Last v. American Family Mutual Insurance

2000 WI App 169, 617 N.W.2d 215, 238 Wis. 2d 140, 2000 Wisc. App. LEXIS 620
CourtCourt of Appeals of Wisconsin
DecidedJuly 5, 2000
Docket98-3424
StatusPublished
Cited by3 cases

This text of 2000 WI App 169 (Last v. American Family Mutual Insurance) 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
Last v. American Family Mutual Insurance, 2000 WI App 169, 617 N.W.2d 215, 238 Wis. 2d 140, 2000 Wisc. App. LEXIS 620 (Wis. Ct. App. 2000).

Opinion

CURLEY, J.

¶ 1. Eleanor Last appeals the trial court's grant of summary judgment to American Family Mutual Insurance Company (American Family). Last argues that the trial court erred in ruling that, because of an exclusion in Last's homeowner's insurance policy, American Family had no obligation to defend her or indemnify her when Joann Zalar, hired to care for Last's disabled husband, filed a worker's compensation claim. Last contends that, since Zalar could arguably have been considered a domestic servant, an exempt employee under the worker's compensation law, American Family should have provided her with a defense. In applying the well-established test that an insurance company's duty to defend is triggered by the allegations contained within the four corners of the complaint, as set forth in Newhouse v. Citizens Security Mutual Insurance Co., 176 Wis. 2d 824, 835, 501 N.W.2d 1 (1993); see also Grieb v. Citizens Casualty Co., 33 Wis. 2d 552, 557-58, 148 N.W.2d 103 (1967), we conclude that all of Zalar's allegations fell within *142 American Family's worker's compensation policy exemption and, consequently, American Family owed no duty to Last. Therefore, we affirm.

I. Background.

¶ 2. Last hired Zalar to assist in the care of her disabled husband who lived at home. Zalar worked for Last from July 1994 through approximately May 1996. In her application for worker's compensation benefits, Zalar alleged that while working on December 22, 1995, she was injured while moving Last's husband without the use of a mechanical lift because it had malfunctioned. Zalar contends that, as a result, she experienced low back pain and left leg problems that eventually resulted in her undergoing a lumbar laminectomy. Last did not have any worker's compensation insurance and she tendered the defense of Zalar's claim to American Family under her homeowner's insurance policy. After receiving Last's letter, American Family wrote Last a "Reservation of Rights" letter explaining that the company was forwarding her request to its legal department. American Family ultimately informed Last that an exclusion in her policy for worker's compensation obligations covered Zalar's allegations and, therefore, American Family would neither defend her nor indemnify her in this matter.

¶ 3. Last then hired an attorney to represent her in the worker's compensation suit. In the initial stages of the Zalar litigation, Last argued that Zalar was not an "employee" under the Worker's Compensation Act because Zalar was a domestic servant and domestic servants are ineligible for benefits as they are excluded from the definition of "employee" found in WlS. Stat. *143 § 102.07(4) (1995-96). 1 She also disputed whether Zalar's disability was the result of the December 22, 1995, incident. Eventually, however, Last and Zalar entered into a compromise agreement with Last paying Zalar $15,000. Last also paid her own attorney approximately $6,500 in legal fees.

¶ 4. Last then sued American Family claiming, inter alia, that American Family failed to properly determine Last's rights under the policy and breached its duty to defend her. Last sought reimbursement from American Family for: (1) the $15,000 settlement amount; (2) the attorney fees she incurred in settling the worker's compensation suit; and (3) her attorney fees in this suit. Both parties filed summary judgment motions. The trial court granted . American Family's motion, determining that American Family had not breached any duty to defend Last because, had Zalar proved her allegations, the policy exclusion would have applied.

*144 II. Analysis.

¶ 5. Last argues that the trial court erred in ruling in favor of American Family. Last acknowledges that the policy had an exclusion for worker's compensation law suits, but she submits that American Family was obligated to do more than simply look at Zalar's complaint when making its decision on coverage. Last posits that because the worker's compensation law exempts domestic servants from the definition of employee, and because she believed that Zalar performed the duties of a domestic servant, it was "debatable" whether Zalar's work-related medical problems were covered by the Workers' Compensation Act and, if her assertions were correct, the policy exclusion would not apply. Coupling her contention with what she believed to be American Family's broad duty to defend, Last submits that American Family breached its duty to defend her.

¶ 6. Last contends that the circumstances present here are comparable to those in Monfils v. Charles, 216 Wis. 2d 323, 575 N.W.2d 728 (Ct. App. 1998), where the underlying third-party complaint created an ambiguity as to whether an exclusion applied and, as a consequence, the insurance company was required to defend the insured. For additional support, Last cites School District of Shorewood v. Wausau Insurance Cos., 170 Wis. 2d 347, 488 N.W.2d 82 (1992) (any doubt about the duty to defend is to be resolved in favor of the insured), and United States Fire Insurance Co. v. Good Humor Corp., 173 Wis. 2d 804, 496 N.W.2d 730 (Ct. App. 1993) (if the question of coverage is fairly debatable, the insurer has an obligation to defend). Last reasons that since case law directs that when the third-party complaint is either ambiguous or incomplete, the insurance company is obligated to provide a defense. *145 Last contends, therefore, that American Family had a duty to defend her because of Zalar's questionable work status.

¶ 7. Finally, Last argues that because American Family wrongfully refused to defend her, under Good Humor, she is "entitled to recover all damages naturally flowing from the breach." Id. at 830. Thus, Last asks this court to overturn the trial court's decision and order the entry of summary judgment in her favor and the reimbursement of her attorney fees and settlement costs in the Zalar litigation and the reimbursement of her attorney fees in this suit. American Family argues that the trial court properly applied the appropriate legal test found in Newhouse and Grieb to Zalar's allegations when it determined that summary judgment was warranted. We agree with American Family.

¶ 8. In an appeal from the entry of summary judgment, this court reviews the record de novo, applying the same standard and following the same methodology required of the trial court under WlS. Stat. § 802.08. See Delta Group, Inc. v. DBI, Inc., 204 Wis. 2d 515, 520, 555 N.W.2d 162 (Ct. App. 1996).

¶ 9. "Determining if an insurance company has a duty to defend is a question of law that we review

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

Related

David M. Marks v. Houston Casualty Company
2016 WI 53 (Wisconsin Supreme Court, 2016)
Menasha Corp. v. Lumbermens Mutual Casualty Co.
361 F. Supp. 2d 887 (E.D. Wisconsin, 2005)

Cite This Page — Counsel Stack

Bluebook (online)
2000 WI App 169, 617 N.W.2d 215, 238 Wis. 2d 140, 2000 Wisc. App. LEXIS 620, Counsel Stack Legal Research, https://law.counselstack.com/opinion/last-v-american-family-mutual-insurance-wisctapp-2000.