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Maine AFL-CIO v. Superintendent of Insurance12/4/1998
Reporter of Decisions
Argued: October 7, 1998
The Maine AFL-CIO appeals from a judgment entered in the Superior Court (Penobscot County, Alexander, J.) dismissing for lack of ripeness its appeal challenging a rule promulgated by the Bureau of Insurance (Bureau) governing "pilot projects" for workers' compensation insurance pursuant to 39-A M.R.S.A. § 403 (Supp. 1998). We affirm the judgment of the Superior Court.
Maine employers have three options in providing workers' compensation coverage for employees. An employer may purchase workers' compensation insurance, § 403(1); establish an authorized self-insurance program, § 403(3); or devise a "workers' compensation health benefits pilot project," § 403(2). A pilot project, also referred to as a "24-Hour Coverage Plan," provides employers and employees the opportunity to design and implement an insurance program that combines benefits for work-related and nonwork-related conditions. The Superintendent of Insurance (Superintendent) has the responsibility of adopting rules governing pilot projects. 39-A M.R.S.A. § 403(2)(A) (Supp. 1998).
At issue here is whether a pilot project that incorporates workers' compensation indemnity payments with general health coverage may reduce indemnity payments if the overall benefits "are equal to or greater than" the benefits otherwise available under the Workers' Compensation Act. Section 403(2)(A) provides that the Superintendent "may approve a proposal only if it confers medical benefits, or medical and indemnity benefits depending on the pilot project proposal, upon injured employees that are equal to or greater than the benefits available under this Title." 39-A M.R.S.A. § 403(2)(A) (Supp. 1998) (emphasis added). The AFL-CIO argues that pilot projects that include indemnity coverage and medical coverage cannot, under any circumstance, reduce the statutory minimum indemnity benefits under the Workers' Compensation Act.
After a Bureau of Insurance Rulemaking Hearing, the Superintendent rejected the AFL-CIO's position. The Bureau promulgated Amendments to Bureau of Insurance Rule 690, which defines "alternative benefit design" as "an integrated or coordinated 24-hour medical coverage plan which provides for medical or disability benefits that differ from the minimum benefits otherwise required under the Workers' Compensation Act . . . ." Amendments to Bureau of Insurance Rule 690, 24-Hour Coverage Pilot Projects § 3(K) (1996). Further, Rule 690 provides that " o alternative benefit design may be approved unless the Superintendent determines, after consultation with the Workers' Compensation Board, that (i) the overall level of benefits, taking into account both amount and duration, remains equal to or greater than the level of benefits otherwise required under the Workers' Compensation Act . . . ." Id. § 8(E) (emphasis added). Therefore, Rule 690 contemplates a pilot project that could reduce the statutory minimum indemnity benefits required by the Workers' Compensation Act, so long as the overall benefits of the pilot project are equal to or greater than benefits pursuant to the Workers' Compensation Act. To date, no pilot project has been proposed to the Superintendent for review.
The AFL-CIO appealed the Bureau's promulgation of Rule 690, arguing, inter alia, that it is inconsistent with section 403. The Superior Court (Penobscot County, Alexander, J.) dismissed the AFL-CIO's claims, finding that the issues were not yet ripe for judicial decision-making because no plan had been offered for approval before the Superintendent. The AFL-CIO appeals.
RIPENESS
The AFL-CIO argues that the Superior Court improperly appli
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