Walker v. Workmen's Compensation Appeal Board

656 A.2d 164, 1995 Pa. Commw. LEXIS 125
CourtCommonwealth Court of Pennsylvania
DecidedMarch 10, 1995
StatusPublished
Cited by7 cases

This text of 656 A.2d 164 (Walker v. Workmen's Compensation Appeal Board) is published on Counsel Stack Legal Research, covering Commonwealth Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Walker v. Workmen's Compensation Appeal Board, 656 A.2d 164, 1995 Pa. Commw. LEXIS 125 (Pa. Ct. App. 1995).

Opinions

DOYLE, Judge.

Judy Walker, Rita McNaughton DeSanto, Charlotte Haas, and Rebecca Kunselman (collectively, Claimants) appeal from four orders of the Workmen’s Compensation Appeal Board reversing the determination of the referee that Nationwide Insurance Company was liable for the payment of compensation benefits due for Claimants’ work-related injuries incurred on January 7 and January 9, 1987.

Claimants were employed as pressers for Sherbren Manufacturing, Inc. (Employer), a clothing manufacturer. While working on January 7 and January 9, 1987, they experienced nausea, dizziness, stomach and chest pains, fainting, and shortness of breath. On

[166]*166February 26, 1987, Claimants filed claim petitions against Employer and Nationwide, alleging that they had sustained work-related injuries as a result of inhaling toxic fumes from a cleaning fluid used by Employer in the workplace.

Employer and Nationwide both filed timely answers denying Claimants’ allegations. Employer further alleged that Nationwide was its workers’ compensation insurance carrier on January 7 and 9, 1987. Nationwide, in its answer, denied that it was Employer’s insurance carrier on these dates.

Hearings were held before Referee Lois W. Morrison1 who found that the Claimants’ injuries were compensable under the Workers’ Compensation Act.2 She also made the following findings of fact regarding the question of insurance coverage:

1.That on December 5, 1986 Nationwide Insurance Company mailed a Cancellation Notice to SherBren Manufacturing Company informing them that their Workers’ Compensation Insurance Policy purchased for the term May 30, 1986 to May 30, 1987 was to be cancelled as of December 25, 1986 for non-payment of premiums.
2. That the cancellation notice was received by SherBren. Robin Coleman of SherBren’s Accounting Department, discovered the notice in a file on January 15, 1987. Apparently this was SherBren’s first acknowledgment of notification that its Workers’ Compensation insurance had been cancelled.
3. That Ms. Coleman testified that she spoke to the local Nationwide agent, Paul (Pappy) Jones, on January 16, 1987. Agent Jones also had received a copy of the cancellation notice. Ms. Coleman stated that Mr. Jones told her to send two months premiums ($514.00) to Nationwide’s Butler office.
4. That Ms. Coleman identified a letter and a copy of a cheek she sent to Nationwide Insurance Company tendering $514.00 to cover two months of unpaid premiums on Policy No. 54 WC 024-431-003. Said check and letter were mailed January 16, 1987; and was returned due to insufficient funds.
5. That Ms. Coleman admitted that the $514.00 check SherBren wrote was returned due to insufficient funds. Sher-Bren alleges Nationwide was told to resubmit the cheek and that the check was never returned.
6. That between January 16, 1987 and January 28, 1987, SherBren received a Billing Statement requesting they pay Nationwide $4,981.00 by January 30, 1987. The statement indicated, on its face, that the sum of $3,283.00 was owed from a ‘prior term’ and that $1,698.00 was owed for the current premium period. The bill clearly stated that the total owed was for the period from May 30,1985 to December 25, 1986.
7. That Robin Coleman further testified that she contacted Paul Jones about the Billing Statement and that he told her that the $3,283.00 was for the past due balance on the policy and that $1,688.00 of the total owed was a 30% down payment for a reinstatement of the cancelled policy. Ms. Coleman and SherBren had the money wired to Nationwide’s Butler office on January 30, 1987.
8. That Nationwide sent a letter to Sher-Bren on February 5, 1987. This letter stated that due to past payment problems Nationwide would not reinstate SherBren’s policy and it would remain cancelled as of December 25, 1986.
9. That Ms. Coleman testified that she knew Mr. Jones was an agent for Nationwide but she did not know his status with the company. She testified that her belief that payment of $1,688.00 to Nationwide would constitute a 30% down payment to reinstate the policy was based upon statements made by Mr. Jones.
[167]*16710. That several SherBren employees testified they contacted Nationwide several times about filing information concerning the events of January 7th and 9th. They stated that Nationwide’s employees cooperated with them and made no mention of the policy being cancelled until after February 5, 1987.
11. That Gerald L. Raab, underwriting supervisor for Nationwide Insurance Company, testified on its behalf. He explained Nationwide’s dealings with SherBren following the issuance of the Cancellation notice. Mr. Raab stated that had the $514.00 check not been returned due to insufficient funds, Nationwide would have rewritten SherBren’s policy, reinstating coverage back to the day the check was mailed, January 16, 1987. However, upon discovering the check was drawn on insufficient funds (which occurred February 3, 1987) Nationwide sent the cancellation letter dated February 5, 1987 which is referred to in Finding of Fact No. 8.
12. That Mr. Raab further testified that it was Nationwide’s practice to rewrite cancelled policies, requiring payment of money owed and a 30% down payment on the premium for a new policy. (Referee’s Note: Mr. Raab occasionally uses the word reinstate but clearly testified (Page 12, March 29,1988 hearing) that the procedure involved writing a new policy.) Mr. Raab stated that this information was given to Mr. Jones to relay to SherBren.
13. That Mr. Raab testified that of the $4,981.00 billed to SherBren, $3,283.00 was for money owed from the policy written for the period May 30, 1985 to May 30, 1986 and that $1,688.00 was for premiums owed from May 31, 1986 to December 25, 1986, when the policy was cancelled. These amounts represented money not paid by SherBren which an audit revealed they owed. In no way did this bill represent any intention by Nationwide to reinstate coverage, Mr. Raab testified. Your Referee finds Mr. Raab to be credible. (Emphasis added.)
14. That Mr. Paul Jones, an independent agent for Nationwide Insurance Company, testified on its behalf. He stated that he had written SherBren’s policy but that he had authority to bind Nationwide only on auto and home insurance policies. He lacked any authority to reinstate a Workers’ Compensation policy. Mr. Jones further testified that it was his understanding, based upon information given to him by Robin Coleman, that SherBren needed to pay $4,981.00 to cover a $3,283.00 balance owed, and to put a $1,704.00, 30% down payment, on an “86 — 87” policy. (3/29/88 Hearing, Page 25) Mr. Jones forcefully denied that the payment of the 30% down payment would reinstate coverage during the period in question. Mr. Jones could not recall ever having a conversation with Robin Coleman concerning sending $514.00 to Nationwide to reinstate the policy. Furthermore, Mr. Jones opined that Nationwide would have rewritten the policy back to January 16, 1987 if the $514.00 check had not been returned for insufficient funds.

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Bluebook (online)
656 A.2d 164, 1995 Pa. Commw. LEXIS 125, Counsel Stack Legal Research, https://law.counselstack.com/opinion/walker-v-workmens-compensation-appeal-board-pacommwct-1995.