Employers Health Insurance v. Tesmer

469 N.W.2d 203, 161 Wis. 2d 733, 1991 Wisc. App. LEXIS 291
CourtCourt of Appeals of Wisconsin
DecidedMarch 14, 1991
Docket90-1682
StatusPublished
Cited by17 cases

This text of 469 N.W.2d 203 (Employers Health Insurance v. Tesmer) is published on Counsel Stack Legal Research, covering Court of Appeals of Wisconsin primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Employers Health Insurance v. Tesmer, 469 N.W.2d 203, 161 Wis. 2d 733, 1991 Wisc. App. LEXIS 291 (Wis. Ct. App. 1991).

Opinion

EICH, C.J.

Employers Health Insurance Company appeals from a judgment and an order dismissing its complaint against James Tesmer and Rural Mutual Insurance Company. Employers seeks a declaratory judgment that sec. 102.30(7) (b), Stats., which precludes nonindustrial insurers from participating in worker's compensation proceedings, is unconstitutional. The issue is whether the statute denies nonindustrial insurers a "certain remedy in the law for all injuries or wrongs" as guaranteed by art. I, sec. 9, of the Wisconsin Constitution. We conclude that the statute is constitutional and affirm the judgment.

James Tesmer was seriously injured in a plane crash. He sought worker's compensation benefits, claiming that the accident occurred during the course of his employment with Tesmer Plumbing. Rural Mutual Insurance Company, Tesmer's employer's worker's compensation carrier, denied coverage, arguing that Tesmer had deviated from the course of his employment at the time of his accident. Tesmer then commenced worker's compensation proceedings, attempting to recover under the Rural policy.

Tesmer required extensive medical treatment for his injuries and Employers, his group health carrier, paid more than $165,000 in medical expenses. Employers maintains that it should be reimbursed for these payments because its policy contains an exclusion for medical expenses covered by worker's compensation insurance. Employers petitioned for leave to intervene in Tesmer's worker's compensation proceeding and the Department of Industry, Labor & Human Relations denied the request under sec. 102.30(7)(b), Stats. The statute provides:

*737 (a) The department may order direct reimbursement out of the . . . payments made under a nonindustrial insurance policy covering the same disability and expenses compensable under s. 102.42 when the claimant consents or when it is established that the payments under the nonindustrial insurance policy were improper ....
(b) An insurer who issues a nonindustrial insurance policy described in par. (a) may not intervene as a party in any proceeding under this chapter for reimbursement under par. (a). 1

Employers then sought a declaratory judgment in circuit court that sec. 102.30(7) (b), Stats., violates art. I, sec. 9 of the constitution, which provides:

Every person is entitled to a certain remedy in the laws for all injuries, or wrongs which he may receive in his person, property, or character; he ought to obtain justice freely, and without being obliged to purchase it, completely and without denial, promptly and without delay, conformably to the laws.

As indicated, the trial court dismissed Employers' complaint and this appeal followed.

The constitutionality of a statute is a question of law which we review de novo. State v. McManus, 152 Wis. 2d 113, 129, 447 N.W.2d 654, 660 (1989). Statutes carry a heavy presumption of constitutionality and the challenger has the burden of proving unconstitutionality beyond a reasonable doubt. Chappy v. LIRC, 136 Wis. 2d 172, 184-85, 401 N.W.2d 568, 573-74 (1987). "If there is any reasonable basis upon which the legislation may constitutionally rest, the court must assume that the legislature had [that] fact in mind [when it passed the *738 act]. The court cannot try the Legislature and reverse its decision as to the facts." State v. Interstate Blood Bank Inc., 65 Wis. 2d 482, 489, 222 N.W.2d 912, 915 (1974) (citation omitted). "Every presumption must be indulged to sustain the law if at all possible and, wherever doubt exists ... it must be resolved in favor of constitutionality." State ex rel. Hammermill Paper Co. v. La Plant, 58 Wis. 2d 32, 46, 205 N.W.2d 784, 792 (1973).

The basic purpose of the worker's compensation act is to provide prompt justice for injured workers and to prevent, as far as possible, the delays that might arise from protracted litigation. See Cruz v. ILHR Dep't, 81 Wis. 2d 442, 449-50, 260 N.W.2d 692, 694 (1978). The proceedings should be as simple and as speedy as possible. Bellrichard v. Indus. Comm'n, 248 Wis. 231, 239, 21 N.W.2d 395, 398 (1946).

Employers contends that sec. 102.30(7)(b), Stats., violates the "certain remedy" clause because its inability to intervene in its insured's compensation proceedings may preclude it from recovering the medical expenses previously paid on the insured's behalf. Employers has other remedies, however. Under the terms of the policy, Tesmer "agree[d] to reimburse the insurer” for benefits paid under the policy for which he might be reimbursed through worker's compensation. If Employers believes it has improperly paid Tesmer's expenses, it may proceed against Tesmer directly for reimbursement. Second, sec. 102.30(7)(a), Stats., permits DILHR to order reimbursement for payments improperly made under a nonindustrial insurance policy covering the same disability and expenses. Thus, if Tesmer should succeed in his worker's *739 compensation claim, Employers may petition DILHR for reimbursement under sec. 102.30(7)(a).

Employers argues, however, that should Tesmer and Rural settle the worker's compensation case by a cash payment from Rural in exchange for Tesmer's agreement that Rural was not liable for his injuries, it (Employers) could be prevented from any recovery. Relying on La Crosse Lutheran Hospital v. Oldenburg, 73 Wis. 2d 71, 241 N.W.2d 875 (1976), Employers contends that the intervention bar of sec. 102.30(7)(a), Stats., may be used by the injured employee in striking a deal with the compensation carrier that would exclude the nonindustrial health insurer from any recoupment of medical benefits paid to the employee.

Employers characterizes La Crosse Lutheran as holding that "a compromise negotiated between the employee and the compensation carrier and approved by the department constitutes a finding, binding upon the health insurance carrier, 'that the employer had no liability.' " Employers argues that such a finding in this case would preclude recovery of the benefits it had paid and thus deprive it of the "remedy in law" guaranteed by the constitution. As we did in a case following La Crosse Lutheran, we disagree.

In Udelhofen v. John Hancock Mut. Life Ins. Co., 128 Wis. 2d 216, 219-20, 381 N.W.2d 579, 581 (Ct. App. 1985), we held that La Crosse Lutheran

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Bluebook (online)
469 N.W.2d 203, 161 Wis. 2d 733, 1991 Wisc. App. LEXIS 291, Counsel Stack Legal Research, https://law.counselstack.com/opinion/employers-health-insurance-v-tesmer-wisctapp-1991.