D Maintenance Company v. Mischke

733 P.2d 903, 84 Or. App. 218
CourtCourt of Appeals of Oregon
DecidedMarch 11, 1987
DocketWCB Nos. 84-01332 and 84-02928 CA A37383
StatusPublished
Cited by3 cases

This text of 733 P.2d 903 (D Maintenance Company v. Mischke) is published on Counsel Stack Legal Research, covering Court of Appeals of Oregon primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
D Maintenance Company v. Mischke, 733 P.2d 903, 84 Or. App. 218 (Or. Ct. App. 1987).

Opinion

*220 JOSEPH, C. J.

This workers’ compensation case involves the responsibility of two insurance companies that provided workers’ compensation coverage for employer. Claimant experienced an industrial injury on March 31, 1983. She filed a claim on April 14, stating that she was suffering right arm strain with numbness in her hand and last two fingers. Employer, then insured by Industrial Indemnity (Industrial), accepted the claim on May 2, 1983. In June of that year, employer moved its workers’ compensation coverage to American Fire & Casualty (American), which agreed to provide coverage as of March 28, 1983, which was before claimant’s injury.

The Workers’ Compensation Department wrote to Industrial on August 2, 1983, advising it that its period of responsibility had ended on March 27, 1983. Industrial, however, continued paying benefits to claimant until January, 1984, when its claims representatives noticed that its coverage had supposedly ended four days before the injury. On January 12, Industrial sent claimant a denial notice and forwarded her file to American, along with a demand for reimbursement of claim expenses. Industrial stopped paying benefits as of that date.

On February 6,1984, claimant requested the designation of a paying agent pursuant to ORS 656.307(1) (b). Industrial responded that it did not provide coverage and that, therefore, a paying agent was not warranted. American denied responsibility, asserting that Industrial could not issue a denial of responsibility for an accepted claim. Then Industrial reversed its position and agreed to a paying agent designation. American responded that it would not concede compensability until it had completed its investigation. A paying agent order never issued.

The referee determined that, under the rule in Bauman v. SAIF, 295 Or 788, 670 P2d 1027 (1983), Industrial could not deny its responsibility for the accepted claim. The referee awarded claimant attorney fees for prevailing against Industrial on the denied claim and a 25 percent penalty on all temporary disability compensation due from January 4, 1984, to the date of the order and additional attorney fees for securing penalties. The referee awarded a 25 percent penalty *221 against American for its unreasonable delay and refusal to provide “interim compensation” from January 12 through February 17,1984, and attorney fees for securing that penalty and for American’s “unreasonable denial of compensability” in refusing to agree to a paying agent order.

The Board reversed on the issue of responsibility on the authority of Retchless v. Laurelhurst Thriftway, 72 Or App 729, 696 P2d 1181, rev den 299 Or 251 (1985), and concluded that, because American was liable in fact, given the effective date in its contract, Industrial was relieved of responsibility for claimant’s compensation. The Board affirmed penalties and attorney fees against both insurers but increased the total attorney fee award against American to $1450 from the referee’s total award of $800.

Only American seeks review of the Board’s order. 1 In its first assignment of error, it argues that it cannot be responsible for claimant’s compensation, because (1) Industrial could not issue a back-up denial, (2) Industrial had waived its right to “avoid responsibility” or (3) American’s contract only extended retroactive coverage to claims not yet accepted when the contract was signed.

The general rule of Bauman v. SAIF, supra, is that an insurer, after accepting a claim, cannot deny it. That bar applies equally to denials of responsibility and to denials of compensability. Jeld-Wen, Inc. v. McGehee, 72 Or App 12, 15, 695 P2d 92, rev den 299 Or 203 (1985). In Retchless v. Laurelhurst Thriftway, supra, 72 Or App at 731, we interpreted those cases to mean that the first employer or insurer must continue to pay compensation unless and until someone else is determined to be responsible. 2

Claimant gave notice of her injury to employer as required by ORS 656.265. Employer then had the burden to notify the insurance carrier of the claim. ORS 656.262(3). *222 Industrial was the carrier at the time and was properly notified. It duly accepted the claim and commenced payment of compensation. At that point, compensability and responsibility were resolved to the extent of the acceptance, and the Bauman and Retchless principles attached to protect claimant from vacillation by her employer or its insurance carrier.

The question is whether responsibility shifted when employer contracted with American to provide retroactive coverage. American argues that it did not intend to pick up existing claims that had already been filed in the retroactive period; rather it intended simply to process new claims based on occurrences in that period but not filed before the execution of its contract. American’s unexpressed intent, however, does not govern the extent of its coverage. The contract does, and it provides that American would bear all of employer’s compensation liability arising during the contract period. Furthermore, ORS 656.419(1) provides:

“A guaranty contract issued by an insurer shall provide that the insurer agrees to assume, without monetary limit, the liability of the employer, arising during the period the guaranty contract is in effect * * (Emphasis supplied.)

Both by the terms of its contract and under the statute, American has responsibility for all workers’ compensation liability that arose after the effective date of its insurance, whenever asserted.

American also argues that Industrial waived any right it had to avoid responsibility, because it did not file its notice of termination with the Department until July, 1983, and in that notice it stated that it had cancelled coverage as of April 15, 1983. Industrial’s responsibility ended, because American and employer entered into an agreement which terminated Industrial’s liability. ORS 656.423(3) provides that an employer may cancel coverage by providing other coverage and that cancellation is “effective immediately upon the effective date of the other coverage.” Industrial could not “waive” employer’s cancellation of its coverage. 3 Under American’s contract, it accepted responsibility for all liability which arose after March 27,1983.

*223

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Related

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Cite This Page — Counsel Stack

Bluebook (online)
733 P.2d 903, 84 Or. App. 218, Counsel Stack Legal Research, https://law.counselstack.com/opinion/d-maintenance-company-v-mischke-orctapp-1987.