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CHAPTER XII.
INSURANCE CARRIER LIABILITY & INSURANCE COVERAGE |
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§ 12.01 Generally
- December 1998. (Award) The employer has the responsibility to obtain insurance, qualify as a self-insured, or
maintain membership in a qualified group-funded pool to secure payment of workers compensation benefits. See
K.S.A. 44-532(b). Failure of the employer's insurance carrier to pay benefits awarded when due subjects the
insurance carrier to penalties as proved for in K.S.A. 44-512a. Also, if an insurance carrier unreasonably denies
insurance coverage or refuses to pay compensation due or awarded, it may be subject to certain penalties and
sanctions contained in the fraud and abuse statutes found at K.S.A. 44-5,120 et seq. Lott-Edwards v. Americold
Corporation and Wausau Underwriters Insurance Co and National Union Fire Insurance Co and Travelers
Property Casualty, Docket Nos. 175,770; 175,771; and 223,800 [Affirmed by Court of Appeals opinion, Docket No.
82,555, June 23, 2000].
- See Also, O'Hara vs. O'Hara Painting Company, Inc. and Insurance Company of North America and Kansas
Workers Compensation Fund, Docket No. 214,169 (September 2000). This decision discusses the apparent
authority of agent to bind insurance carrier.
- August 1997. (Ph) Although not expressly decided by the Kansas appellate courts, the Appeals Board concludes
the insurance carrier is a proper party but not a necessary party in workers compensation proceedings. Judgment
against the employer is binding on the insurance carrier even if the insurance carrier did not receive notice. See
Landes v. Smith, 189 Kan. 229, 368 P.2d 302 (1962). Eldridge v. Champ Service Line Division and Zurich
American Insurance Company, Docket No. 189,361.
- April 1997. (Ph) Held, respondent's insurance carrier, as of the date of claimant's accident, is responsible for
benefits whether or not it formally attended the hearing. Smith v. National Vision Center and Hartford Accident &
Indemnity Co. & Travelers Indemnity Company, Docket Nos. 206,033 & 220, 001.
12.02 Notice of Hearings
- September 1997. (Ph) Notice to insurance carriers of hearings is not required under Kansas' Workers
Compensation Act. Knoles v. Groendyke Transport, Inc. and Continental Casualty Company, Docket No. 223,341
[Affirmed by unpublished Court of Appeals opinion, Docket No. 82,792].
- August 1997. (Ph) Notice to the insurance carrier needs to be looked at separately from notice to the employer.
The Act does not require the claimant to identify or notify the correct insurance carrier. Notice to the insurance
carrier should be considered the responsibility of the respondent. Eldridge v. Champ Service Line Division and
Zurich American Insurance Company, Docket No. 189,361.
- July 1997. (Ph) In Kansas, notice of a preliminary hearing need only be given to an employer. See K.A.R. 51-3-5a. Separate notice to the insurance carrier need not be given, as notice to the employer is notice to the insurance
carrier. See Landes v. Smith, 189 Kan. 229, 368 P.2d 302 (1962). Martel v. Waste Management of Wichita and
Continental Casualty Company, Docket No. 222,516.
- See Also, Villalobos v. Hayes Company, Inc and Fireman's Fund, Docket No. 228,349 (March 1998).
- But See, June 1997. (Ph) Where claimant's physician sent an office note to the insurance carrier stating claimant
reported suffering an aggravation of his left shoulder injury as a direct result of the authorized medical treatment he
was receiving for the work-related left knee injury, the Appeals Board finds the insurance carrier more probably than
not received notice of the aggravated injury from the doctor's office note. Under these circumstances, notice to the
workers compensation insurance carrier satisfies the statutory requirement for notice to the employer. Kiehl v.
Allied Group Insurance and Cigna Property & Casualty Ins., Docket No. 217,855.
- See Also, June 1997. (Order) Respondent received sufficient notice of the Preliminary Hearing, when its
authorized agent--its insurance carrier-- received notice of the preliminary hearing. Church v. Wichita Janitorial
Services and Patrons Insurance Company, Docket No. 220,425.
12.03 Which Carrier is Liable / Whether Board Has Jurisdiction To Consider Insurance Coverage Issues
- May 2000. (Award) The Board's findings resulted in liability being assessed against an insurance carrier that did
not participate in the proceedings. Liability for medical and temporary total disability compensation benefits are the
responsibility of the insurance carrier on the risk when the medical expense or temporary disability occurred.
Liability for a permanent partial disability compensation and future medical will be the responsibility of the
insurance carrier on the risk on the accident date. Marsha L. Kelley vs. Kinedyne Corporation and American Home
Assurance Company and Fremont Compensation Ins. Group, Docket No. 233,493.
But See, Dissent, by which this Board member argues that the Division of Workers Compensation does not have the
authority or jurisdiction to decide the respective liability of two or more insurance companies. To the Dissent, the Award
should be entered jointly and severally against both insurance carriers. Id.
- February 1999. (Ph) The ALJ found the workers compensation claim compensable and ordered two of
respondent's workers compensation insurance carriers to split the cost of preliminary hearing benefits. One
insurance carrier appealed. Held: there is no dispute about the compensability of claimant's injuries, so the Board
has no jurisdiction to hear the appeal. The ALJ did not exceed his jurisdiction by ordering the two insurance carriers
to split the costs. The only question is date of accident for purposes of assigning insurance carrier liability. This is
not a proper question for an appeal from a preliminary hearing order. Burton v. Electrical Corporation of America
and Liberty Mutual Insurance Company, Insurance Company of North America and Builders' Assoc. Self Insurance
Fund, Docket Nos. 236,797; 236,798; 236,799; and 236,800.
- February 1999. (Ph) Since compensability of claim (claimant's entitlement to benefits) is not disputed, the appeal
does not give rise to a jurisdictional issue. Which insurance carrier should pay is not an issue the Board can decide
on an appeal from a preliminary hearing Order. Ireland v. Ireland Court Reporting and St. Paul Fire & Marine
Insurance and Utica National Insurance Company and Kansas Workers Compensation Fund, Docket Nos. 176,441
& 234,974.
- December 1998. (Award) The insurance carrier on the risk during a period of accident for a repetitive trauma
injury should be responsible for temporary total disability compensation and medical expenses incurred during its
period of coverage. Lott-Edwards v. Americold Corporation and Wausau Underwriters Insurance Co and National
Union Fire Insurance Co and Travelers Property Casualty, Docket Nos. 175,770; 175,771; and 223,800 [Affirmed
by Court of Appeals opinion, Docket No. 82,555, June 23, 2000].
- ----- The case at hand involves a repetitive trauma injury occurring over a period of time in which respondent was
insured by two separate insurance companies. The Appeals Board concludes, since it found claimant suffered from
repetitive injuries over a period of time from June 1992 and culminating on claimant's last day of work on
March 10, 1995, that National Union, the first insurance company, should be responsible for the temporary total
disability compensation and medical expenses incurred during its period of coverage. Travelers, the subsequent
insurance company and the insurance carrier on the risk on claimant's last day of work, then should be responsible
for all temporary total disability compensation and authorized medical treatment incurred during its period of
coverage plus permanent total disability compensation and any other benefits owed after March 10, 1995.
Accordingly, Travelers should reimburse National Union for any temporary total disability compensation and
medical treatment incurred and paid by National Union after Traveler's coverage commenced. See Kimber v.
U.S.D. No. 418, 24 Kan. App. 2d 280, 283, 944 P.2d 169, rev. denied Kan. (1997). Id.
- But See, Concurring Opinion and Dissent, whereby this Board Member feels that the Division and Board have
no jurisdiction to apportion liability as between insurance carriers, and that disputes as to which carrier is liable are
not to be decided in workers compensation proceedings. See Kuhn v. Grant County, 201 Kan. 163, 439 P.2d 155
(1968); Hobelman v. Krebs Construction Co, 188 Kan. 825, 366 P.2d 270 (1961). The award should have been
entered against respondent and its insurance carriers without apportioning liability. Id.
- December 1998. (Award) The Board reverses the decision to assess 50 percent of the award against each insurance
carrier. The respective liability of insurance carriers is not to be decided in the workers compensation proceeding
unless the employee's interests are involved. American States Ins. Co. v. Hanover Ins. Co., 14 Kan. App. 2d 492,
794 P.2d 662 (1990). Instead, the award in the workers compensation proceedings should be against both disputing
carriers jointly and severally with their respective rights determined in a separate independent action. Hobelman v.
Krebs Construction Co., 188 Kan. 825, 366 P.2d 270 (1961); Kuhn v. Grant County, 201 Kan. 163, 439 P.2d 155
(1968). The Board, therefore, finds this award should be made against State Farm and Continental jointly and
severally. Fugate v. Stardust Feed, Inc and Continental Western Insurance Company State Farm Fire & Casualty,
Docket No. 214,259.
- December 1998. (Ph) Respondent changed insurance carriers during the alleged period of injury. The parties
agreed that claimant suffered a compensable, work-related injury. The issue for review is the date of accident for
purpose of determining which insurance carrier is liable. Held: the issue does not go to a jurisdictional issue.
Appeal dismissed. Gomez v. Thermal Equipment Corporation and American Assurance Company and Safeco
Insurance Company of Illinois, Docket No. 236,062.
- ----- It is inconsistent with the intent of the Workers Compensation Act for a respondent to delay preliminary
hearing benefits to an injured employee while its insurance carriers litigate their respective liability. Id.
- See also, Rogers v. Smith Construction Company, Inc and Insurance Company of North America, Wausau
Underwriters Insurance Co and Business Insurance Co and Kansas Workers Compensation Fund, Docket No.
196,798.
- June 1998. (Ph) On appeal from a preliminary hearing order entered pursuant to K.S.A. 1997 Supp. 44-534a, the
Appeals Board does not have jurisdiction to review an order by an ALJ where the issue is date of accident for
purposes of determining which insurance carrier is responsible for the payment of benefits. Where compensability
of the claim is not disputed, date of accident is not a jurisdictional issue. The appeal is dismissed. Linville v.
Grandview Products Co., Inc and Wausau Business Insurance Company and Travelers Property Casualty, Docket
No. 230,739.
- January 1998. (Ph) Generally, disputes between insurance carriers regarding their respective liabilities should not
be litigated in workers compensation proceedings unless the claimant's interests are at stake. See Kuhn v. Grant
County, 201 Kan. 163, 439 P.2d 155 (1968); and American States Ins. Co. v. Hanover Ins. Co., 14 Kan. App.2d 492,
794 P.2d 662 (1990). Celuch v. Luce Press Clippings and Fireman's Fund Insurance Company and American
Home Assurance Company, Docket Nos. 214,959 & 222,711.
- See also, Scheier v. Scheier Masonry and American Family Mutual Insurance Co., Docket No. 236,919 (May
1999).
- November 1996. (Award) Claimant, who worked for multiple employers, is awarded benefits for a work-related
injury. Any subsequent dispute between the two employers regarding what, if any, potential reimbursement will be
due and owing is a matter to be decided in a court of appropriate jurisdiction. The Board is obligated to determine
what benefits may or may not be due to an injured employee. The issues as to the contractual relationships between
the two respondents and their various insurance carriers are not matters over which the Board retains jurisdiction.
Schuler, Jr v. Schock Transfer Company, Inc and Schuler, Jr v. Crooks Driver Leasing and Aetna Casualty &
Surety, Docket Nos. 204,130 & 204,131 [Affirmed by unpublished Court of Appeals opinion, Docket No. 78,067].
- October 1996. (Award) The Board found that claimant sustained injury to her upper extremities during the period
of December 1991 through June 1994, when she left work for surgery. Considering both Berry and Condon, the
Board finds the appropriate date of accident to be June of 1994. As such, the Board finds that one insurance carrier
is responsible for claimant's temporary total and permanent partial disability benefits and medical expenses incurred
after 12/31/93 but another insurance carrier is responsible for medical expenses incurred before 1/1/94. Lund v. The
Boeing Company and American Manufacturers Mutual Insurance Company and Aetna Casualty and Surety Co and
Workers Compensation Fund, Docket No. 199,057.
12.04 Insurance Coverage / Whether The Board Has Jurisdiction to Review
- August 1999. (Ph) Where the existence or nonexistence of insurance coverage determined whether claimant's
accident was compensable under the Act, the Board found it had jurisdiction to review the insurance coverage issue
on appeal from a preliminary hearing order. Vanderwoude v. American Mobil Homes and Travelers Insurance
Company, Docket No. 244,213
- March 1999. (Award) The Board finds it does not have jurisdiction to decide the insurance coverage issue
concerning the nonrenewal or cancellation of respondent's insurance policy as the issue does not pertain to the rights
of the claimant [Court of Appeals decision in Helms v. Tollie Freightways, Inc discussed. Corrigan v. Degginger's
Foundry and Commercial Union Ins., Co. and Kansas Workers Compensation Fund, Docket No. 210,434.
- December 1998. (Award) Claimant does not have the burden of proving insurance coverage or which insurance
carrier has respondent's workers compensation insurance coverage on any given date. Lott-Edwards v. Americold
Corporation and Wausau Underwriters Insurance Co and National Union Fire Insurance Co and Travelers
Property Casualty, Docket Nos. 175,770; 175,771; and 223,800 [Affirmed by Court of Appeals opinion, Docket No.
82,555, June 23, 2000].
- December 1997. (Ph) The issue of insurance coverage may, in certain circumstances, be jurisdictional and subject
to review from a preliminary hearing. Sanchez v. Habaneros Mexican Restaurant and ITT Hartford, Docket No.
223,835.
- ----- The Appeals Board has jurisdiction to review the insurance issue at this stage of the proceeding because it
directly addresses the question whether claimant's accident is covered under the Workers Compensation Act. Under
K.S.A. 44-542a, self employed individuals may bring themselves within the provisions of the Act by securing
insurance coverage. Therefore, if claimant is deemed to have obtained insurance coverage upon herself, her accident
would be compensable under the Act. If not, the accident is not compensable. Therefore, in this specific instance,
the insurance coverage issue is a jurisdictional issue which may be addressed in the review of a preliminary hearing
order. Id.
- December 1997. (Award) Unless the Act otherwise expressly provides, the Division of Workers Compensation
does not have jurisdiction to decide insurance coverage issues which do not affect a workers right to benefits. See
Also American States Ins. Co. v. Hanover Ins.. Co., 14 Kan. App. 2d 492, 794 P.2d 662 (1990), and Hobelman v.
Krebs Construction Co., 188 Kan. 825, 366 P.2d 270 (1961), which hold that insurance carriers may not litigate their
respective liabilities in workers compensation proceedings when the claimant's interest is not at stake unless the act
should otherwise expressly provide. Owings v. Walter A. Young Construction, Inc. and Steve Beyrle, d/b/a Beyrle
Construction and Cigna and Travelers Insurance Company, Docket No. 192,579.
- See also, Remmenga, Jr v. Technical Irrigation Service and Hartford Accident & Indemnity Union Insurance
Company, Docket Nos. 220,853 & 237,147 (March 1999).