DocketNumber: No. 102,280
Judges: Opala, Watt, Winchester, Hargrave, Kauger, Edmondson, Colbert, Lavender, Taylor
Filed Date: 10/10/2006
Status: Precedential
Modified Date: 11/13/2024
¶ 1 The question presented on certiorari is whether COCA erred when it sustained the three-judge panel’s order that ruled the terms of 85 O.S.2001 § 65.2
I.
ANATOMY OF THE LITIGATION
¶2 John Shorter (Shorter or claimant) is sole shareholder of Tulsa Used Equipment and Industrial Engine Services (Tulsa Used Equipment), a Subchapter S corporation engaged in heavy equipment sales and service. National American Insurance Company (NAIC) is Tulsa Used Equipment’s workers’ compensation insurance provider (these two entities together with the Workers’ Compensation Court (WCC) are collectively called respondents). Tulsa Used Equipment’s compensation policy contains a “partners, officers and others exclusion endorsement” which excludes from compensation coverage those whose names are listed on the form. Shorter’s name is listed on this endorsement.
¶ 3 Shorter filed a compensation claim alleging he sustained a work-related injury to his hands on 28 July 2003. NAIC initially provided 52 weeks of benefits to claimant but later denied its liability for the injury. At a hearing before the WCC, Shorter urged respondents were estopped to deny liability by the provisions of 85 O.S.2001 §§ 65.2 and 65.3 (the estoppel act)
¶ 4 Respondents urged that the es-toppel act may not be invoked because NAIC did not accept an insurance premium that included Shorter’s wages in the calculation; rather, it accepted only a deposit. This is so because Shorter’s wages, which were included in determining the premium at the beginning of the policy’s term, were deducted from the computations in the annual end-of-policy audit and refunded to Tulsa Used Equipment.
¶ 5 The trial judge ruled that: 1) the court has jurisdiction and 2) Shorter is within the compensation policy’s coverage by the estop-pel act. This is so because, according to the judge, NAIC breached the terms of its exclusion endorsement.
II.
STANDARD OF REVIEW
¶ 6 The issue presented calls for resolution of a question of law. Review of contested law is governed by a de novo standard.
III.
A.
THE PARTIES’ ARGUMENTS
¶7 Respondents urge COCA’s analysis— Shorter, in essence, must,first be found to be an employee in accordance with the Act before he may invoke the terms of § 65.2
¶8 Respondents cite to the teachings of Rosamond Construction Co. v. Rosamond.
¶ 9 Claimant, in his lower-court materials, cites Young v. the City of Holdenville
B.
DOMINIC CONCRETIZED THE APPLICATION AND OUTER REACHES OF THE ESTOPPEL ACT, 85 O.S.2001 §§ 65.2 and 65.3, TO PROVIDE COMPENSATION PROTECTION FOR ALL CLAIMANTS WHO AT THE TIME OF INJURY WERE ACTING FOR THE INSURED AND UPON WHOSE EARNINGS THE INSURER COLLECTED PREMIUMS
¶ 10 Claimant’s status is of no consequence in determining here whether the es-toppel act may be invoked. The sole legal question presented is whether the insurance carrier is statutorily estopped from denying workers’ compensation coverage.. When denying an award to this claimant, the three-judge panel clearly relied on, and gave paramount importance to, Shorter’s express exclusion from the compensation protection to be1 provided by the carrier. This analysis was clearly in error. The terms of §§ 65.2 and 65.3 are utterly devoid of requirements that either contractual or consensual elements of claimant’s relationship to the insured be established.
¶ 11 Respondents’ interpretation of and reliance on the court’s pre-Dominic jurisprudence (dealing with the estoppel act) is in error. Indeed, a review of this body of law reveals the cacophony of voices entangling application of the estoppel provisions.
¶ 12 An insured’s compensation policy is treated as a guarantee that its workers are protected by the Act.
¶ 13 Respondents’ analysis of today’s cause would make utterly immaterial the consideration of a worker’s remuneration in setting and accepting compensation premiums.
¶ 14 The court’s decision in Rosa-mond,
¶ 15 Estoppel’s reach is broad. While the text of § 65.2
¶ 16 Shorter has met his burden. Evidence shows that insurance carrier used claimant’s wages to compute the premium due. The premiums that included Shorter’s salary were in fact collected, but after claimant’s accident that gave rise to the injury here in suit, the insurance carrier refunded the excess premiums after a routine end-of-term policy audit.
¶ 17 There is an additional basis for today’s conclusion that we raise sua sponte.
IY.
SUMMARY
¶ 18 Once the existence of a workers’ compensation insurance policy is established in a worker’s favor, that worker is free to invoke the jurisdiction of the Workers’ Compensation Court. A claimant who relies upon the estoppel act, 85 O.S.2001 §§ 65.2 and 65.3, must show that the claimed injury occurred when claimant was acting for the insured and premiums computed on his/her earnings were accepted under a policy insuring the insured against the liability risk under the Workers’ Compensation Act. Once this is shown, the insurance contract is conclusively presumed to be for the benefit of the injured claimant. Claimant has the burden of proving the facts necessary to raise the Act’s conclusive presumption in his favor. Here, claimant has met that burden.
. For the terms of § 65.2 see supra note 1.
. For the terms of §§ 65.2 and 65.3 see supra note 1.
. The policy was issued for a term of one year (2 July 2003 to 2 July 2004) and was in effect at the
Respondents, in their post-trial brief, assert the contract for insurance was executory. The condition precedent was for the insurer to estimate wages and receive a deposit. The condition subsequent was to audit the payroll and determine the actual premium due. According to respondents, only after the insurer made a refund was the contract complete and the premium considered actually paid. No controlling authority is cited for the claim that this contract provision may protect the insurer from the operation of the estoppel statute.
. Respondents challenge the trial tribunal's jurisdiction and contend that it is without power to reform the contract. While the WCC has authority to interpret and construe insurance policies, it, unlike courts of general jurisdiction, is without authority to decide general contract matters and reform an insurance policy. (Hefley v. Neely Ins. Agency, Inc., 1998 OK 12, ¶ 10, 954 P.2d 135, 137-38) Although this proposition is correct, today’s pronouncement does not require that we address this issue.
. Respondents urge the claim of estoppel was not available to Shorter. This is so because he waived his right to be covered by the policy and because he accepted the refund. One may not waive a right provided under contract and then claim an estoppel within that transaction at a later date. (Indian Tenitory Operating v. Bridget, 500 F.Supp. 449, 451 (W.D.Okla.1980)) One who relies on estoppel "must have exercised such reasonable diligence as circumstances require, and he cannot evoke estoppel if he conducted himself with careless indifference to means of information reasonably at hand or ignored highly suspicious circumstances which should have warned him of danger or loss.” (Jones Trucking Co. v. Cargill, 1955 OK 93, 282 P.2d 753, 756; see also First State Bank v. Diamond Plastics, 1995 OK 21, ¶ 29, 891 P.2d 1262, 1272; Hillers v. Local Federal Savings and Loan Ass'n., 1951 OK 57, 1114, 232 P.2d 626, 630) All of the causes cited by respondents dealt with common-law equitable estoppel or waiver. Although these legal doctrines are often used interchangeably, waiver requires an intentional relinquishment of a known right. The transcript does not reveal that this is so here. Today's cause deals with statutory estoppel, not those of common law and equity origin.
. The trial tribunal, applying strict construction of insurance policies, ruled that where one provision of a contract appears to exclude coverage and another seems to include it the policy will be strictly construed against the insurer and in favor of coverage. It further found that NAIC's purpose of including the endorsement provision— "[t]he premium basis for the policy does not include the remuneration of [listed] persons”— was to avoid the effects of statutory estoppel, (miscellaneous order, record, p. 9)
. The Workers' Compensation Act, 85 O.S.2001 § 1 et seq.
Claimant, owner of respondent employer, because of his election in accordance with § 8 was excluded from the definition of employer. (Three-judge panel order, p. 1) For the text of § 8 see supra note 2.
. For the terms of § 65.2 see supra note 1.
. COCA ruled Shorter was not an employee and, hence, not entitled to benefits, either under the terms of the policy or by estoppel.
. Arrow Tool & Gauge v. Mead, 2000 OK 86, ¶ 6, 16 P.3d 1120, 1122-23; Neil Acquisition L.L.C. v. Wingrod Investment Corp., 1996 OK 125, ¶ 5, 932 P.2d 1100, 1103; Brown v. Nicholson, 1997 OK 32, ¶ 5, 935 P.2d 319, 321.
. Arrow Tool, supra note 13, at ¶ 6 at 1122-23; Neil Acquisition, supra note 13, at ¶ 5 at 1103; Kluver v. Weatherford Hosp. Auth., 1993 OK 85, ¶ 14, 859 P.2d 1081, 1084.
. For the terms of § 65.2 see supra note 1.
. COCA did not address respondents' other lower-court arguments.
Respondents urge that estoppel is an ancillary issue and because Shorter did not contest the denial of his status as an "employee,” he concedes that the court cannot award benefits regardless of other factors. Today's pronouncement deals with the application of the estoppel act and its impact upon the court's jurisdiction. Neither is an ancillary issue. Claimant did not concede to respondents' interpretation of his status as an employee.
. Rosamond Construction Co. v. Rosamond, 1956 OK 13, ¶ 14, 292 P.2d 392, 395.
Respondents also cite to Mills v. R.T. "Bob" Nelson's Painting Service, 1966 OK 262, ¶ 9, 421 P.2d 849, 851. The court there found the claimant was an independent contractor and not an employee. He, hence, was not entitled to compensation benefits. There the claimant unsuccessfully sought to invoke the estoppel provisions. The court ruled the estoppel act goes only to the question of hazardousness, and the nature of claimant's work was clearly hazardous and not in dispute, (citing Folsom Auto Supply v. Bristow, 1954 OK 254, ¶ 16, 275 P.2d 706, 711) We note that although the body of the opinion does not address whether the claimant’s wages were considered in setting compensation premiums, the court’s syllabus provides "[t]he effect of the 'Estoppel Act, ... is to prohibit interposition by an employer of the defense that the employment of a claimant was nonhazardous if the remuneration paid claimant is scheduled, considered or used in determining the amount of premium paid for workmen's compensation insurance.” supra.
. Rosamond, supra note 17, at ¶ 10 at 395.
. Rosamond, supra note 17, at ¶ 10 at 395.
. Young v. City of Holdenville, 1963 OK 154, ¶ 17, 384 P.2d 905, 906.
. Dominic v. Creek Nation, 1997 OK 41, 936 P.2d 935; Wahpepah v. Kickapoo Tribe of Oklahoma, 1997 OK 63, 939 P.2d 1151; Muscogee Nation v. Smith, 1997 OK 66, 940 P.2d 498; Little v. Muscogee (Creek) Nation, 1997 OK 57, 938 P.2d 739. In each of these cases the sovereign Indian nation purchased insurance policies from the State Insurance Fund and paid premiums based on its employees' salaries. Each policy was issued to cover claims filed in accordance with the Act. The court held the insurer was statutorily estopped to deny coverage based on the tribe/nation's sovereign immunity in accordance with the terms of §§ 65.2 and 65.3 be-causé the insurer collected premiums on covered employees.
. Young, supra note 20, at ¶ 10 at 906; see also Atlas Rock Bit Service Co. v. Henshaw, 1979 OK 20, ¶ 8, 591 P.2d 294, 294.
. Young, supra note 20, at ¶ 12 at 906.
. Dominic, supra note 21.
. Respondents contend the Indian sovereignty cases are not applicable because they challenge an employer's, not an employee's status, under the Act.
. Dominic, supra note 21, at ¶ 14 at 939; Wahpepah, supra note 21, at ¶ 13 at 1154-55; Muscogee Nation, supra note 21, at ¶ 8 at 501; Little, supra note 21, at ¶ 16 at 744.
. Dominic, supra note 21, at ¶ 8 at 938; Little, supra note 21, at 1110 at 742 (citing State Insurance Fund v. Brooks, 1988 OK 50, ¶ 7, 755 P.2d 653, 656).
. This analysis is the same as that which the court applied in the Indian sovereignty cases supra note 21.
. Discord exists in the court's pre-Dominic jurisprudence. For support of claimant’s proposition — that a claimant whose wages were considered in calculating compensation insurance premiums may invoke the estoppel act — see Barney U. Brown & Sons, Inc., et al. v. Savage, 1953 OK 131, ¶ 6, 258 P.2d 183, 185 (where a salesman of employer's feed and grain company whose wages were mistakenly listed in the calculation of the compensation premium for employer's oil and gas sales business was held to be covered and the insurer was estopped to deny liability in accordance with the terms of §§ 65.2 and 65.3); Jot Davis Welding Service v. Davis, 1962 OK 243, 118, 376 P.2d 259, 260-61 (an insurer was estopped to deny liability for an employee’s on-the-job injury where employer had but one employee); Young, supra note 20,
For support of respondents' proposition — that jurisdictional elements must first be established before the estoppel act may be invoked — see Rosamond, supra note 17, at ¶ 14 at 395. See also Mills, supra note 17, at ¶ 9 at 851.
. Dominic, supra note 21, at ¶ 9, at 938.
. Dominic, supra note 21, at ¶ 8 at 938; Wahpepah, supra note 21, at ¶ 7 at 1153; Little, supra note 21, at ¶ 10 at 743.
. Dominic, supra note 21, at¶ 8 at 938 (citing Jot Davis supra note 29, at ¶ 8 at 260-61); Wah-pepah, supra note 21, at ¶ 7 at 1153; Muscogee Nation, supra note 21, at ¶ 7 at 501; Little, supra note 21, at ¶ 10 at 743.
. The term concretize is derived from Hans Kelsen's General Theory of Law and State, 119, 135, 397 (1945) (reprinted (1961)). "The process through which law constantly creates itself anew goes from the general and abstract to the individual and concrete. It is a process of steadily increasing individualization and concretization.” (supra at 134-35)
. Dominic, supra note 21, at ¶ 9 at 938; Wahpepah, supra note 21, at ¶ 8 at 1153; Little, supra note 21, at ¶ 11 at 743.
The second element applies even if the premium was calculated using a method that considered the scheduling of workers or the number of workers and their job duties. Dominic, supra note 21, ¶ 11 at 938.
. Dominic, supra note 21, at ¶ 11 at 938 (citing Young, supra note 20, at ¶ 16 at 907 and National Bank of Tulsa Building v. Goldsmith, 1951 OK 5, ¶ 29, 204 Okla. 45, 226 P.2d 916, 923); Wahpepah, supra note 21, at ¶ 10 at 1153; Little, supra note 21, at ¶ 13 at 743.
. Respondents’ argument parallels that of the State Insurance Fund in Barney U. Brown, supra, note 29, at ¶ 5 at 186. There the court held an employee of employer's second business which, unlike the first business, was not covered by compensation insurance but whose wages were mistakenly included in setting the premium for the covered business was protected by the estop-pel act.
. Barney U. Brown, supra, note 29, at ¶ 5 at 670.
. For the text of the estoppel act see supra note 1.
Estoppel implements the policy decision of the legislature that it would be inequitable to allow a workers’ compensation insurer to accept premiums and then contest coverage. Miller v. Sears, Roebuck and Co., 1976 OK 67, ¶ 14, 550 P.2d 1330, 1334.
. See Dominic, supra note 21, at ¶ 14 at 939, Muscogee Nation, supra note 21, at ¶ 7 at 501, Wahpepah, supra note 21, at ¶ 13 at 1154-55; Little, supra note 21, at ¶ 16 at 744.
. Rosamond, supra note 17.
. As the court instructed in Young when it distinguished Rosamond, the latter’s holding can be understood only in light of its unique factual situation. Estoppel’s bar cannot be invoked to protect an employer against liability to an employee when they are of one and the same identity. Two separate individuals — in the nature of employer and employee — must first exist before an estoppel can be asserted. (Young, supra note 20, at ¶ 12 at 906.) Rosamond's teachings are not otherwise instructive in the application of the estoppel act. Today’s cause clearly deals with two separate entities.
. Dominic, supra note 21.
. For the text of § 65.2 see supra note 1.
. Dominic, supra note 21, at ¶ 11 at 939 (citing Young, supra note 20, at ¶ 6 at 906; Jot Davis, supra note 29, at ¶ 8, at 260).
. Dominic, supra note 21, at ¶ 11 at 939 (citing Jot Davis, supra note 29, at ¶ 9 at 260).
. Dominic, supra note 21 at ¶ 10 at 939.
. Respondents urge the initial premium was merely a deposit. Although a premium and a deposit may share some common characteristics, they are not synonymous for the purpose of applying the estoppel act An insurance premium for compensation coverage is effected by payment that keeps a policy in effect. While, as here, a premium may be adjusted after its earlier payment, the adjustment does not serve retroactively to alter the quantum of risk coverage. Nor does it exonerate the liability already incurred. The risk is accepted when the premium payment is initially received and its amount is calculated on the basis of remuneration paid to claimant. That initial premium payment effects the extent of the insurer’s compensation risk coverage.
. An insurer’s acceptance and retention of the premiums until after the insured’s death, without investigation to determine whether grounds existed for cancellation, is estopped from denying
. Supra note 38.
. We note that although the trial transcripts do not make clear if respondents stipulated to the question whether Shorter's accident arose out of and in the course of his employment, the trial tribunal ruled that it did. This issue was not raised in respondents' appellate briefs.
. Barney U. Brown, supra note 29, at ¶ 6 at 671 (citing Rose Hill Burial Park v. Garrison, 1936 OK 285, ¶ 2, 55 P.2d 1045, 1046, 176 Okla. 355).
. When resolving a public-law question, we are free to choose sua sponte the dispositive public-law theory although the wrong one is advanced. Amos v. Spiro Public Schools, 2004 OK 4, ¶ 7, 85 P.3d 813, 816 (citing Special Indemnity Fund v. Reynolds, 1948 OK 14, ¶ 5, 188 P.2d 841, 842).
. Dominic, supra note 21, at ¶ 13 at 939.