CNA (Continental Casualty) v. William King

CourtCourt of Appeals of Tennessee
DecidedSeptember 28, 2006
DocketM2004-02911-COA-R3-CV
StatusPublished

This text of CNA (Continental Casualty) v. William King (CNA (Continental Casualty) v. William King) is published on Counsel Stack Legal Research, covering Court of Appeals of Tennessee primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
CNA (Continental Casualty) v. William King, (Tenn. Ct. App. 2006).

Opinion

IN THE COURT OF APPEALS OF TENNESSEE AT NASHVILLE January 10, 2006 Session

CNA (CONTINENTAL CASUALTY) v. WILLIAM KING, ET AL.

Appeal from the Circuit Court for Cheatham County No. 5517 Robert Burch, Judge

No. M2004-02911-COA-R3-CV - Filed on September 28, 2006

A roofing contractor applied for workers compensation insurance, declaring in his application that he had no employees. He paid a $750 minimum premium, and the insurance company issued a policy. The company subsequently audited his records and assessed an additional premium of over $14,700 for roofers who worked under contract with him or his subcontractors, but who were not covered by their own workers compensation policies. The contractor refused to pay, and the insurance company brought suit. The contractor claimed at trial that all the workers were independent contractors and, thus, that he was not obligated to insure them. The trial court ruled against him. We affirm the trial court.

Tenn. R. App. P. 3 Appeal as of Right; Judgment of the Circuit Court Affirmed

PATRICIA J. COTTRELL, J., delivered the opinion of the court, in which WILLIAM C. KOCH , JR., P.J., M.S., joined. WILLIAM B. CAIN , J., not participating.

Mark C. Scruggs, Nashville, Tennessee, for the appellant, William King d/b/a Kustom Roofing & Consultants.

Blakeley D. Matthews, Brian W. Holmes, Nashville, Tennessee, for the appellee, CNA (Continental Casualty).

OPINION

I. A CONTRACT OF INSURANCE

William Stanley King operates a roofing business under the name Kustom Roofing and Consultants. He does not carry any employees on his payroll, but when a general contractor hires him to install a roof, he then hires others to do the work and pays them according to the number of roofing squares they complete. In July of 2001, Mr. King went to an insurance agency to obtain general liability and workers compensation insurance. A general contractor, a subdivision developer for whom Mr. King intended to work, required proof that he had such insurance before it would agree to have him install its roofs. Mr. King had been refused coverage by two insurance companies in the previous sixty days.

The insurance agent asked Mr. King questions, and an application/information page was filled out purportedly based on those answers. The form stated that the applicant had no employees, and “NO” was checked in response to the questions “Are subcontractors used?” and “Is any work sublet without certificates of insurance?” Mr. King paid the minimum premium of $750 and signed the application without reading it.

The agent forwarded the application to NCCI, which administers Tennessee’s assigned risk program. A few weeks later, Mr. King received a policy in the mail from CNA Continental Casualty to cover him for one full year.1 The first part of the five page policy states that “[w]e will pay promptly when due the benefits required of you by the Workers Compensation Law,” and further “[w]e have the right and duty to defend at our expense any claim, proceeding or suit against you for benefits payable by this insurance.”

The premium portion of the policy declares that “[t]he premium shown on the Information Page, schedules and endorsements is an estimate. The final premium will be determined after this contract ends by using the actual, not the estimated, premium basis and the proper classification and rates that lawfully apply to the business and work covered by this policy.”

The document further explains that the premium is calculated by multiplying a rate by a premium basis and that the most common basis is remuneration paid to officers and employees engaged in work covered by the policy, and also to “[a]ll other persons engaged in work that could make us liable under Part One (Workers Compensation Insurance) of this policy.” In the absence of payroll records, the contract price for the services and materials furnished by such “other persons” can be used as the premium basis. However, this section “will not apply if you give us proof that the employers of these persons lawfully secured their workers compensation obligation.”

The policy further sets out the right of the insurer to examine and audit all the records relating to the policy in order to determine the final premium. Mr. King’s policy carried a premium rate of $32.77 for each $100 of remuneration.

On July 31, 2001, the underwriter for CNA sent a letter to Mr. King asking him to fill out and return an enclosed questionnaire about any subcontractors he hired as part of his business. The letter underscored the policy provisions discussed above by stating:

1 The evidence showed that CNA had actually contracted with St. Paul Travelers Insurance Company to write the policy. But since CNA is named as the plaintiff in this suit, any reference to CNA in this opinion will also include any role exercised or interest held by Travelers.

-2- Please note that the payroll for uninsured sub-contractors will be included in your premium basis at audit unless you can provide evidence that the sub-contractor is not subject to the state workers compensation statutes and that all appropriate forms have been completed and filed with the state and with our office. (emphasis added).

On November 20, 2001, CNA sent a letter to Mr. King notifying him that the policy had been cancelled because “requested underwriting information has not been provided.” It appears that Mr. King had failed to include any specific information about subcontractors in the questionnaire that he returned.2

An audit of Mr. King’s records was conducted on December 28, 2001. It resulted in the insurer assessing him with an additional premium of $14,790 for the months that he had been insured. Mr. King refused to pay, and CNA filed a collection suit in the General Sessions Court of Cheatham County. Following a hearing in November of 2003, the General Sessions Court returned a judgment in favor of Mr. King. CNA then appealed for a trial de novo in the Circuit Court of Cheatham County. Mr. King filed a counterclaim, which was dismissed prior to trial.

II. TRIAL COURT PROCEEDINGS

The trial in Circuit Court was conducted on October 22, 2004. The only witnesses to testify were the auditor who had examined Mr. King’s records; an attorney for the insurer; Martin Munoz, a roofer who worked for Mr. King; and Mr. King himself.

The auditor testified that his examination revealed that during the period the insurance was in effect, Mr. King had employed two workers, Daniel Borck and William Wissman, who did not sign I-18 forms. These are documents used by subcontractors to waive their rights to be covered by workers compensation.3 Mr. King paid them total remuneration of $10,000. Mr. King had also paid $40,488 to Martin Munoz. Mr. Munoz had filled out an I-18 form, but the amount paid suggested to the auditor the possibility that Mr. Munoz was paying other workers out of the money paid to him. In fact, this proved to be the case.

2 Shortly after the policy was cancelled, one of Mr. King’s workers was injured on the job and went to the hospital. Mr. King notified CNA that the injury had occurred. The insurance company declined coverage to the worker because the injury happened after the policy period ended.

3 The forms are actually titled “Election of Non-Coverage by Sub-Contractor” and must be signed by both the subcontractor and the general contractor. Although they provide a mechanism whereby a subcontractor can waive his own right to be covered by the W orkers Compensation Law, the form itself states that he cannot waive the rights of his employees.

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CNA (Continental Casualty) v. William King, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cna-continental-casualty-v-william-king-tennctapp-2006.