Custard Insurance Adjusters, Inc. v. Aldridge

57 S.W.3d 284, 2001 Ky. LEXIS 152, 2001 WL 1143058
CourtKentucky Supreme Court
DecidedSeptember 27, 2001
Docket2000-SC-1121-WC
StatusPublished
Cited by9 cases

This text of 57 S.W.3d 284 (Custard Insurance Adjusters, Inc. v. Aldridge) is published on Counsel Stack Legal Research, covering Kentucky Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Custard Insurance Adjusters, Inc. v. Aldridge, 57 S.W.3d 284, 2001 Ky. LEXIS 152, 2001 WL 1143058 (Ky. 2001).

Opinion

OPINION OF THE COURT

The claimant, a resident of Indiana, sustained a work-related injury on June 20, 1995, while working in Kentucky. His employer was an Indiana corporation that did business in Kentucky and maintained separate workers’ compensation coverage for accidents that occurred in Kentucky. 1 In June, 1997, the claimant filed a claim in Kentucky, naming his employer and the administrator for the Indiana carrier as defendants. Shortly thereafter, the Kentucky carrier became involved and it, too, *286 began paying TTD benefits and was joined as a defendant. The administrator for the Indiana carrier then moved to be reimbursed for benefits that it had paid erroneously. It alleged that it had thought that Indiana workers’ compensation law would apply, that it was unaware of the employer’s separate Kentucky coverage, and that it had paid temporary total disability (TTD) and medical benefits of nearly $155,000.00 through September 15, 1997, for which the Kentucky carrier was hable.

The sole question presented by this appeal is whether the Administrative Law Judge (ALJ) and the Workers’ Compensation Board (Board) properly exercised jurisdiction over the question of reimbursement under these circumstances. Following a decision of the Court of Appeals that they did not and that the proper forum for this dispute was in circuit court, the Indiana carrier appeals.

At the prehearing conference, the parties stipulated to an average weekly wage of $515.59. They also stipulated to the payment of TTD benefits at the rate of $379.26 per week from August 18, 1995, through September 15, 1997, and at the rate of $343.71 per week from August 5, 1997, through March 9, 1998. Thus, the Indiana carrier paid benefits at a weekly rate that was $35.55 per week more than the rate that was paid by the Kentucky carrier, and both carriers paid TTD benefits during the period from August 5 through September 15,1997.

From the outset of the administrative proceeding, the Indiana carrier sought reimbursement from the Kentucky carrier for all of the benefits that it had paid erroneously. The Kentucky carrier admitted that it was responsible for the payment of any award to the claimant, and it did not question, in principle, the Indiana carrier’s right to reimbursement. It asserted, however, that because there was no dispute over coverage, the proper forum to decide the question of reimbursement was the circuit court, not an administrative agency. Furthermore, it asserted that it was entitled to credit the benefits that the Indiana carrier had paid against its own liability.

When the matter came before the ALJ, the Kentucky carrier, the administrator for the Indiana carrier, and the employer were parties-defendant. At issue were the extent and duration of disability; the extent of prior, active disability; appropriate temporary total disability; and whether the ALJ had jurisdiction to rule on the Indiana carrier’s claim for reimbursement from the Kentucky carrier. The ALJ determined that the claimant was totally disabled but that 30% of the disability was active before the injury. Exercising jurisdiction over the question of reimbursement, the ALJ ordered the Kentucky carrier to reimburse the Indiana carrier for all of the TTD and medical benefits that it had paid. The award gave the employer and the Special Fund credit “for any compensation heretofore paid.”

The award did not address whether benefits were paid under Indiana law or contain the appropriate weekly rate for the payment of TTD benefits, and no party requested specific findings on those matters when petitioning for reconsideration. Furthermore, the award did not address whether there was a period during which the compensable injury, by itself, caused the claimant to be totally disabled.

Although denying petitions for reconsideration by the carriers, the ALJ granted the claimant’s request for a finding that he was totally disabled by the effects of his injury, by itself, up until he reached maximum medical improvement on March 9, 1998. His request for an award of TTD benefits through that date also was granted, but, again, the weekly rate at which the benefit was payable was not stated.

*287 At the heart of this dispute is the scope of the subject matter jurisdiction of the Department of Workers’ Claims. The jurisdiction of an administrative agency extends only to those matters that are delegated to it by the legislature. KRS 342.325 provides that “all questions arising under this chapter, if not settled by agreement of the parties interested therein... shall be determined by the [ALJ] except as otherwise provided in this chapter.” A number of provisions in Chapter 342 address the relationships between employers, their insurance carriers, and injured workers, and several of them are relevant to a consideration of the matter at issue. In summary, they are as follows:

1.) KRS 342.305—permits any party in interest to enforce a final award in circuit court and gives the circuit court sole jurisdiction over its enforcement. See Fruchtenicht v. U.S.F. & G., Ky., 451 S.W.2d 835 (1969); Stearns Coal & Lumber Co. v. Duncan, 271 Ky. 800, 113 S.W.2d 436 (1938); Pierce v. Russell Sportswear Corp., Ky.App., 586 S.W.2d 301 (1979).
2.) KRS 342.340—requires that every employer must either insure or otherwise secure the payment of its workers’ compensation liability.
3.) KRS 342.360—charges the insurer with the employer’s notice or knowledge of the injury; provides that “jurisdiction of the insured for the purpose of this chapter shall be jurisdiction of the insurer;” and provides that “the insurer shall in all things be bound by and subject to the awards, judgments or decrees entered against the insured.”
4.) KRS 342.365—requires workers’ compensation insurance policies to contain an agreement by the insurer to promptly pay all benefits to those workers who are entitled to receive them and also provides that the agreement is to be construed as a direct promise between the insurer and the injured worker and that it is enforceable by the worker.
5.) KRS 342.375—makes every workers’ compensation insurance policy subject to the provisions of Chapter 342 and allows the Department of Workers’ Claims to authorize an employer to purchase a separate policy for a specified location.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

Kentucky Employers' Mutual Insurance v. Roger Hall
Court of Appeals of Kentucky, 2024
Barnes v. Arkansas Department of Finance & Administration
419 S.W.3d 20 (Court of Appeals of Arkansas, 2012)
Zurich American Insurance Co. v. Journey Operating, LLC
323 S.W.3d 696 (Kentucky Supreme Court, 2010)
Greene v. Paschall Truck Lines
239 S.W.3d 94 (Court of Appeals of Kentucky, 2007)
Southeast Coal Co. v. Mansfield
231 S.W.3d 122 (Kentucky Supreme Court, 2007)

Cite This Page — Counsel Stack

Bluebook (online)
57 S.W.3d 284, 2001 Ky. LEXIS 152, 2001 WL 1143058, Counsel Stack Legal Research, https://law.counselstack.com/opinion/custard-insurance-adjusters-inc-v-aldridge-ky-2001.