Martinez v. ACG Roofing, Inc.

2023 TN WC App. 28
CourtTennessee Workers' Compensation Appeals Board
DecidedJuly 12, 2023
Docket2021-08-0059
StatusPublished

This text of 2023 TN WC App. 28 (Martinez v. ACG Roofing, Inc.) is published on Counsel Stack Legal Research, covering Tennessee Workers' Compensation Appeals Board primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Martinez v. ACG Roofing, Inc., 2023 TN WC App. 28 (Tenn. Super. Ct. 2023).

Opinion

FILED Jul 12, 2023 04:03 PM(CT) TENNESSEE WORKERS' COMPENSATION APPEALS BOARD

TENNESSEE BUREAU OF WORKERS’ COMPENSATION WORKERS’ COMPENSATION APPEALS BOARD

Francisco Martinez ) Docket No. 2021-08-0059 ) v. ) State File Nos. 47716-2020 ) 800503-2021 ACG Roofing, Inc., et al. ) ) ) Appeal from the Court of Workers’ ) Heard June 15, 2023 Compensation Claims ) in Murfreesboro, Tennessee Robert V. Durham, Judge )

Affirmed and Remanded

This appeal arises from the trial court’s denial of an insurer’s motion for summary judgment. The case, which arose in a construction industry setting, involves multiple contractors and multiple insurers. The primary issues addressed during the summary judgment hearing were whether the immediate employer’s workers’ compensation insurance policy had lapsed for non-payment of premium the day before the work accident and, consequently, whether that insurer was entitled to dismissal from the case. Having determined there were disputed issues of material fact regarding whether the policy had lapsed, the trial court denied the insurer’s motion, and the insurer appealed. Upon careful consideration of the record, arguments of counsel, and relevant precedent, we conclude the trial court cannot exercise subject matter jurisdiction over a coverage dispute between an employer and its insurer under the circumstances presented here, but we nevertheless affirm the trial court’s order denying the motion for summary judgment and remand the case.

Presiding Judge Timothy W. Conner delivered the opinion of the Appeals Board in which Judge Pele I. Godkin and Judge Meredith B. Weaver joined.

Gregory H. Fuller and Ashley B. McGee, Knoxville, Tennessee, for the insurer-appellant, Technology Assigned Risk

Monica R. Rejaei, Memphis, Tennessee, for the employee-appellee, Francisco Martinez

Jeffrey G. Foster, Jackson, Tennessee, for the appellees, Brian Elder Roofing and Builders Mutual Ins. Co.

1 Wm. Ritchie Pigue, Nashville, Tennessee, for the appellees, Stephanie Nava d/b/a Nava Roofing and Travelers Ins. Co.

ACG Roofing, Inc., employer-appellee, not participating

Factual and Procedural Background

On January 17, 2020, Francisco Martinez (“Employee”) was working for ACG Roofing, Inc. (“ACG Roofing”), when he fell from a ladder and injured his right leg. For purposes of the current appeal, the occurrence of that injury is not refuted. Prior to the accident, ACG Roofing, owned and operated by Moises Garcia, had contacted an insurance agency, Premier Seguranza, LLC (“Premier”), to purchase a policy of workers’ compensation insurance. Premier completed an insurance application on behalf of ACG Roofing and forwarded it to Technology Assigned Risk (“Technology”). Technology then issued a policy to ACG Roofing with a stated policy period of October 18, 2019, through October 18, 2020. The payment schedule required ACG Roofing to make certain installment payments of the premium. Some evidence indicates that Mr. Garcia delivered cash to Premier for ACG Roofing’s premium payments, which then issued checks to Technology. In December 2019, Technology did not receive a timely installment payment and, as a result, it issued a cancellation notice on or about December 19, 2019. However, Technology then received a premium payment from Premier prior to the date of its intended cancellation, so there was no cancellation or lapse in coverage at that time.

Unfortunately, the check for the premium payment received by Technology in late December was returned for insufficient funds. Thereafter, Technology issued a second cancellation notice on December 31, 2019, with an effective cancellation date of January 16, 2020, and informed ACG Roofing and Premier that it required “certified funds” for subsequent premium payments. Although Technology received another premium payment check by certified mail on or about January 22, 2020, which was dated January 15, Technology rejected and returned the check because it was not “certified funds.” Consequently, Technology maintained that the policy lapsed as of January 16, 2020, the day before Employee’s accident, and it therefore declined to cover the accident.

Thereafter, certified funds were received by Technology on or about February 19, 2020, with a postmark date of February 13, 2020. Consequently, Technology reinstated ACG Roofing’s policy as of February 14, 2020. When the policy period expired later in 2020, a “final audit” was completed by Technology and, despite the purported lapse in coverage, the calculated premium remained the same as the estimated premium calculated at the beginning of the policy period. As such, even though ACG Roofing purportedly went without coverage for a period of time, it ultimately paid Technology the same amount as it would have had there not been a lapse. Both Employee and the co- defendants maintained that this fact supports a finding that Technology had accepted a premium for the period during which it claimed the policy had lapsed. Conversely,

2 Technology maintained that the premium calculated as a result of the final audit had increased from the original estimate but that it had credited ACG Roofing for the amount of premium representing the period of the lapse. Thus, according to Technology, the increase in premium resulting from the final audit was essentially balanced by the premium credit attributable to the lapsed period.

Moreover, the general contractor, Brian Elder Roofing, submitted evidence suggesting that another contractor, Stephanie Nava d/b/a Nava Roofing, had allowed Moises Garcia and ACG Roofing, Inc. to operate under her company name and under her policy of workers’ compensation insurance for jobs Mr. Garcia completed for Brian Elder Roofing in 2019 and 2020. It further asserted that it issued checks to Nava Roofing for work completed by Mr. Garcia from October 2019 until May 2020. Thus, Brian Elder Roofing took the position that either ACG Roofing and its insurer or Nava Roofing and its insurer are responsible for the claim. For its part, Nava Roofing asserted that it only allowed ACG Roofing to operate under its policy of workers’ compensation insurance for purposes of one job and that it was not liable for Employee’s accident on January 17, 2020.

Technology, Brian Elder Roofing, and Nava Roofing all filed separate motions for summary judgment in mid-to-late 2022. On November 16, 2022, the trial court entered an order denying all dispositive motions, and that order was not appealed. Thereafter, Technology filed a second motion for summary judgment and submitted additional evidence for the court’s consideration. Following a hearing, the court again denied Technology’s motion. The trial court determined that, despite the additional evidence submitted by Technology, there remained disputed issues of material fact, including whether Technology’s insistence on receiving “certified funds” justified its rejection of the premium check dated January 15, 2020 (the day before the accident) despite there being no such term in the insurance contract. The court also noted a dispute regarding whether Premier had acted as agents for both ACG Roofing and Technology with respect to the receipt and acceptance of premium payments. Finally, the court noted that Technology had failed to submit evidence documenting it had notified the Bureau of Workers’ Compensation (“Bureau”) of its cancellation of the policy. Citing the Tennessee Supreme Court’s opinion in Karstens v. Wheeler Millwork Cabinet & Supply Co., 614 S.W.2d 37, 41 (Tenn. 1981), the court determined that “a question of material fact remains as to whether Technology gave adequate notice to the Bureau, assuming a valid policy cancellation.” Technology has appealed. 1

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Related

William H. Mansell v. Bridgestone Firestone North American Tire, LLC
417 S.W.3d 393 (Tennessee Supreme Court, 2013)
Robinson v. Tennessee Farmers Mutual Insurance Co.
857 S.W.2d 559 (Court of Appeals of Tennessee, 1993)
Madden v. Holland Group of Tennessee, Inc.
277 S.W.3d 896 (Tennessee Supreme Court, 2009)
Karstens v. Wheeler Millwork, Cabinet & Supply Co.
614 S.W.2d 37 (Tennessee Supreme Court, 1981)

Cite This Page — Counsel Stack

Bluebook (online)
2023 TN WC App. 28, Counsel Stack Legal Research, https://law.counselstack.com/opinion/martinez-v-acg-roofing-inc-tennworkcompapp-2023.