2) (2001)
requires [d]ue consideration shall be given . . . to dividends,
savings, or unabsorbed premium deposits allowed in setting rates.
No specific number must be assigned to these factors. 1996 Auto, 350 N.C. at 547, 516 S.E.2d at 154-155. However, there must be
substantial evidence in the record to show that dividends and
deviations were given due consideration. Id. In 1996 Auto, our
Supreme Court found that the Commissioner's rates expressly
included a 5% margin for dividends and deviations and held that
substantial evidence supported the Commissioner's findings of fact
regarding dividends and deviations. Id. at 548, 516 S.E.2d at 155.
That case is distinguishable. Here, the Commissioner claims that
he included a 4.5 to 5% margin as he did in 1996 Auto. However,
unlike in 1996 Auto, nothing in the Commissioner's order shows that
this 4.5 to 5% margin was expressly included in the rates. The
order simply states that the 4.5 to 5% margin is implicit in his
calculations. In his dissent from the 1996 Auto case, Chief
Justice Mitchell stated:
[T]he Commissioner is required to give each
factor some weight and that this must be
reflected in his order. Otherwise, a
reviewing court is faced with an inadequate
appellate record and must, as here, simply
accept the Commissioner's conclusory
statements that he has taken all of the
statutory factors into account. It is not
enough for the Commissioner to note in
conclusory fashion that dividends and
deviations crossed his mind when he was
entering his order.
Id. at 549, 516 S.E.2d at 156. The majority opinion states:
The weight to be given the respective factors
is for the Commissioner to determine in the
exercise of his sound discretion and
expertise, but he may not arrive at his
determination as to the propriety of the
filing by shutting his eyes to experience
shown by evidence of reasonably probative
value. . . .
Id. at 547, 516 S.E.2d at 155, quoting State ex. rel. Comm'r of
Ins. v. N.C. Fire Ins. Rating Bureau, 292 N.C. 471, 488-489, 234
S.E.2d 720, 729-730 (1977). N.C. Gen. Stat. § 58-36-10(2)
requires that the Commissioner shall give due consideration to
dividends and deviations, not implicit inclusion.
B. Classification of Dividends and Deviations
In their second assignment of error, the Bureau asserts error
in the Commissioner's finding that dividends and deviations are
profits to the Bureau's member companies rather than costs.
As previously noted, [t]he whole record test requires the
reviewing court to consider the record evidence supporting the
Commissioner's order, to also consider the record evidence
contradicting the Commissioner's findings, and to determine if the
Commissioner's decision had a rational basis in the material and
substantial evidence offered. State ex rel. Comm'r of Ins. v.
N.C. Rate Bureau, 124 N.C. App. at 678, 478 S.E.2d at 797. The
Commissioner relied on Schwartz's expert opinion and found that
dividends and deviations were profits instead of costs for the
Bureau's member companies. The Commissioner concluded that since
a provision for profit already existed, adding an additional
provision in the ratemaking formula for these types of profit is
redundant. The Commissioner based these findings on Schwartz's
opinion that these dividends and deviations are a voluntarily
distribution based upon individual company management decisions.
As Judge Johnson held in State ex rel. Comm'r of Ins. v. N.C. Rate
Bureau:
In addition, we are unprepared to adopt his
finding that dividends and deviations arevoluntary decisions of the member companies
and cannot be guaranteed by the Rate Bureau or
the Commissioner. To the extent that the
Commissioner ignored dividends to
policyholders and rate deviations in his
calculations, the ordered underwriting profit
provisions must be recalculated to reflect an
adjustment for these rating criteria.
102 N.C. App. 824, 404 S.E.2d 368, slip op. at 7 (May 7,
1991)(citations omitted). The logic of that case applies equally
here.
The Commissioner also found that including a specific
provision for dividends and deviations was unnecessary because
the use of an average rate implicitly included consideration of
dividends and deviations. The Commissioner's findings that
dividends and deviations are profits and not costs to the Bureau's
member companies has no basis in fact. Treating dividends and
deviations as profits and assuming a zero percent factor forces the
Bureau's member companies to either: (1) absorb these costs, which
causes the rates to be inadequate, or (2) exclude higher risk
policyholders who would otherwise qualify for the manual rate,
which causes the rates to be discriminatory. N.C. Gen. Stat. §
58-36-10(1) (2001).
1. Absorption of Costs by Bureau's Member Companies
The Commissioner set his rate based upon the average profit
or return. The average or midpoint return places an equal number
of policyholders in the risk pool on either side of the average.
Lower risk policyholders demand and receive discounts or deviations
from the manual rate from the Bureau's member companies.
Deviations are discounts from the manual rates and are never paid
by the policyholders. 1996 Auto, 350 N.C. at 545, 516 S.E.2d at154; see N.C. Gen. Stat. § 58-36-30 (2001). Dividends are,
essentially, rebates returned to policyholders at the end of the
policy period. Id.; see N.C. Gen. Stat. § 58-36-60 (2001). The
reason the statute requires due consideration of discounts and
deviations in setting rates is that both reductions from the manual
rate are tools the Bureau's member companies expend to attract and
retain lower risk policyholders within the risk pool. Id. at 546,
516 S.E.2d at 154.
Retention of lower risk policyholders in the risk pool is the
basis for the legislature's policy choice that dividends and
deviations be given due consideration in setting rates. Without
retention of lower risk policyholders in the risk pool, the
relative risk of the pool to the insurer increases.
Expressly excluding or ignoring the costs of dividends and
deviations to a zero percent factor in setting the manual rate
causes the average risk of the pool to shift higher, destroys the
equilibrium required by the statute, and makes rates inadequate.
N.C. Gen. Stat. § 58-36-10(1) (2001). Applying a zero percent
factor excludes due consideration of dividends and deviations,
shifts the average risk, and causes the relative risk of the pool
to be 4.5 to 5.0% higher, without providing the insurer offsetting
compensation for the higher risk. To disallow insurers from
treating dividends and deviations as costs requires the companies
to absorb this cost and to subsidize rates for higher risk drivers.
This forces the insurer to absorb these costs on a pool that is
riskier than average, and makes the rates inadequate. Id.
2. Exclusion of Higher Risk Policyholders
If insurers are not allowed consideration for dividends and
deviations, they may seek to exclude higher risk drivers from
manual rates who would have otherwise qualified. If otherwise
qualified drivers are excluded from manual rates, this zero
percent factor for dividends and deviations makes the rates
discriminatory. Id. Using a zero percent factor for dividends
and deviations causes the relative risk of the pool of
policyholders to be higher than the average risk of the pool.
Higher risk policyholders, who would have otherwise qualified for
manual rates, may be excluded from manual rates and be assigned to
the reinsurance facility in order to restore balance to the risk
pool. In this situation, if dividends and deviations are not
treated as costs, rates become discriminatory against excluded
policyholders, who would have otherwise qualified for manual rates.
Id. The statute's requirement of due consideration to dividends
and deviations reflects the General Assembly's public policy
choice: (1) to provide affordable insurance coverage to the widest
possible pool of drivers, at rates that are neither excessive,
inadequate, or unfairly discriminatory and (2) to encourage
efficient and economic practices for the purchase of liability
insurance by all owners of vehicles operated on our highways. N.C.
Gen. Stat. § 58.40-1 (2001); also see generally George A. Akerlof,
The Market for Lemons: Quality Uncertainty and the Market
Mechanism, 84 Qu. J. Econ. 488, 488-490, 492-500 (1970) (2001 Nobel
Laureate in Economics).
V. Substantial Evidence to Support Findings of Fact
Judicial reviews of other North Carolina Commissions' orders
have held that findings of fact are not supported by substantial
evidence when the expert opinion, upon which these findings were
based, ignored legally required factors. Holley v. Acts, Inc., 357
N.C. 228, 581 S.E.2d 750 (2003); In re Corbett, 355 N.C. 181, 558
S.E.2d 82 (2002). Holley involved an appeal from the Industrial
Commission granting a worker's compensation claim. Our Supreme
Court held when such expert testimony is based merely upon
speculation and conjecture, . . . it is not sufficiently reliable
to qualify as competent evidence . . . . 357 N.C. at 232, 581
S.E.2d at 753. Our Supreme Court reversed the Industrial
Commission and held that the expert opinion evidence, upon which
the Industrial Commission relied to make its findings, failed to
meet the reasonable degree of medical certainty standard required
by law. Id. at 234, 581 S.E.2d at 754. Without expert testimony
based upon legal requirements, no competent evidence supported the
Industrial Commission's findings of fact. The Supreme Court
reversed the Industrial Commission's decision. Id.
In re Corbett involved an appeal from the Property Tax
Commission's order of value of real property. Our Supreme Court
held that based on statutory mandate, once it is determined that
valuation or revaluation of a property is statutorily required, any
valuation which is not made in accordance with the schedules,
standards and rules used in the County's most recent general
reappraisal or horizontal adjustment is in violation of the
statutory requirements of section 105-287. 355 N.C. at 189, 558
S.E.2d at 87. Our Supreme Court stated if the provisions of [thestatute] are triggered, it necessarily follows that the only
statutorily permissible method of valuation is through the
application of the County's schedules, standards and rules. Id. at
185, 558 S.E.2d at 84. Our Supreme Court reversed and remanded
because the expert witness did not follow the statutory
requirements in formulating his opinion. Id. at 189, 558 S.E.2d at
87.
VI. Conclusion
N.C. Gen. Stat. § 58-36-10 (2001) requires that the
Commissioner's findings shall give due consideration to
credible and available North Carolina data from the most
recent three year period and to dividends and deviations in
setting rates. The Commissioner primarily relied on one expert's
testimony, who not only ignored, but expressly excluded on public
policy grounds, these statutorily required factors in formulating
his opinion. This expert witness also based his opinion on
eighteen year old countrywide data after the Commissioner had found
North Carolina data from the most recent three year period to be
credible and available. Schwartz's opinion testimony failed to
comply with the statute and fails to provide substantial evidence
to support the Commissioner's findings of fact. I would reverse
and remand this case to the Commissioner to base his order on
substantial evidence that includes due consideration to the
General Assembly's statutory requirements. I respectfully dissent.
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