Russell v. Protective Insurance

751 P.2d 693, 107 N.M. 9
CourtNew Mexico Supreme Court
DecidedMarch 22, 1988
Docket16966
StatusPublished
Cited by28 cases

This text of 751 P.2d 693 (Russell v. Protective Insurance) is published on Counsel Stack Legal Research, covering New Mexico Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Russell v. Protective Insurance, 751 P.2d 693, 107 N.M. 9 (N.M. 1988).

Opinions

OPINION

SOSA, Senior Justice.

In Russell v. Protective Ins. Co. (1987), we ruled that NMSA 1978 §§ 59A-16-1 to -30 (Trade Practices and Fraud), and particularly §§ 59A-16-20 and -30, allow a cause of action against workers’ compensation insurers for bad faith refusal to pay compensation benefits to workers. We held that the cause of action must be for damages unrelated to the worker’s physical or psychological job-related disability. On October 13, 1987, respondents Protective Insurance Company (Insurer) and Merchants Fast Motorline, Inc. (Employer) filed their motion for rehearing urging us to reconsider our opinion in Russell and to allow “extensive briefs to be filed by the parties as well as other interested persons (amicus curiae) before making a final determination in this case.” Upon consideration of respondents’ motion, we withdraw the opinion originally submitted and substitute in its stead the following:

This case is before the court on petition for writ of certiorari. Petitioner Richard Russell (Russell) alleged in count II of his complaint that respondent, Protective Insurance Company (Insurer), had refused “to attempt in good faith to effectuate a prompt, fair and equitable settlement of [his workers’ compensation] claim.” The language tracks NMSA 1978, Section 59A-16-20(E). The Insurer filed a motion to dismiss count II of the complaint. The motion was denied with leave to file an interlocutory appeal. On appeal, the court of appeals reversed the trial court. After reviewing the record and briefs on appeal, we reverse the court of appeals.

The issue concerns the applicability of the New Mexico Insurance Code, Article 16, “Trade Practices and Frauds,” 1 to the Workers’ Compensation Act.2 The New Mexico Insurance Code was enacted by the legislature in 1984, two years after our opinion in Dickson v. Mountain States Mut. Casualty Co., 98 N.M. 479, 650 P.2d 1 (1982), in which we denied recovery to a worker who had sought damages from her employer’s compensation carrier for bad faith refusal to pay hospitalization and medical expenses. In Dickson we stated:

This Court has expressly stated that if the compensation act provides a remedy for the alleged wrong, then that remedy is exclusive. Here, the alleged wrong is the refusal to pay a medical bill. The compensation act clearly provides a remedy. As noted in [Chavez v. Kennecott Copper Corp., 547 F2d 541 (10th Cir. 1977) ] and in [Escobedo v. Am. Employers Ins. Co., 547 F.2d 544 (10th Cir. 1977)], a plaintiff need only file a complaint in state court to compel payment of any benefits to which she may be entitled. A defendant’s responsibility to pay, if it is in fact responsible, exists solely by virtue of the Workmen’s Compensation Act [now referred to as Workers’ Compensation Act]. The Act itself provides the benefits and the remedies for any failure to pay.

Id. at 481, 650 P.2d at 3.

In Gonzales v. United States Fidelity & Guar. Co., 99 N.M. 432, 659 P.2d 318 (Ct. App.1983), the court of appeals addressed a somewhat similar situation when it held that a workman had no independent cause of action against an insurer who allegedly acted in bad faith by attempting to coerce the workman into accepting an unfavorable compensation settlement. In that case, the workman had argued that the Unfair Insurance Practices Act3 gave him an implied private right of action against the insurer.

The Unfair Insurance Practices Act had the same purpose as the present New Mexico Insurance Code, namely, “to regulate trade practices in the insurance business and related businesses in accordance in part with the intent of Congress as expressed in * * * 15 U.S.C. Sections 1011 to 1015.” NMSA 1978, § 59A-16-2. Section 5(1) of the prior act is equivalent to the present Section 59A-16-20. Under the former act, the insurance superintendent of New Mexico had authority to assess civil penalties against offending insurance companies. There was no private right of action. The new act explicitly grants a private right of action. § 59A-16-30.

Thus the issue is narrowed as follows: In light of the legislature’s enactment of a new act with a private right of action, do the decisions in Gonzales v. United States Fidelity & Guar. Co. and Dickson v. Mountain States Mut. Casualty Co. cease to bar a worker from pursuing an independent tort action against a compensation insurer for bad faith refusal to pay compensation benefits?

In reversing the trial court, the court of appeals reasoned that “Section 59A-16-30 is not so broad in its terms and so clear and explicit in its words as to show it was intended to displace the exclusivity provision of the [Workers’ Compensation] Act.” (Opinion filed February 24, 1987, page 3, lines 5-6). The court of appeals relied on Galvan v. City of Albuquerque, 87 N.M. 235, 531 P.2d 1208 (1975), which held that a “later * * * broader * * * more liberal” statute implicitly repealed an earlier “special” statute. Id. at 236, 531 P.2d at 1209. The court held that the later statute was “so broad in its terms and so clear and explicit in its words as to show it was intended to cover the whole subject, and therefore, to displace the prior statute * * (Emphasis added.) Id. at 237, 531 P.2d at 1210. Russell does not contend that Sections 59A-16-1 to -30 were intended by the legislature to “cover the whole subject” of workers compensation actions asserted against insurers who refuse or fail to pay compensation benefits. Rather, he argues that these sections implicitly amended the Workers’ Compensation Act by allowing a cause of action against compensation insurers for bad faith refusal to pay compensation benefits. We agree with Russell on this point.

In our opinion, the legislature, in enacting Sections 59A-16-1 to -30, intended to broaden the Workers’ Compensation Act so as to provide for a separate tort action against insurers who in bad faith refuse to pay compensation benefits. In other words, we hold that the private right of action created by Section 59A-16-30 applies only to intentional, willful refusal to pay compensation benefits, and not to an insurer’s negligent or dilatory failure to pay benefits, since the latter situation is already covered by the Workers’ Compensation Act.

NMSA 1978, Section 52-l-6(D) (Repl.Pamp.1987) provides: “Nothing in the Workmen’s Compensation Act * * * shall affect or be construed to affect, in any way, the existence of * * * any claim or cause of action which the workman has against * * * the insurer * * * of his employer.” In Dickson, we read those words as restating “the exclusivity of compensation benefits in a slightly different manner.” 98 N.M. at 480, 650 P.2d at 2. In light of the new statute (Section 59A-16-1 to -30), however, we conclude that Section 52-l-6(D) should be read as permitting the cause of action which Russell asserted in count II of his complaint.

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Bluebook (online)
751 P.2d 693, 107 N.M. 9, Counsel Stack Legal Research, https://law.counselstack.com/opinion/russell-v-protective-insurance-nm-1988.