Continental Casualty Company v. Theraco, Inc.

437 S.W.3d 841, 2014 WL 172382, 2014 Tenn. App. LEXIS 16
CourtCourt of Appeals of Tennessee
DecidedJanuary 14, 2014
DocketM2012-02100-COA-R3-CV
StatusPublished
Cited by3 cases

This text of 437 S.W.3d 841 (Continental Casualty Company v. Theraco, Inc.) 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
Continental Casualty Company v. Theraco, Inc., 437 S.W.3d 841, 2014 WL 172382, 2014 Tenn. App. LEXIS 16 (Tenn. Ct. App. 2014).

Opinion

OPINION

DAVID R. FARMER, J.,

delivered the opinion of the Court,

in which ALAN E. HIGHERS, P.J., W.S., and HOLLY M. KIRBY, J., joined.

Continental Casualty Company (“CNA”) and Travelers Property Casualty Company of America (“Travelers”) filed this suit against Theraco, Inc. (“Theraco”) seeking compensation for additional workers’ compensation premiums. Theraco’s insurance contracts with CNA and Travelers provided that it would pay premiums for employees and all other persons who posed a risk of workers’ compensation liability. Pursuant to the contracts, CNA and Travelers both charged Theraco premiums for physical therapists with whom Theraco had contracted. Theraco disputes that it is liable for paying premiums for the workers. After a hearing, the Department of Commerce and Insurance ruled that Theraco was not liable for the additional premiums because the physical therapists were independent contractors rather than employees. CNA and Travelers appealed the Department’s decision to the Chancery Court for Davidson County. The trial court upheld the Department’s ruling, not only concluding that the physical therapists were independent contractors, but also that they did not pose a risk of workers’ compensation liability. CNA and Travelers appealed to this Court. We affirm in part, reverse in part and remand for entry of a judgment consistent with this opinion.

I. Background And Procedural History

Defendant/Appellee Theraco is a company that contracts with home health agencies in Middle Tennessee to provide physical therapy sessions to homebound patients. If a physician determines it is necessary, he or she sends an order for physical therapy to a home health agency. The home health agency then faxes the referral for physical therapy to Theraco. Theraco has contracts with twenty to thirty licensed physical therapists (“PTs”) throughout Middle Tennessee. After receiving the order, Theraco will offer the assignment to one of its PTs in the appropriate geographic area. The PTs send periodic invoices to Theraco listing their patient visits and Theraco pays them biweekly on a per-visit basis.

In addition to the PTs, Theraco has four salaried employees-two officers and two clerical workers. Both of Theraco’s officers elected exemption from workers’ compensation coverage. Beginning in 2004, Theraco provided workers’ compensation insurance coverage for the two clerical workers through CNA. In February 2007, Theraco’s owner, Jeff McEver (“McEver”) *844 renewed Theraco’s policy with CNA through March 2008 (the “2007 CNA policy”). The following year, McEver renewed the policy again with CNA through March 2009 (the “2008 CNA policy”). In July 2008, Theraco cancelled the 2008 CNA Policy and entered a new policy with Travelers covering July 2008 through July 2009 (the “Travelers Policy”). Each of the policies contained identical provisions with regards to calculating Theraco’s premium liability.

All three of the aforementioned policies provided that Theraco’s insurance premium would be calculated using a retroactive assessment of premiums. Using a retroactive assessment method, the insurance premium is based on the total payroll of covered individuals during the policy period. Retroactive assessments are often used in workers’ compensation insurance policies because the exact number of the insured’s employees may vary during the policy period, making the insurer’s risk difficult to measure at the outset. See Steven Plitt et al., 5 Couch on Ins.3d § 69:16 (2012). Under the policies, Theraco was required to pay an estimated premium amount, based on the estimated amount of risk that it would expose the insurer to during the policy period. After each policy period ended, the insurer would conduct an audit of Theraco’s payroll and other business records to determine the amount of risk that it had actually been exposed to during the policy period. The final premium Theraco owed would be calculated by multiplying the insurer’s insurance rate by the premium basis or payroll for covered individuals. If the final premium exceeded what Theraco had already paid, Theraco would be required to pay the balance. If the actual final premium was less than what Theraco had already paid, Theraco would receive a refund from the insurer. Notably, each of the policies created two categories of individuals for whom Theraco would be charged premiums: (1) “[a]ll your officers and employees engaged in work covered by this policy” (the “Employee Provision”); and (2) “[a]ll other persons engaged in work that could make us liable under Part One (Workers’ Compensation Insurance) of this policy” (the “Risk of Loss Provision”).

In April 2008, CNA conducted a physical audit of Theraco’s activity during the 2007 CNA Policy period. Following the audit, CNA concluded that during the 2007 CNA Policy period, CNA had been at risk for defending workers’ compensation claims filed by the PTs. CNA concluded that the payroll for the PTs should be included in its determination of Theraco’s premium for the 2007 CNA Policy period. After including the PTs in its calculation, CNA notified Theraco that it owed an outstanding premium balance of $138,267 under the 2007 CNA Policy.

On May 9, 2008, Theraco informed CNA by letter that it dispúted the results of its audit and did not intend to pay the outstanding premium balance. Theraco’s letter stated that the PTs were independent contractors and that they each assumed responsibility for obtaining their own workers’ compensation insurance. The letter pointed out that Theraco had maintained the policy for four years and its PTs had never been included in determining its premium obligation before.

On June 3, 2008, CNA responded by letter to Theraco. Though CNA maintained its position that Theraco had an employer-employee relationship with the PTs, it acknowledged that the PTs had been erroneously excluded from its calculations of Theraco’s premiums in the past. In light of the mistake in previous years, CNA informed Theraco it would not retroactively include their payroll in calculating Theraco’s premium under the 2007 CNA *845 Policy. Thus, Theraco was no longer liable for the $138,267 CNA originally billed it under the 2007 CNA Policy. However, the letter went on to state that the PTs’ payroll would be included to calculate Theraco’s premium under the 2008 CNA Policy. In response to that representation, Theraco cancelled the 2008 CNA Policy-

After Theraco terminated its relationship with CNA, CNA performed another audit of Theraco to determine Theraco’s premium under the 2008 CNA Policy. Not surprisingly, CNA again concluded that Theraco’s PTs were employees as opposed to independent contractors and included the PTs’ payroll in determining the premium liability. After including the PTs’ payroll in its calculation, CNA determined that Theraco owed an outstanding premium balance of $44,089 under the 2008 CNA Policy.

After ending its relationship with CNA, Theraco contracted with Travelers to cover its workers’ compensation liability from July 2008 through July 2009. The structure and language of the Travelers Policy was identical to Theraco’s previous policies with CNA. Premiums were to be calculated retrospectively and Theraco was to be charged premiums for all individuals covered under either the Employee Provision or the Risk of Loss Provision.

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437 S.W.3d 841, 2014 WL 172382, 2014 Tenn. App. LEXIS 16, Counsel Stack Legal Research, https://law.counselstack.com/opinion/continental-casualty-company-v-theraco-inc-tennctapp-2014.