Iowa Contractors Workers' Compensation Group v. Iowa Insurance Guaranty Ass'n

437 N.W.2d 909, 1989 Iowa Sup. LEXIS 60, 1989 WL 24789
CourtSupreme Court of Iowa
DecidedMarch 22, 1989
Docket88-96
StatusPublished
Cited by34 cases

This text of 437 N.W.2d 909 (Iowa Contractors Workers' Compensation Group v. Iowa Insurance Guaranty Ass'n) is published on Counsel Stack Legal Research, covering Supreme Court of Iowa primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Iowa Contractors Workers' Compensation Group v. Iowa Insurance Guaranty Ass'n, 437 N.W.2d 909, 1989 Iowa Sup. LEXIS 60, 1989 WL 24789 (iowa 1989).

Opinion

LAVORATO, Justice.

In this declaratory judgment action, the Iowa Contractors Workers’ Compensation Group (Group) asked the district court to rule that the Iowa Insurance Guaranty Association (Association) was liable for unpaid *911 claims owed to the Group by an insolvent insurance company. The district court decided that the Association was indeed liable. We agree and affirm.

I. Background Facts and Proceedings.

In Iowa a number of statutory provisions establish a comprehensive scheme to provide statutory benefits to injured Iowa workers. See Iowa Code chs. 85, 85A, 85B, 87 (1987). Iowa Code section 87.1 guarantees that employers will have sufficient funds to pay these benefits. It does so by requiring employers to obtain workers’ compensation liability insurance. See id. § 87.1. This requirement has been a part of workers’ compensation law since its inception.

Recognizing that some employers by themselves could fund compensation benefits, the legislature has permitted them to qualify as self-insurers. As self-insurers, these employers are exempt from the statutory requirement to purchase workers’ compensation insurance. See id. §§ 87.4, 87.5, 87.11.

In addition, individual employers who do not have sufficient assets to qualify as self-insurers are permitted to combine their assets and form self-insurance associations to provide benefits for their employees. See id. § 87.4. An employer satisfies the statutory requirements for workers’ compensation insurance by evidence of the employer’s membership in, and payment of premiums to, the self-insurer association. Id.

In 1979, acting pursuant to section 87.4, the Master Builders of Iowa and the Associated General Contractors formed the Group to provide workers’ compensation benefits for employees of member contractors. The Iowa insurance commissioner approved the formation of the Group as required by section 87.4.

The Group engaged a service company to process claims and to run its day-to-day operations. Thus, the premiums paid by the employer members were intended to cover not only workers’ compensation claims but also the service company’s fees and other administrative costs.

Eligible contractors could apply for membership in the Group. Upon acceptance, a member of the Group entered into a liability agreement with the Group. This agreement provided that the Group would “pay promptly when due the benefits” required of the member by the workers’ compensation laws. The agreement also provided that the Group was “directly and primarily liable to any person entitled to the benefits payable” under the agreement.

Pursuant to the liability agreement, members were assessed premiums for their workers’ compensation coverage. The assessments were based on the particular employer’s previous workers’ compensation losses. The members’ assessments were placed in a fund for the payment of workers’ compensation to injured employees of the members.

In addition, the Group and its members entered into a separate indemnity agreement under which they agreed to be jointly and severally liable for any payments the assessment fund could not cover. Consequently, each member retained the financial risk of loss, not only for claims by its own employees, but also for claims by the employees of other members of the Group.

After its inception, the Group began purchasing an annual excess workers’ compensation policy to protect against a catastrophic loss or a large accumulation of losses in a single year. Such a policy would protect the Group if specific or total losses in a policy year exceeded a “deductible” amount. This amount would usually be defined as a certain percentage of the members’ paid assessments. The excess policy thus reduced the members’ risk of joint and several liability.

In 1985 the Group purchased this type of insurance from the Mission Insurance Company (Mission), a California-based insurer that had been licensed in Iowa since 1964 under Iowa Code chapter 515. During negotiations with the Group regarding coverage, Mission indicated concerns about the risk of insuring some of the Group’s members. Mission wanted its coverage to begin when the workers’ compensation claims ex *912 ceeded 100% of the annual gross assessments paid by the Group’s members.

The Group balked at the 100% attachment point because it would have left the Group without funds to cover operating and administrative expenses. A compromise was reached when Mission agreed to issue the policy if another company could be found to reinsure Mission for the difference between 80% and 100% of the Group’s annual gross assessments. Under such a reinsurance agreement, the second insurer would reimburse Mission for all amounts Mission paid to the Group as a result of claims exceeding 80% of the Group’s annual gross assessments; the reinsurer’s liability would end when claims rose to 100% of those assessments.

Neither Mission nor the Group was able to find a second insurer to cover the twenty percent “gap” between the differing attachment points desired by Mission and the Group. At the time, the trade associations that had formed the Group were joint owners of an insurance company known as White Oak. As a last resort, it was agreed that White Oak would provide reinsurance to Mission. Under the agreement between the two insurance companies, Mission would cover all claims exceeding eighty percent of the Group’s annual gross assessments. Mission would then have the right to recover from White Oak the amount of payments made until the claims exceeded 100% of such assessments.

For the year beginning January 1, 1985, Mission issued the Group a policy of “specific excess” and “aggregate excess” workers’ compensation insurance. The specific excess provision covered liability resulting from each occurrence in the policy period. The aggregate excess provision covered liability from all occurrences during the policy period.

Under the policy’s specific excess coverage, the Group retained liability for losses in the amount of $300,000 for each occurrence. Mission was liable under this provision for losses up to $9,000,000 for statutorily imposed liability to employees and $1,000,000 for negligent acts.

Under the aggregate excess coverage, the Group retained liability for losses in an amount equal to eighty percent of the annual gross assessment collected for 1985 from the Group’s members, with a minimum retention amount of $1,200,000. In other words, the Group was liable either for losses up to an amount equal to eighty percent of the members' annual gross assessments for 1985 or for losses up to $1,200,000, whichever amount was greater. Mission’s aggregate excess limit of liability was $2,000,000 beyond the amount of liability retained by the Group.

The Group paid a premium of $112,000 for this policy. Mission paid Iowa premium taxes on the $112,000 premium pursuant to Iowa Code sections 432.1 and 515.24.

In 1985 workers’ compensation claims against the Group far exceeded the deductible amount under the Mission policy, thus obligating Mission under both the “specific excess” and “aggregate excess” portions of the policy.

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Bluebook (online)
437 N.W.2d 909, 1989 Iowa Sup. LEXIS 60, 1989 WL 24789, Counsel Stack Legal Research, https://law.counselstack.com/opinion/iowa-contractors-workers-compensation-group-v-iowa-insurance-guaranty-iowa-1989.