Court Opinion

ID: 9784742
Source: CourtListenerOpinion
Date Created: 2023-08-30 20:52:54.340093+00
Date Added: 2024-06-11T07:35:58.619395
License: Public Domain

LEVY, J.,
with whom MEAD, J., joins, dissenting.
[¶ 15] Although technically moot, I would permit this appeal to proceed because the issue presented falls within a recognized exception to the mootness doctrine. The core legal issues this appeal presents arise from an annual rate approval process, are likely to be repeated if not resolved, and will consistently evade review because of their “fleeting or determinate nature.” Lewiston Daily Sun v. Sch. Admin. Dist. No. 43, 1999 ME 143, ¶ 17, *829738 A.2d 1239, 1243; see also Me. Sch. Admin. Dist. No. 37 v. Pineo, 2010 ME 11, ¶ 9, 988 A.2d 987, 991.
[¶ 16] The Superintendent’s regulations require that Anthem review its claims experience no less than annually and “file rate revisions, upward or downward, as appropriate.” 6 C.M.R. 02031 940-2 § 6(D) (2006). This regulatory requirement results in a yearly cycle of rate proceedings before the Superintendent. An annual process for approving rates necessarily produces an administrative decision that is fleeting. The majority opinion nonetheless concludes that the exception to mootness for decisions that are capable of repetition and will evade review does not apply because it is “not convinced that the precise issues presented in this case will recur.” This misses the point.
[¶ 17] The issue presented for decision is not simply whether the Superintendent was correct in setting a 0% profit margin for 2009, but more broadly, whether, pursuant to 24-A M.R.S. § 2736(2) (2010), rates that are “not ... inadequate” must include a reasonable return, including a reasonable profit. In her decision setting 2009 rates, the Superintendent treated the adequacy requirement as a solvency standard designed to assure that insurance rates are sufficient to cover claims and losses. Anthem contends that the Superintendent applied the same interpretation in deciding the 2010 rate case. This is far different from analyzing rates based on the principle that insurers are entitled to receive a reasonable rate of return, including a reasonable profit. Solvency and profit are not synonymous.
[¶ 18] Whether a rate is “not ... inadequate” for purposes of section 2736(2) if it assures nothing more than the insurer’s solvency is an important question of law that will continue to present itself unless the Superintendent abandons her current interpretation of the statute. Notwithstanding the changing political tides alluded to in the majority opinion, the Superintendent has not abandoned or modified her interpretation of the statute. I thus conclude that we should reach and decide the merits.