Roth v. L.A. Door Co.

115 Cal. App. 4th 1249, 2004 Cal. Daily Op. Serv. 1555, 10 Cal. Rptr. 3d 1, 69 Cal. Comp. Cases 86, 2004 Cal. App. LEXIS 208
CourtCalifornia Court of Appeal
DecidedJanuary 23, 2004
DocketNo. G031221
StatusPublished
Cited by3 cases

This text of 115 Cal. App. 4th 1249 (Roth v. L.A. Door Co.) 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
Roth v. L.A. Door Co., 115 Cal. App. 4th 1249, 2004 Cal. Daily Op. Serv. 1555, 10 Cal. Rptr. 3d 1, 69 Cal. Comp. Cases 86, 2004 Cal. App. LEXIS 208 (Cal. Ct. App. 2004).

Opinion

Opinion

MOORE, J.

The employer of an employee injured on the job, after paying workers’ compensation benefits out of its self-insured retention, sought reimbursement from the California Insurance Guarantee Association (CIGA). The trial court denied the requested relief because the employer’s claim was not a “covered claim” under Insurance Code section 1063.1, subdivision (c). The employer contends the court erred in interpreting subdivision (c), because it is not an “insurer” within the meaning of that provision. It also contends that it has a right to proceed directly against the manufacturer of the overhead door that injured the employee.

We disagree on both counts. First, the employer, as a self-insurer for purposes of providing workers’ compensation benefits, is deemed to be an “insurer” providing “other insurance” within the meaning of Insurance Code section 1063.1, subdivision (c)(9). Therefore, its claim is excluded as a “covered claim” and CIGA is not responsible for the amounts paid to the injured employee from the employer’s self-insured retention. Furthermore, to permit the employer to recover the sums directly from the manufacturer of the door, whose insurer was insolvent, would be to permit the employer, as an “insurer” for the purposes of workers’ compensation insurance, to obtain indirectly what it could not obtain directly from CIGA. We affirm.

I

FACTS

John Michael Roth (Roth), a Nutrilite Products (Nutrilite) employee, was injured on November 1, 1999, during the course and scope of his employment. While Roth was on Nutrilite premises, a metal overhead trailer door fell to a “closed” position, striking him in the back of the head. Roth suffered injuries to his head, neck and left hand.

[1252]*1252Nutrilite paid workers’ compensation benefits to Roth through RSKCo., Nutrilite’s independent third party workers’ compensation benefits administrator. Nutrilite had workers’ compensation insurance through Insurance Company of Pennsylvania. However, Nutrilite was responsible for the first $250,000 per incident, as its self-insured retention.1

In October 2000, Roth filed a complaint against L.A. Door Company (L.A. Door), alleging that it had designed and manufactured the door. He asserted causes of action for negligence, strict products liability and breach of warranty.

In November 2000, Nutrilite “c/o RSKCo.” filed a complaint in intervention. It sought reimbursement for the workers’ compensation benefits it had paid to Roth on account of his injuries. Nutrilite ultimately paid at least $78,985.99 in workers’ compensation benefits to Roth.

L.A. Door had insurance coverage through United Pacific Insurance Company. Roth’s claim was covered by that insurance. United Pacific Insurance Company was a subsidiary of Reliance Insurance Company. Reliance Insurance Company was declared insolvent on October 3, 2001.

Roth settled his claim against L.A. Door before trial and dismissed his complaint. On the date scheduled for trial on the complaint in intervention, L.A. Door stipulated to liability. The matter went to trial on the issue of whether a workers’ compensation subrogation claim is considered a “covered claim” under the laws applicable to CIGA, and if not, whether Nutrilite could proceed directly against L.A. Door.

The court ruled against Nutrilite, for two reasons. First, it held the complaint in intervention was barred by Insurance Code section 1063.1, subdivision (c)(5) because Nutrilite, “as a permissively self-insured employer, [was] an ‘insurer’ pursuant to Labor Code section 3211 and because its claim as set forth in the complaint in intervention [was] a subrogation claim.” Second, Insurance Code section 1063.1, subdivision (c)(9) barred the complaint in intervention because Nutrilite was “not the ‘original claimant’ as its [1253]*1253claim for reimbursement of workers’ compensation benefits [was] derivative and also because [Nutrilite’s] claim [was] a claim by way of subrogation.”

Nutrilite filed an appeal from the judgment.

II

DISCUSSION

A. CIGA: “Covered Claims"

CIGA was formed to provide insurer insolvency insurance for its members. (Ins. Code, § 1063.) Pursuant to Insurance Code section 1063.2, CIGA pays and discharges “covered claims.” The term “covered claims” is defined in Insurance Code section 1063.1, subdivision (c). Subdivision (c)(1) defines “covered claims” as “the obligations of an insolvent insurer . . . .”

However, Insurance Code section 1063.1, subdivision (c) contains a number of exclusions from this definition. Subdivision (c)(5) provides in pertinent part: “ ‘Covered claims’ does not include any obligations to insurers, insurance pools, or underwriting associations, nor their claims for contribution, indemnity, or subrogation, equitable or otherwise . . . .”

Insurance Code section 1063.1, subdivision (c)(9) provides: “ ‘Covered claims’ does not include (i) any claim to the extent it is covered by any other insurance of a class covered by this article available to the claimant or insured nor (ii) any claim by any person other than the original claimant under the insurance policy in his or her own name . . . and does not include any claim asserted by an assignee or one claiming by right of subrogation . . . ,”2

At issue is whether the trial court correctly interpreted these provisions in determining, in essence, that Nutrilite’s claim against CIGA was not a “covered claim.”

B. Workers’ Compensation Subrogation Under CIGA Provisions

(1) Nutrilite’s contention

Nutrilite claims that the trial court, in interpreting Insurance Code section 1063.1, subdivision (c), incorrectly applied California Ins. Guarantee Assn. v. [1254]*1254Argonaut Ins. Co. (1991) 227 Cal.App.3d 624 [278 Cal.Rptr. 23], rather than Burrow v. Pike (1987) 190 Cal.App.3d 384 [235 Cal.Rptr. 408]. Nutrilite claims there is a split of authority between the appellate courts in the Fifth District (Burrow) and the Third District (Argonaut), and that the trial court should have followed the former as the better reasoned. We disagree.

(2) Burrow v. Pike

We first address Burrow v. Pike, supra, 190 Cal.App.3d 384, on which Nutrilite relies. In that case, the plaintiff, an employee of the Department of Transportation, was injured when struck by a truck. The plaintiff filed suit against the owner and the operator of the truck. The Department of Transportation, seeking to recoup the money it had paid to the plaintiff in workers’ compensation benefits, filed a notice of lien claim against any judgment entered in favor of the plaintiff. During the pendency of the action, the defendants’ insurer became insolvent.

The defendants then filed a motion for judgment on the pleadings as to the claim of lien, and the trial court granted the motion. Thereafter, the jury returned a verdict in the amount of $75,000 in favor of the plaintiff. However, because the plaintiff and the defendants had stipulated that the workers’ compensation credit was $50,000, the trial court reduced the amount of the award to $25,000.

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Bluebook (online)
115 Cal. App. 4th 1249, 2004 Cal. Daily Op. Serv. 1555, 10 Cal. Rptr. 3d 1, 69 Cal. Comp. Cases 86, 2004 Cal. App. LEXIS 208, Counsel Stack Legal Research, https://law.counselstack.com/opinion/roth-v-la-door-co-calctapp-2004.