Ogden v. Workers' Compensation Appeals Board

153 Cal. App. 3d 786, 49 Cal. Comp. Cases 280, 200 Cal. Rptr. 406, 1984 Cal. App. LEXIS 1825
CourtCalifornia Court of Appeal
DecidedMarch 27, 1984
DocketNo. F003227
StatusPublished
Cited by2 cases

This text of 153 Cal. App. 3d 786 (Ogden v. Workers' Compensation Appeals Board) is published on Counsel Stack Legal Research, covering California Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Ogden v. Workers' Compensation Appeals Board, 153 Cal. App. 3d 786, 49 Cal. Comp. Cases 280, 200 Cal. Rptr. 406, 1984 Cal. App. LEXIS 1825 (Cal. Ct. App. 1984).

Opinion

Opinion

BROWN (G. A.), P. J.

Facts

On January 18, 1982, Manuel Perez Fuentes, an employee of petitioner, Mel Ogden, had toes on his left foot amputated and his left foot severely injured when, in the course of his employment, a piece of metal fell on his [789]*789foot. Fuentes filed an application for workers’ compensation benefits, and after a hearing it was decided that he was entitled to the benefits.

However, because there was a dispute over whether or not petitioner’s workers’ compensation insurance policy had been canceled prior to the injury to Fuentes, further hearings were scheduled. After the completion of the hearings, the workers’ compensation judge found that although the policy had been canceled, respondent Underwriters Insurance Company (Underwriters) was estopped from denying coverage to petitioner.

Respondent Underwriters filed a petition for reconsideration with the Workers’ Compensation Appeals Board (Board). The judge who originally heard the case filed a report and recommendation regarding the petition for reconsideration. In this report the judge wrote, “It is recommended that the panel read all of the arguments set out by the parties and come to their own decision, [f] The judge does have grave doubts as to whether or not his decision was correct on the issue of estoppel, that is were all of the elements for an estoppel proved.” The Board granted the petition for reconsideration and issued a decision reversing the decision by the judge. The Board found that the policy had been canceled and that petitioner had failed to prove all of the elements needed to establish an estoppel. Accordingly, there was no insurance coverage available to the employer, Ogden, for the injuries suffered by his employee, Fuentes. We will annul the order and remand to the Board for further consideration of its finding of no estoppel and to make findings on the issue of agency.

Monolith Portland Cement Company (Monolith) hired petitioner, Mel Ogden, to remove an obsolete kiln and ball mill and dispose of the salvage. However, Monolith would not permit Ogden to undertake the operation without first obtaining proper insurance coverage, including workers’ compensation insurance. Monolith referred Ogden to an insurance agent by the name of David Laube doing business as Insure-West in Victorville, a distance of approximately 60 miles from Monolith. Ogden contacted Laube by telephone and requested that Laube obtain workers’ compensation insurance for Ogden. Ogden and Laube had no personal contact prior to the injury to Fuentes.

Laube submitted an application on behalf of Ogden for workers’ compensation insurance directly to Market Insurance Corporation (Market Insurance) in Los Angeles, respondent Underwriters’ general agent. However, for reasons which do not appear on the record, the application was denied. Laube then brokered the application through Kevin Lynch, who is the principal in a corporation known as Western Los Angeles Insurance Company, Inc. (Western).

[790]*790Lynch resubmitted Ogden’s application to Market Insurance, and the application was accepted and a workers’ compensation insurance policy was issued by respondent Underwriters with effective dates of between February 18, 1981, and February 18, 1982. The policy was delivered to Lynch, who delivered it to Laube, who delivered it to Ogden. Ogden paid the premium in advance on the workers’ compensation policy but had no contact with anyone except Laube concerning the policy. He knew nothing of Lynch, Western or Market Insurance until after the injury to Fuentes.

Laube had submitted Ogden’s application to Lynch, and Lynch gave it to Market. The application contained Ogden’s correct address in Rosamond but did not include a zip code. Ms. Gloria Dumkel, an underwriter for Market Insurance, obtained a zip code from Western and added it to the face of the policy. However, the zip code which Western gave Dumkel was for Victorville, the location of the offices of Laube, rather than Rosamond, the residence and business location of petitioner, and was therefore incorrect.

Because of the hazardous character of Ogden’s operation, Dumkel of Market Insurance required an onsite inspection. She engaged insurance consultants by the name of Jensen & More, Inc. of Bakersfield to make such an inspection. Their representative reported to Market that despite numerous efforts he had been unable to make contact with Ogden and could not locate the job site. Laube, on the other hand, testified that he had been contacted several times by a representative of Market Insurance seeking directions to the job site and had given the representative explicit directions to the job site.

In April 1981 two of petitioner’s employees were injured and their claims were considered and paid by respondent Underwriters. Communication concerning the claims of these employees took place between Market Insurance and Bobbie Ogden, petitioner’s wife and bookkeeper, during a period of several months following the cancellation of Underwriters’ policy.

On May 8, 1981, Market Insurance mailed to petitioner, at his address in Rosamond (the address with the wrong zip code), a voluntary payroll audit statement with a notation that the report must be returned prior to June 3, 1981, to avoid cancellation of the policy. Apparently because of the incorrect zip code, the audit statement was not received by Bobbie Ogden until June 1, 1981. She immediately completed the statement and returned it the same day. Because of the warning about cancellation, she phoned Laube’s office and inquired whether the audit had been received in time to prevent cancellation. She was told that Laube’s office would check with Underwri[791]*791ters and if she was not notified of any problem she could assume that the policy remained in effect. She was never notified of any problem.

The notice of cancellation was mailed on May 27, 1981. The sole reason for cancellation of the coverage was the failure to complete an onsite inspection. The notice of cancellation was mailed to petitioner’s address in Rosamond, using the Victorville zip code. Both Bobbie Ogden and petitioner testified that it was never received.

Market Insurance delivered a copy of the cancellation notice to Kevin Lynch of Western. Lynch testified that he notified Laube by telephone of the cancellation but did not notify him in writing or provide him with a copy of the cancellation notice. Laube testified that he was not notified of the cancellation until after the injury to Fuentes on January 18, 1982. A return premium was due to petitioner by reason of the cancellation but it was not delivered until November of 1982.

Diana Olson, who was a claims supervisor for Warner Insurance Group (the part of Underwriters which handles the claims), was responsible for overseeing the claims that had been filed by the two employees who had been previously injured. She was not aware of the cancellation of the policy until after the injury to Fuentes. Olson telephoned Dumkel to confirm coverage upon receiving notice of the injury to Fuentes. Olson testified that Dumkel questioned if Ogden knew of the cancellation because of the fact that there was a subproducer involved. Olson was also aware of the fact that correspondence sent to the Rosamond address did not elicit immediate responses and that she would receive quicker responses if she sent the correspondence to Bobbie Ogden at an address in Mojave.

Discussion

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Cite This Page — Counsel Stack

Bluebook (online)
153 Cal. App. 3d 786, 49 Cal. Comp. Cases 280, 200 Cal. Rptr. 406, 1984 Cal. App. LEXIS 1825, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ogden-v-workers-compensation-appeals-board-calctapp-1984.