SCF General Insurance v. Industrial Commission

342 P.3d 1285, 236 Ariz. 545, 2015 Ariz. App. LEXIS 24
CourtCourt of Appeals of Arizona
DecidedFebruary 24, 2015
DocketNo. 1 CA-IC 14-0017
StatusPublished

This text of 342 P.3d 1285 (SCF General Insurance v. Industrial Commission) is published on Counsel Stack Legal Research, covering Court of Appeals of Arizona primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
SCF General Insurance v. Industrial Commission, 342 P.3d 1285, 236 Ariz. 545, 2015 Ariz. App. LEXIS 24 (Ark. Ct. App. 2015).

Opinion

OPINION

THOMPSON, Judge:

¶ 1 This is a special action review of an Industrial Commission of Arizona (ICA) award and decision upon review finding that the respondent employer, Walia, LLC (Wa-lia), had workers’ compensation coverage in effect at the time the respondent employee (claimant) sustained his January 24, 2013 industrial injury. The petitioner carrier, SCF General Insurance Company (SCF), raises four issues:

(1) whether the administrative law judge (ALJ) erred by finding that SCF failed to meet its burden of proof under Arizona Revised Statutes (A.R.S.) § 20-1109 (the rescission statute);
(2) whether SCF was required to comply with A.R.S. § 23-961(1) (the cancellation statute) before it could rescind Walia’s workers’ compensation coverage;
(3) whether SCF and Walia entered into a binding agreement for insurance pursuant to A.R.S. § 23-1102; and
(4) whether SCF waived its right to rescind Walia’s insurance policy.

Because we hold that the ALJ erroneously found the continuing duty rule inapplicable and erroneously found that AR.S. § 23-961(1) precluded SCF from rescinding Wa-lia’s coverage, we set aside the award.1

I. JURISDICTION AND STANDARD OF REVIEW

¶ 2 This court has jurisdiction pursuant to AR.S. §§ 12-120.21(A)(2) (2003), 23-951(A) (2012), and Arizona Rule of Procedure for Special Actions 10 (2009).2 In reviewing findings and awards of the ICA, we defer to the ALJ’s factual findings, but review questions of law de novo. Young v. Indus. Comm’n, 204 Ariz. 267, 270, ¶ 14, 63 P.3d 298, 301 (App.2003). We consider the evidence in the light most favorable to upholding the ALJ’s award. Lovitch v. Indus. Comm’n, 202 Ariz. 102, 105, ¶ 16, 41 P.3d 640, 643 (App.2002).

II. PROCEDURAL AND FACTUAL HISTORY

¶ 3 Claimant was injured on January 24, 2013, while working as a tow truck driver for Walia. Claimant filed a worker’s report of injury, but SCF denied his claim for benefits because it had rescinded Walia’s workers’ compensation coverage. Claimant and Walia protested the denial of benefits and asserted that Walia had valid workers’ compensation coverage with SCF on the date of claimant’s injury. Based on SCF’s denial of coverage, the respondent party in interest, Special Fund Division/No Insurance Section (No Insurance), entered an award accepting claimant’s claim for benefits and notifying Walia that it would be subject to a lien for all benefits paid on its behalf by No Insurance.

¶ 4 The ICA scheduled a hearing, and the ALJ entered an order joining both SCF and No Insurance as interested parties. At the [547]*547hearing, the ALJ heard testimony from Wa-lia’s owner and two SCF employees. Both parties subsequently filed legal memoranda. The ALJ entered an award finding claimant’s claim compensable and the sole responsibility of SCF. SCF timely requested administrative review. The ALJ summarily affirmed the award. This petition followed.

III. DISCUSSION

¶ 5 SCF first argues that the ALJ erred by finding that it had failed to meet its burden of proof under A.R.S. § 20-1109 for rescinding Walia’s workers’ compensation coverage. The rescission statute provides:

All statements and descriptions in any application for an insurance policy or in negotiations therefor, by or in behalf of the insured, shall be deemed to be representations and not warranties. Misrepresentations, omissions, concealment of facts and incorrect statements shall not prevent a recovery under the policy unless:
1. Fraudulent.
2. Material either to the acceptance of the risk, or to the hazard assumed by the insurer.
3. The insurer in good faith would either not have issued the policy, or would not have issued a policy in as large an amount, or would not have provided coverage with respect to the hazard resulting in the loss, if the true facts had been made known to the insurer as required either by the application for the policy or otherwise.

SCF asserts that Walia’s failure to inform it of the claimant’s January 24, 2013 industrial injury during the reinstatement process was fraud material to SCF’s acceptance of the risk and that it would not have reinstated Walia’s workers’ compensation policy if it had known of the injury.

¶ 6 Mary Owens, an SCF sales and service manager, testified that SCF had written two prior workers’ compensation insurance policies for Walia: the first from January 2, 2011 to January 22, 2012, and the second from January 22, 2012 to January 22, 2013. She explained that Walia’s annual policy premium was an estimate based on the National Council on Compensation Insurance manual. At the end of each policy term, SCF audited its insured’s payroll to determine if additional premiums were due or overpaid.

¶ 7 Ms. Owens testified that policies are written for twelve months and renew automatically, but a policy audit must be completed within thirty days after the previous policy term ends. On June 1, 2012, SCF sent Walia a notice of nonrenewal because no audit had been completed for the 2011-12 policy year. When Walia did not submit information for the 2011-12 audit, its workers’ compensation insurance lapsed on January 22, 2013.

¶ 8 On that same date, Walia filed a request to reinstate its workers’ compensation policy with SCF. It submitted SCF’s Request to Reinstate Form which stated:

Please consider this request to reinstate the above canceled policy. The policy has not been reinstated within the last three years; there have been no claims or injuries since the cancellation date and all premiums and payments due up to the date of this request have been paid.

(Emphasis added.) SCF agrees that these statements were true when the form was submitted. Walia subsequently submitted materials for the SCF audits for both the 2011-12 and 2012-13 policy years, and on January 24, 2013, at 4:40 p.m., it paid SCF $19,468 for premiums owed pursuant to the audits. SCF reinstated Walia’s insurance policy on January 25, 2013, with coverage retroactive to January 22, 2013, at 12:01 a.m.

¶ 9 Unbeknownst to SCF, on January 24, 2013, at 2:00 p.m., claimant sustained an industrial injury. When SCF became aware that an injury had occurred before the policy reinstatement, it rescinded Walia’s coverage. Ms. Owens testified that SCF reasonably relied on Walia’s representation that there were “no claims or injuries” after the cancellation date, because the policy would not have been reinstated if SCF had been aware of the uncovered injury.

¶ 10 With regard to the rescission statute, SCF asserts that Walia was subject to Arizona’s “continuing duty” rule.

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752 P.2d 1 (Court of Appeals of Arizona, 1987)
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McCollum v. Continental Casualty Co.
728 P.2d 1242 (Court of Appeals of Arizona, 1986)
Lovitch v. Industrial Commission
41 P.3d 640 (Court of Appeals of Arizona, 2002)
Young v. Industrial Commission
63 P.3d 298 (Court of Appeals of Arizona, 2003)

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Bluebook (online)
342 P.3d 1285, 236 Ariz. 545, 2015 Ariz. App. LEXIS 24, Counsel Stack Legal Research, https://law.counselstack.com/opinion/scf-general-insurance-v-industrial-commission-arizctapp-2015.