Koken v. Legion Insurance Company

In Koken v. Legion Insurance Company, 831 A.2d 1196 (Pa. Cmwlth. 2003), a decision of this Court rendered in its original jurisdiction and affirmed in a per curiam order by our Supreme Court in 2005, this Court granted four policyholders (Policyholder Intervenors) direct access to reinsurance. Only one policyholder, American Airlines, produced a cut-through endorsement of the type that arguably complied with the Reliance Guidelines. Legion, 831 A.2d 1196. Nevertheless, the Court granted direct access to all four Policyholder Intervenors because they had demonstrated that they, not Legion, were the intended beneficiaries of the reinsurance agreements in question. Legion functioned only as a pass-through for premium and claim payments and not as a true underwriter of insurance risk. In reaching this conclusion, the Court explained the rationale for the general rule that reinsurance recoveries are assets of the insolvent insurer's estate and why that general rule did not apply to Policyholder Intervenors. It stated, in relevant part, as follows: The two main reasons cited for purchasing reinsurance are capacity and stability. By arranging for reinsurance a primary carrier can relieve itself from the full burden of a large loss. By accepting a share of the loss, reinsurance has the effect of adding to the financial capacity of the primary insurer and stabilizing the primary carrier's financial results .... Where the direct insurer seeks safety in reinsurance in the above-described manner, generally the policyholder has no knowledge of either the existence or application of reinsurance proceeds to his claims... . The usual occasion for reinsurance has no application to Legion the insolvent insurer. The Policyholder Intervenors, not Legion, placed the reinsurance; Legion neither adjusted nor funded claims; and Legion did not seek to expand its underwriting capacity through reinsurance. Indeed, it sought to avoid any underwriting because its business plan called for generation of fees not underwriting profits. Legion, 831 A.2d at 1234. In Legion, in contrast to the usual "occasion for reinsurance," the Policyholder Intervenors did have knowledge of the existence of the reinsurers in the program. Id. Indeed, the decision of the Policyholder Intervenors to choose the insurance program developed by their brokers and consultants was based upon the expertise and financial strength of the reinsurers. It was Legion's qualifications in these respects that were unknown, which made sense in light of its limited role as fronting company. The Court also rejected the Rehabilitator's invitation to apply the Reliance Guidelines to the Legion Policyholder Intervenors. The Rehabilitator argued that Section 534 required a cut-through endorsement in order for a Policyholder Intervenor to obtain the benefit of the reinsurance that it, not Legion, had chosen to be responsible for claims. Specifically, the Court explained as follows: Section 534 of Article V does not require a cut-through endorsement in the form of holy writ; it does not even use the term "cut-through." Even if the statute had used those words, its meaning would be less than clear in light of the fact that there is more than one way to effect a cut-through. Id. at 1241. In Legion, the Court explained that determining the merits of a policyholder claim for third-party beneficiary status is done on a case-by-case basis, reviewing the relationship among the reinsurer, the reinsured and the direct insured. Legion, 831 A.2d at 1236. In Legion, the Policyholder Intervenors accepted the programs developed by their brokers after being persuaded that the reinsurer, which was intended to function as the direct insurer, had the requisite expertise and financial strength to handle their program successfully. It was Legion's identity that was obscure. Legion was not chosen by American Airlines, or its broker Aon, because of its experience in underwriting airline risks. It was chosen for one reason: it had a license in all 50 states. Aon sold American Airlines on the program precisely because of the reinsurers' history of writing airline coverage on a direct basis in Europe. Legion, 831 A.2d at 1217.