Mitchell v. Scott Wetzel Services, Inc.

227 Cal. App. 3d 1474, 278 Cal. Rptr. 474
California Court of Appeal·Decided February 26, 1991·No. G008689·Published·Cited by 8 cases

Opinion

227 Cal.App.3d 1474 (1991)
278 Cal. Rptr. 474

MICHAEL MITCHELL et al., Plaintiffs and Appellants,
v.
SCOTT WETZEL SERVICES, INC., et al., Defendants and Respondents.

Docket No. G008689.

Court of Appeals of California, Fourth District, Division Three.

February 26, 1991.

*1476 COUNSEL

Lawrence E. Hanna for Plaintiffs and Appellants.

Murchison & Cumming and Edmund G. Farrell III for Defendants and Respondents.

OPINION

SILLS, P.J.

This case involves serious allegations of intentional misconduct by the workers' compensation claims administrator of a self-insured employer. Because these allegations relate to the enforcement of workers' compensation benefits, we conclude exclusive jurisdiction lies with the workers' compensation system. We do so, however, reluctantly.

*1477 FACTS

Plaintiff Michael Mitchell appeals a judgment of dismissal following the sustaining of the demurrer of defendant Scott Wetzel Services, Inc. (1) A demurrer admits all material facts properly pleaded, but not contentions, deductions or conclusions of fact or law. (Serrano v. Priest (1971) 5 Cal.3d 584, 591 [96 Cal. Rptr. 601, 487 P.2d 1241, 41 A.L.R.3d 1187].) Stripped of contentions, deductions and conclusions, the first amended complaint alleges the following facts:

Mitchell suffered an injury while working for Alpha Beta. Wetzel administers Alpha Beta's workers' compensation claims. Mitchell made a claim for workers' compensation benefits. Wetzel denied medical treatment, and denied and delayed rehabilitation benefits to Mitchell. It consistently made late temporary disability payments. It threatened to terminate benefits for untrue reasons.

In addition to generalized allegations, the complaint specified a number of particular instances of misconduct on Wetzel's part:

— Twice, during 1984, Wetzel told Mitchell a check was in the mail, when it had not yet been sent.

— On February 7, 1986, Wetzel told Mitchell to come to Wetzel's office to pick up a check. When Mitchell arrived, Wetzel told Mitchell the check had already been mailed. In fact, the check was not mailed until almost a week later.

— On February 13, 1986, Wetzel issued a $591.36 check for temporary disability benefits to Mitchell, only to stop payment on the check by the time Mitchell presented it to the bank for payment.

— On February 20, 1986, a Wetzel adjuster lied before a workers' compensation appeals board judge when she said the adjuster who had been working on the Mitchell file was no longer employed by Wetzel. The adjuster also lied when she said Wetzel did not know why there were so many errors and late payments concerning Mitchell's file. Her purpose was to deprive the Workers' Compensation Appeals Board (WCAB) of information relevant to penalties against Wetzel.

— On April 16, 1986, Wetzel issued Mitchell a check for $4,000, representing a permanent disability payment. Mitchell requested assurance the check was negotiable. Wetzel said it was. However, when the vice-president *1478 of the bank negotiating the check contacted Wetzel, Wetzel told the vice-president not to negotiate the check until three days had passed.

— On August 26, 1986, Wetzel told Mitchell (then in Texas) a rental car would be waiting for him at Long Beach Airport to take him to a medical examination. When Mitchell arrived, however, no car was waiting and he had to make his own transportation arrangements.

The complaint did not allege the incidents involving the check constituted criminal conduct.[1] Rather, the complaint charged these incidents constituted false representations made by Wetzel to Mitchell.[2]

Mitchell also alleged all of Wetzel's actions were done with full knowledge of his emotional and financial vulnerability, and with the intent to cause him injury. His wife, Sharon, alleged loss of consortium.

DISCUSSION

This case presents an issue which has received considerable attention in published opinions — when does a workers' compensation insurer step out of its role as an insurer so as to be vulnerable to civil suit? The Workers' Compensation Act invests the WCAB with exclusive jurisdiction over disputes regarding an employee's right to compensation or an employer's liability. (Lab. Code, § 5300, subds. (a) and (b); Marsh & McLennan, Inc. v. Superior Court (1989) 49 Cal.3d 1, 5 [259 Cal. Rptr. 733, 774 P.2d 762].) (2) This exclusive jurisdiction extends to claims against the employer's workers' compensation insurer. (Lab. Code, § 3850, subd. (b); Marsh & McLennan, Inc., supra, 49 Cal.3d at p. 6.)

Independent administrators of self-insured employers are treated as insurers. (See Schlick v. Comco Management, Inc. (1987) 196 Cal. App.3d 974, 978-980 [242 Cal. Rptr. 241]; Santiago v. Employee Benefits Services (1985) 168 Cal. App.3d 898, 901 [214 Cal. Rptr. 679]; Denning v. Esis Corp. (1983) 139 Cal. App.3d 946 [189 Cal. Rptr. 118].) This division has rejected Dill v. Claims Admin. Services, Inc. (1986) 178 Cal. App.3d 1184 [224 Cal. Rptr. 273], holding to the contrary. (Schlick, supra, 196 Cal. App.3d at p. 980.)

*1479 (3) There is, however, a judicially created exception to the WCAB's exclusive jurisdiction over insurers. Conduct which "goes beyond the normal role of an insurer" renders the insurer vulnerable to suit as a "person other than the employer." (Unruh v. Truck Insurance Exchange (1972) 7 Cal.3d 616, 630-631 [102 Cal. Rptr. 815, 498 P.2d 1063].)

In Unruh, a workers' compensation carrier hired an investigator to evaluate the plaintiff's back injury. The investigator beguiled the plaintiff into becoming romantically interested in him. He took her to Disneyland, where he had her filmed trying to negotiate the rope and barrel bridges on Tom Sawyer's island.[3] The investigator showed the film at a WCAB hearing, prompting a breakdown requiring hospitalization. The plaintiff was allowed to sue the carrier for its investigator's alleged assault and intentional infliction of emotional distress. (See 7 Cal.3d at pp. 630-631.)

As the Supreme Court recently noted, however, decisions of the Courts of Appeal have "limited the liability of insurance carriers under Unruh." (Marsh & McLennan, Inc., supra, 49 Cal.3d at p. 7.) Those decisions have established delay or refusal to pay benefits, even if done intentionally and with full knowledge of the hardship to the injured claimant, is insufficient to avoid exclusive jurisdiction. (E.g., Stoddard v. Western Employers Ins. Co. (1988) 200 Cal. App.3d 165, 171 [245 Cal. Rptr. 820]; Schlick v. Comco Management, Inc., supra, 196 Cal. App.3d at p. 982; Cervantes v. Great American Ins. Co. (1983) 140 Cal. App.3d 763, 771 [189 Cal. Rptr. 761]; Everfield v. State Comp. Ins. Fund (1981) 115 Cal. App.3d 15, 19 [171 Cal. Rptr. 164].) Exclusive jurisdiction is still the rule even though the delay or refusal creates emotional distress separate from the original injury (Schlick, supra, 196 Cal. App.3d at p. 981; Everfield, supra, 115 Cal. App.3d at p. 21) or is otherwise egregious. (See Stoddard, supra, 200 Cal. App.3d at pp.

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Mitchell v. Scott Wetzel Services, Inc., 227 Cal. App. 3d 1474, 278 Cal. Rptr. 474 (Cal. Ct. App. 1991).

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