California Insurance Guarantee Ass'n v. Workers' Compensation Appeals Board

10 Cal. App. 4th 988, 12 Cal. Rptr. 2d 848, 57 Cal. Comp. Cases 660, 92 Cal. Daily Op. Serv. 8888, 92 Daily Journal DAR 14626, 1992 Cal. App. LEXIS 1271
CourtCalifornia Court of Appeal
DecidedOctober 28, 1992
DocketB061743
StatusPublished
Cited by13 cases

This text of 10 Cal. App. 4th 988 (California Insurance Guarantee Ass'n v. Workers' Compensation Appeals Board) is published on Counsel Stack Legal Research, covering California Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
California Insurance Guarantee Ass'n v. Workers' Compensation Appeals Board, 10 Cal. App. 4th 988, 12 Cal. Rptr. 2d 848, 57 Cal. Comp. Cases 660, 92 Cal. Daily Op. Serv. 8888, 92 Daily Journal DAR 14626, 1992 Cal. App. LEXIS 1271 (Cal. Ct. App. 1992).

Opinion

Opinion

NOTT, J.

A workers’ compensation judge (WCJ) determined that the California Insurance Guarantee Association (CIGA) was obligated to pay workers’ compensation benefits awarded to an injured employee, Thomas Conces, after CIGA was called upon to meet the obligations of an insolvent workers’ compensation carrier, Homeland Insurance Company (Homeland). The Workers’ Compensation Appeals Board (Board) denied CIGA’s petition for reconsideration. The WCJ and the Board ruled that Homeland was estopped to deny insurance coverage to Blue Jay Enterprises, Inc., the employer of the injured worker. CIGA contends, among other things, that the WCJ and the Board erred because CIGA has no statutory liability for (1) a claim against an insolvent insurer based on obligations created by estoppel to deny workers’ compensation insurance coverage or (2) obligations of an insolvent insurer that allegedly arose because of the tortious negligence of an agent of the insolvent insurer.

*991 The case presents issues of first impression. As we shall explain, we are unpersuaded by CIGA’s contentions, and we affirm the Board’s order denying reconsideration.

Facts

Ida Jenkins was the owner of Blue Jay Enterprises, Inc. (Blue Jay), a small business she had operated for 10 years with her husband, and for 5 years by herself after his death. Blue Jay, doing business as Aamco Transmission, repaired automobiles and had five mechanics working at all times. Blue Jay had always maintained workers’ compensation insurance.

On March 19, 1987, Jenkins met with Robert Pixley, an insurance salesman, to obtain workers’ compensation insurance. Jenkins had heard about Pixley from other Aamco Transmission dealers. Pixley was the owner of a 10 percent interest in The Factory Insurance Service, Inc. (Factory). Factory was an authorized agent of Homeland, and Pixley, as a Factory agent, was a subagent of Homeland.

Pixley filled out a document entitled “Workers’ Compensation Application,” based on information provided to him by Jenkins. The application was for Homeland’s participating workers’ compensation insurance policy and the box next to “issue” was checked. 1 The total estimated annual premium was $2,955. The proposed duration of the policy was from March 23, 1987, through March 23, 1988. Pixley took a $500 deposit from Jenkins. Pixley, rather than Jenkins, signed the application. Pixley told Jenkins she was “covered” and would receive a policy in the mail. Pixley deposited the $500 check in Factory’s trust account.

On March 23, 1987, Pixley wrote a memorandum to Jill Belt, an underwriter at Homeland, stating: “Application] enclosed for Code 7397[.] [P]lease write seperate [sic] policy since this does not fit our group. Call if you need any more information.” 2 Pixley put this memorandum in the outgoing mail basket at work. On April 29, 1987, Pixley drafted another memorandum to Belt at Homeland. It stated: “Per our phone conservation [s7c][,] duplicate application] enclosed. Please issue soon as possible. Thank you for your help.” Again, Pixley placed the second memorandum and the duplicate application in the outgoing mail basket. Homeland has no record of receiving either the memoranda or the applications.

*992 Rainy Earp, an underwriter at Homeland in 1987, testified that Factory’s authority to bind Homeland was limited to a 10-day period. She further testified that in 1987 Homeland would not issue any insurance policy if the premium was less than $5,000 a year. Notice of this limitation was sent to Homeland’s agents, but Earp had no personal knowledge that Factory received notice. There was also no evidence that Jenkins or Blue Jay was informed of the limitations on Factory’s authority.

After March 19, 1987, Jenkins called Pixley at Factory 15 or 20 times because she had not received the workers’ compensation insurance policy. Pixley never returned her calls, but Jenkins was always advised by other persons working at Factory that she should not worry because she was covered.

Homeland was later declared insolvent, and on September 12, 1987, all insurance policies of Homeland were cancelled by order of the Insurance Commissioner because Homeland had lost its reinsurance coverage. No notice of cancellation of policy was received by Blue Jay or Jenkins. Pixley did not notify Jenkins of Homeland’s insolvency.

On September 24, 1987, Thomas Gonces sustained injuries during his employment as a shop manager and mechanic by Blue Jay. Just after Gonces was injured, Jenkins discovered that Homeland denied coverage and was insolvent as well. After Gonces filed his application for workers’ compensation benefits, Homeland, GIGA, and the Uninsured Employers Fund (UEF) were made parties in the ensuing litigation.

The WCJ found that Gonces had sustained work-related injuries to the right lower extremity, left knee, low back, and psyche that resulted in temporary disability from October 26, 1987, through January 4, 1988. The WCJ also found the injuries resulted in continuing temporary disability since March 1, 1990. The WCJ ordered GIGA to pay temporary disability indemnity and to adjust self-procured medical expenses. The WCJ also ordered GIGA to provide further medical treatment for the right lower extremity and psyche.

The WCJ determined Homeland was estopped to deny coverage to Blue Jay and Jenkins, and GIGA was responsible for payment of Homeland’s obligations that had been created by the estoppel. UEF was dismissed from the case. In the WCJ’s opinion on decision, she stated: “Where no coverage occurs, without fault of the employer, through acts, omissions, or errors of agents of the insurer, acting within their actual or ostensible authority, the insurer is bound thereby and estopped to deny coverage. [Citation.]” The *993 WCJ pointed out that Jenkins had relied on Pixley’s representations to her detriment. The WCJ cited three Board rulings wherein estoppel had been applied to establish workers’ compensation insurance coverage for injured workers in similar situations. 3

In response to other contentions of CIGA, the WCJ held that coverage was not precluded by the cancellation of Homeland’s policies on September 12, 1987, because, in view of Pixley’s negligence, there was no evidence that Blue Jay or Jenkins had received notice of cancellation. The WCJ stated that, had Jenkins received such notice, she would have secured other insurance. The WCJ concluded that CIGA’s statutory obligation to pay only “covered claims” (Ins. Code, §§ 1063.1, 1063.2, 1063.12) did not prevent protection of Blue Jay and Jenkins, because covered claims were not, as CIGA contended, limited to only those arising from written and actually issued policies of insurance. The WCJ emphasized that covered claims were statutorily defined as the obligations of an insolvent insurer. The WCJ stated: “Although this is a case of first impression, I find that CIGA is liable for the benefits awarded in this matter. The definition of ‘covered claims’ is for ‘obligations.’ Had the Legislature wanted to define the term insurance policy to only include written and endorsed policies, it could have done so.

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10 Cal. App. 4th 988, 12 Cal. Rptr. 2d 848, 57 Cal. Comp. Cases 660, 92 Cal. Daily Op. Serv. 8888, 92 Daily Journal DAR 14626, 1992 Cal. App. LEXIS 1271, Counsel Stack Legal Research, https://law.counselstack.com/opinion/california-insurance-guarantee-assn-v-workers-compensation-appeals-board-calctapp-1992.