Hoff v. Industrial Claim Appeals office

2014 COA 137M, 383 P.3d 50, 2014 Colo. App. LEXIS 1683
CourtColorado Court of Appeals
DecidedOctober 9, 2014
DocketCourt of Appeals No. 13CA1798
StatusPublished
Cited by9 cases

This text of 2014 COA 137M (Hoff v. Industrial Claim Appeals office) is published on Counsel Stack Legal Research, covering Colorado Court of Appeals primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hoff v. Industrial Claim Appeals office, 2014 COA 137M, 383 P.3d 50, 2014 Colo. App. LEXIS 1683 (Colo. Ct. App. 2014).

Opinions

Opinion by

JUDGE DAILEY

¶ 1 In this workers’ compensation insurance coverage dispute, petitioner, Norma Patricia Hoff, seeks review of a final order of the Industrial Claim Appeals Office (Panel) affirming the order of an administrative law judge (ALJ). The ALJ’s order awarded claimant, Hernán Hernandez, medical and disability benefits, and held Hoff (a statutory employer), MDR Roofing, Inc. (MDR) (claimant’s direct employer), and the general contractor, Alliance Construction (Alliance), jointly liable for claimant’s benefits. The Panel held that Hoff lacked standing to challenge the ALJ’s ruling that MDR was not covered by an insurance policy issued by Pinnacol Assurance (Pinnacol) to MDR when claimant sustained serious work-related injuries.

¶ 2 We conclude that Hoff has standing.1 We also conclude as a matter of law that the cancellation provision of the certificate of insurance issued by Pinnacol’s agent required that notice of cancellation be given to Alliance, and that no such notice was given.2 We finally conclude that there are issues of fact that the ALJ must address in applying the law and, thus, a remand is required.3 In addition, the Panel misconstrued the applicable law concerning estoppel; thus, we correct that interpretation. Accordingly, we set aside the Panel’s order as it relates to the liability of Hoff and Pinnacol, and remand for further proceedings.

I. Background

¶ 3 Hoff owns a house that she uses as a rental property. After sustaining hail damage to the roof, Hoff and her husband engaged Alliance to negotiate with their insurance company to resolve their damage claim. Following a successful resolution, she and her husband contracted with Alliance to repair the roof. Without the Hoffs’ knowledge, Alliance verbally subcontracted the roofing job to MDR. Claimant was employed by MDR as a roofer.

¶ 4 While working on the Hoff roof in March 2011, claimant fell approximately twenty-five feet to the ground from the top of a ladder, sustaining serious injuries.

¶ 5 Claimant sought medical and temporary total disability (TTD) benefits for his work-related injuries. However, Pinnacol, MDR’s insurer, denied the claim because MDR’s policy had lapsed for failure to pay the premiums. Neither Alliance nor Hoff carried workers’ compensation insurance.

¶ 6 The following facts are pertinent to the coverage issue. In October 2010, before starting the roofing job on the Hoff property, Alliance obtained a certificate of insurance (certificate) from Pinnacol’s agent, Bradley Insurance Agency (Bradley), which verified that MDR had worker’s compensation insurance through Pinnacol.

¶ 7 On February 10, 2011, Pinnacol sent a certified letter to MDR advising it that the policy was going to be cancelled if payment of a past due premium was not received by March 2, 2011. A relative of MDR’s owner signed for the letter. However, MDR’s owner testified he never received the letter and [53]*53was not informed of its delivery. A copy of the letter was also mailed to and received by Bradley, as evidenced by the entry in Bradley’s computerized log of events. Alliance did not receive notice of the pending cancellation of MDR’s workers’ compensation insurance from Bradley or Pinnacol.

¶ 8 MDR did not pay the outstanding premium. The policy was therefore cancelled effective March 3, 2011. Pinnacol sent letters to MDR and Bradley advising of the policy’s cancellation, but not to Alliance.

¶ 9 Claimant was injured on the job on March 10, 2011. On March 11, 2011, MDR’s owner went to Bradley’s office seeking -to reinstate the policy. The agent advised him that the policy could be reinstated if he paid the past due premium, paid a reinstatement fee, and signed a no-loss letter. A no-loss letter is a statement by the insured that no injuries have occurred since the cancellation of the policy. Although the owner knew claimant had been injured since the policy’s cancellation, he signed and submitted the no-loss letter. ' He did not inform Bradley about the accident.

¶ 10 Pinnacol reinstated the policy on March 11, 2011. Shortly thereafter, MDR’s owner returned to Bradley’s offices to report claimant’s injuries. . Bradley contacted a Pin-nacol underwriter to advise her of the claim, Pinnacol contested the claim on coverage grounds, and subsequently cancelled the policy-

' ¶ 11 After conducting a hearing on the matter, the ALJ determined that the owner’s failure to disclose claimant’s injuries when he signed the no-loss letter to reinstate the policy was a material misrepresentation. He further found that the reinstated policy was void because of MDR’s misrepresentation. Finding claimant was temporarily and totally disabled and concluding that no workers’ compensation insurance policy was in effect insuring any of them, the ALJ held MDR, Alliance, and Hoff jointly liable for claimant’s medical and TTD benefits. The Panel agreed and affirmed.,

¶ 12 Hoff now appeals.4 She contends that Pinnacol is estopped from denying benefits to claimant because

• Bradley, acting as Pinnacol’s agent, issued the certificate to Alliance;
•,the issuance of the certificate obligated Pinnacol or Bradley to notify Alliance that MDR’s policy was being cancelled; and,
• she and Alliance relied on the certificate; and
• neither Bradley nor Pinnacol sent notice of cancellation to Alliance.

¶ 13 Pinnacol contends that we need not reach this issue because Hoff has no standing to challenge the cancellation of MDR’s policy. Addressing, first, the issue of standing, we reject Pinnacol’s argument. Addressing Hoffs contention, we agree in part, and remand the matter to the ALJ for further consideration.

II. Standing

¶ 14 As Pinnacol points out, we lack jurisdiction to decide an issue unless the party seeking review has standing to assert it. See Ainscough v. Owens, 90 P.3d 851, 855 (Colo.2004) (“In order for a court to have jurisdiction over a dispute, 'the plaintiff must have standing to bring the ease. Standing is a threshold issue that must be satisfied in order to decide a case on the merits.”). If Hoff lacks standing to challenge Pinnacol’s cancellation procedures then her “case must be dismissed.” First Comp Ins. v. Indus. Claim Appeals Office, 252 P.3d 1221, 1222 (Colo.App.2011).

¶ 15 To establish standing, a plaintiff must demonstrate (1) that she has sustained an injury in fact, and (2) that the injury is to a legally protected interest. Id. at 1223; see also City of Greenwood Village v. Petitioners for Proposed City of Centennial, 3 P.3d 427, 437 (Colo.2000). “Whether the plaintiffs alleged injury was to a legally protected interest ‘is a question of whether the plaintiff has a claim for relief under the constitution, the common law, a statute, or a rule or regulation.’ ” Barber v. Ritter, 196 P.3d 238, 246 (Colo.2008) (quoting Ains-[54]*54cough, 90 P.3d at 856). The question of “[w]hether a plaintiff has standing to sue is a question of law that we review de novo.” Id. at 245.

¶ 16 The first prong of the standing test is met in this ease. The liability imposed on Hoff by the ALJ and the Panel exceeds $300,000.

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Cite This Page — Counsel Stack

Bluebook (online)
2014 COA 137M, 383 P.3d 50, 2014 Colo. App. LEXIS 1683, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hoff-v-industrial-claim-appeals-office-coloctapp-2014.