Auto Parts v. Employment Relations Division Uninsured Employers' Fund

2001 MT 72, 23 P.3d 193, 305 Mont. 40, 2001 Mont. LEXIS 91
CourtMontana Supreme Court
DecidedApril 26, 2001
Docket00-456
StatusPublished
Cited by12 cases

This text of 2001 MT 72 (Auto Parts v. Employment Relations Division Uninsured Employers' Fund) is published on Counsel Stack Legal Research, covering Montana Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Auto Parts v. Employment Relations Division Uninsured Employers' Fund, 2001 MT 72, 23 P.3d 193, 305 Mont. 40, 2001 Mont. LEXIS 91 (Mo. 2001).

Opinions

JUSTICE COTTER

delivered the Opinion of the Court.

¶1 Appellant Auto Parts of Bozeman (Auto Parts) carried workers’ compensation insurance with Montana State Fund (State Fund). State Fund canceled Auto Parts’ coverage for failure to pay a premium. Thereafter, the Uninsured Employers’ Fund (UEF), assessed a penalty against Auto Parts for failure to carry workers’ compensation insurance. Following a contested hearing, the Workers’ Compensation Court found that the Department of Labor and Industry (DLI) erred by not allowing Auto Parts to defend the UEF claim on the basis that State Fund had improperly canceled its policy. The court found that DLI had improperly shifted the burden of proof from UEF to Auto Parts, thus denying Auto Parts its right to due process of law. UEF appeals the decision of the Workers’ Compensation Court. The Montana State Fund and the American Insurance Association have filed amicus curiae briefs with the Court. We reverse and remand.

¶2 The UEF raises the following issues on appeal:

¶3 1. Whether the Workers’ Compensation Court erred when it ruled that the UEF failed to meet its burden of proving that [42]*42Auto Parts was an uninsured employer because it did not present evidence that the purported cancellation was proper as a matter of law.

¶4 2. Whether the Workers’ Compensation Court erred in determining that the issue of jurisdiction was not barred by the doctrine of collateral estoppel.

¶5 3. Whether it was error to give DLI jurisdiction to adjudicate a contract dispute of the propriety of cancellation.

Factual and Procedural History

¶6 Auto Parts carried a workers’ compensation insurance policy with the State Fund. Following non-payment of an advance premium, the State Fund sent a notice to Auto Parts in January, 1996, warning that the policy would be canceled if the advance premium, due January 1, was not received by February 1. The “Cancellation Notice” sent by the State Fund reads as follows:

We will cancel your policy at 12:01 a.m. on the pending cancellation date(s) shown below unless each item is received by its respective pending cancellation date. We will not accept claims occurring on or after the pending cancellation date(s) unless we receive each item by its pending cancellation date.
Once your coverage is canceled, we must re[c]eive all delinquent reports, amounts due, a new application, and sufficient advance premium or deposit to initiate new coverage. THERE WILL BE A LAPSE OF COVERAGE FROM THE CANCELLATION DATE TO THE NEW POLICY EFFECTIVE DATE.
The Department of Labor and Industry’s Uninsured Employer’s Fund receives information concerning all cancellations of coverage. You are subject to fines, penalties and court action if you have not complied with coverage requirements under the Workers’ Compensation Act. (Emphasis in original.)

¶7 Auto Parts issued a check for the premium, but did not mail it to the State Fund until sometime during the month of February. The State Fund marked it as received on February 21,1996. The check was cashed and the amount was applied by the State Fund to the unpaid portion of the policy. The President of Auto Parts testified he believed that since the check for the premium had been cashed by State Fund, the policy had not been canceled and coverage continued. The State Fund, however, maintained that the policy was rightfully canceled and that the payment was applied not as an advance premium, but instead [43]*43against amounts still owed by Auto Parts for the unpaid period prior to cancellation. According to the State Fund, the policy was canceled as of February 1 and the cancellation was reported to the appropriate databases. A status report reflecting this was sent to Auto Parts by the State Fund, but it is not clear whether it was received.

¶8 Auto Parts claims it was unaware of the cancellation of its policy when in April, 1996, one of its employees was injured in an on-the-job accident. Auto Parts submitted a first report of injury to the State Fund. At that point, the State Fund again informed Auto Parts of the previous cancellation and sent them an application to re-enroll. Auto Parts paid the necessary premium to re-enroll, and coverage became effective April 23, 1996.

¶9 Auto Parts requested a “customer service review” by the State Fund to determine if State Fund had failed to abide by its internal policies or made a mistake when the first policy was canceled. After a review, the State Fund determined that it had complied with the terms of the contract and that coverage had properly been canceled. The State Fund refused to back-date the new policy.

¶10 Because it had determined that the original Auto Parts policy was not in effect at the time of the work-related accident, the injury report filed by Auto Parts was forwarded by the State Fund to the UEF. As a result, an auditor for the UEF investigated Auto Parts’ workers’ compensation insurance coverage, checking both the State Fund database and the National Workers’ Compensation Insurance Database. The UEF determined, based on this information, that Auto Parts was uninsured for the period between February 2,1996 and April 23, 1996. The UEF therefore paid the medical bills for the injured employee, assessed a penalty against Auto Parts for the period of non-coverage, and presented a claim for indemnification for the medical bills paid by UEF for the injured worker.

¶11 Facing a UEF penalty and indemnification claim, Auto Parts requested a contested hearing before the DLL (Auto Parts v. State Compensation Insurance Fund, Policy No. 3-119389-3). Auto Parts argued that the State Fund had acted improperly in canceling the policy. On February 4, 1998, the hearing officer issued an order dismissing the hearing request on the grounds that DLI lacked subject matter jurisdiction over the contract dispute. The hearing officer reasoned:

Procedures governing payments from the insured and cancellation are set forth in the contract of insurance between the parties. The [44]*44contract specified that the District Court, Lewis and Clark County, has jurisdiction to hear any suits brought under the policy. This matter is one in which Petitioner seeks a remedy or the enforcement of a right founded in the contract or insurance law.

Ultimately, the matter was dismissed by the department:

The Department of Labor and Industry does not have jurisdiction over contract disputes between an insurance carrier and its policyholder. This is purely a contract dispute over how a policyholder’s payment is applied by the insurance company when that policy has been canceled.

The order noted that either party could appeal within 30 days to the Workers’ Compensation Court. Auto Parts did not appeal this order.

¶12 Auto Parts then requested a contested case hearing from the DLI to challenge UEF’s determination that Auto Parts was an uninsured employer. (Auto Parts v. Employment Relations Division, Uninsured Employers’ Fund, UEF Case No. 9258). Auto Parts contested the penalty assessed by the UEF, and raised two other issues relating to the propriety of State Fund’s cancellation of the insurance policy. The hearing officer again refused to consider Auto Parts’ contention that it believed it was insured by the State Fund on the date of the employee’s injury.

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Cite This Page — Counsel Stack

Bluebook (online)
2001 MT 72, 23 P.3d 193, 305 Mont. 40, 2001 Mont. LEXIS 91, Counsel Stack Legal Research, https://law.counselstack.com/opinion/auto-parts-v-employment-relations-division-uninsured-employers-fund-mont-2001.