Pinnacol Assurance v. Hoff

2016 CO 53, 375 P.3d 1214, 2016 Colo. LEXIS 678, 2016 WL 3574393
CourtSupreme Court of Colorado
DecidedJune 27, 2016
DocketSupreme Court Case 15SC87
StatusPublished
Cited by518 cases

This text of 2016 CO 53 (Pinnacol Assurance v. Hoff) is published on Counsel Stack Legal Research, covering Supreme Court of Colorado primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Pinnacol Assurance v. Hoff, 2016 CO 53, 375 P.3d 1214, 2016 Colo. LEXIS 678, 2016 WL 3574393 (Colo. 2016).

Opinions

[1217]*1217JUSTICE HOOD

delivered the Opinion of the Court.

11 In this workers' compensation insurance case, we consider whether an insurer had a legal obligation to notify a non-insured holder of a certificate of insurance when the insurance policy evidenced by the certificate was cancelled. Based on the certificate at issue here and the relevant statute, we conclude that the insurer had no such obligation. We therefore reverse the court of appeals' judgment to the contrary.

I. Facts

12 Norma Hoff owns a house that she rents out through a property management agency. When the roof of the house sustained hail damage, Hoff and her husband contracted with Alliance Construction & Restoration, Inc. ("Alliance") to repair it. Without Hoffs knowledge, Alliance subcontracted the roofing job to MDR Roofing, Inc. ("MDR"). MDR employed Hernan Hernandez as a roofer.

183 While working on Hoff's roof, Hernandez fell from a ladder and suffered serious injuries. He sought medical and temporary total disability benefits for these work-related injuries, but MDR's insurer, Pinnacol Assurance ("Pinnacol"), denied the claim because MDR's insurance coverage had lapsed. Neither Hoff nor Alliance had workers' compensation insurance. Hernandez then brought an action under the Workers' Compensation Act ("WCA" or "the Act"), §§ 8-40-101 to 8-47-209, 8-55-101 to -105, C.R.S. (2015), seeking benefits against MDR, Alliance, Hoff, and Pinnacol.

._ T4 The facts relevant to this claim are best summarized chronologically.

115 In July 2010, MDR applied for workers' compensation insurance from Pinnacol through Pinnacol's agent, Bradley Insurance Agency ("Bradley"). Shortly thereafter, Pin-nacol issued a policy to MDR. **

T6 In October 2010, before starting the roofing job on Hoffs property, Alliance obtained from Bradley a certificate of insurance 1 which verified that MDR had a workers' compensation insurance policy in effect from July 9, 2010, to July 1, 2011.

1? On February 10, 2011, Pinnacol informed MDR by certified letter that MDR's insurance policy would be cancelled if Pinnsa-col did not receive payment of a past-due premium by March 2, 2011. Pinnacol also mailed a copy of this letter to Bradley. Alliance was not notified of the pending cancellation.

fig MDR did not pay the past-due premium, and the policy was therefore cancelled effective March 8, 2011. Pinnacol sent letters to MDR and Bradley advising them of the cancellation, but it did not send a letter to Alliance.

T9 One week later, on March 10, 2011, Hernandez’s injuries occurred.

110 On March 11, 2011, MDR's owner went to Bradley's office and asked to reinstate the policy. Bradley personnel informed MDR's owner that the policy could be reinstated only if the owner paid the outstanding premium, paid a reinstatement fee, and signed a "no-loss" letter, which is a statement by an insured certifying that no injuries have occurred since the insured's policy was can-celled. MDR's owner made the necessary payments and, although he knew Hernandez had been injured since the policy's cancellation, signed and submitted the no-loss letter. He did not inform Bradley of Hernandez's accident. That same day, upon receiving the payments and no-loss letter, Pinnacol reinstated MDR's policy retroactively to the March 3 cancellation date.

111 On March 16, 2011, MDR's owner returned to Bradley's office to report Hernandez's March 10 injuries. Bradley contacted Pinnacol to advise it of the claim. Pinnacol contested the claim on coverage grounds and later cancelled the policy.

[1218]*1218II. Procedural History -

12 After conducting a hearing on Hernandez's workers' compensation claim, an administrative law judge ("ALJ") determined that Pinngcol's March 3 cancellation of MDR's insurance policy was proper. The ALJ further determined, that MDR's owner's failure to disclose Hernandez's injuries when he signed the no-loss letter was a material misrepresentation that rendered void the March 11 reinstatement of the policy, As a result, MDR had no workers' compensation coverage on March 10-the day of Hernandez's injuries-and Pinnacol could not be held liable on the claim.

T13 The ALJ also concluded that, in addition to MDR, who was Hernandez's direct employer, Hoff and Alliance were Hernandez's statutory employers under sections 8-41-402 and 841-401 of the WCA, respectively. Finding that none of these three parties had a workers' compensation insurance policy in effect on March 10, 2011, the ALJ held them jointly liable for Hernandez's benefits.

14 On appeal to the Industrial Claim Appeals Office ("ICAO" or "the Panel"), Hoff argued that, under the doctrine of promissory estoppel, Pinnacol should be barred from denying coverage because the certificate of insurance required Pinnacol to notify Alliance that MDR's policy was being cancelled, she and Alliance relied on the certificate as proof that MDR had insurance, and Pinnacol failed .to notify Alliance of the policy's cancellation, The Panel rejected this argument and affirmed the ALJ's order.

15 Hoff then appealed the Panel's order to the court of appeals,2 again asserting a claim of promissory estoppel. In Hoff v. Industrial Claim Appeals Office, 2014 COA 137M, -- P.3d --, a division of the court of appeals reversed, with each of the division's three judges writing separately. Although the division unanimously rejected the Panel's promissory estoppel analysis,3 id. at ¶¶ 28-30; id. at ¶ 46 (Cagebolt, J,, concurring in part and dissenting in part); id, at T 69 (Berger, J., concurring in part and dissenting in part), it disagreed as to how the estoppel claim should be resolved.

T16 The majority (Judges Dailey and Berger) held that the certificate required Pinna-col to notify Alliance if MDR's insurance policy was cancelled and that any contrary disclaimer language 4 in the certificate was void; accordingly, this notice obligation satisfied the "promise" element of Hoff's promissory estoppel claim as a matter of law. See id. at ¶ 2, 31-43 (majority opinion); Id at ¶ 70 (Berger, J., concurring in part t and dissenting in part). Judge Casebolt dissented from this holding, instead finding that the certificate was ambiguous and that "the kind and nature of the promises and disclaimers contained in the certificate present[ed] factual issues that the ALJ should first decide" on remand. See id. at f 51 (Casebolt, J., concurring in part and dissenting in part).

117 The majority (Judges Dailey and Case-bolt) also held, however, that the question of whether the other elements of promissory estoppel were satisfied was a factual issue best resolved by the ALJ in the first instance and that remand was therefore necessary. Id, at ¶¶ 2, 44 (majority opinion); id. at ¶ 46 (Casebolt, J., concurring in part and dissenting in part). Judge Berger dissented from this holding. In his view, the facts relevant to all elements of Hoffs promissory estoppel claim were undisputed, and the court there[1219]*1219fore should have resolved the claim as a matter of law. Id. at 1% 68-69 (Berger, J., concurring in part and dissenting in part). Applying the law to the facts, Judge Berger would have héld that Pinnacol was estopped from denying coverage for Hernandez's benefits. See id. at I1 69-76.

18 We granted Pinnacol's petltlon for cer-tiorari.5

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Cite This Page — Counsel Stack

Bluebook (online)
2016 CO 53, 375 P.3d 1214, 2016 Colo. LEXIS 678, 2016 WL 3574393, Counsel Stack Legal Research, https://law.counselstack.com/opinion/pinnacol-assurance-v-hoff-colo-2016.