William C. Brown v. Muskego Norway School District Group Health Plan

CourtCourt of Appeals of Wisconsin
DecidedOctober 16, 2019
Docket2018AP001799
StatusUnpublished

This text of William C. Brown v. Muskego Norway School District Group Health Plan (William C. Brown v. Muskego Norway School District Group Health Plan) is published on Counsel Stack Legal Research, covering Court of Appeals of Wisconsin primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
William C. Brown v. Muskego Norway School District Group Health Plan, (Wis. Ct. App. 2019).

Opinion

COURT OF APPEALS DECISION NOTICE DATED AND FILED This opinion is subject to further editing. If published, the official version will appear in the bound volume of the Official Reports. October 16, 2019 A party may file with the Supreme Court a Sheila T. Reiff petition to review an adverse decision by the Clerk of Court of Appeals Court of Appeals. See WIS. STAT. § 808.10 and RULE 809.62.

Appeal No. 2018AP1799 Cir. Ct. No. 2016CV353

STATE OF WISCONSIN IN COURT OF APPEALS DISTRICT II

WILLIAM C. BROWN AND BETH A. BROWN,

PLAINTIFFS-COUNTER DEFENDANTS-APPELLANTS,

V.

MUSKEGO NORWAY SCHOOL DISTRICT GROUP HEALTH PLAN,

DEFENDANT-COUNTER CLAIMANT-RESPONDENT.

APPEAL from a judgment and an order of the circuit court for Waukesha County: WILLIAM DOMINA, Judge. Affirmed in part; reversed in part and cause remanded with directions.

Before Reilly, P.J., Gundrum and Kessler, JJ.

¶1 REILLY, P.J. William C. Brown was injured in a motorcycle accident. Brown declined worker’s compensation coverage and wanted coverage No. 2018AP1799

provided by his own health insurance policy. The circuit court found that Brown was in the course of his employment when he was injured and further found that Brown’s health insurance policy expressly excluded coverage as benefits were available to Brown under the worker’s compensation law. We affirm.

¶2 On November 4, 2015, Brown suffered significant injuries in a serious motorcycle accident. At the time, Brown was a salaried employee of Gardner Pet Group, which had two plant locations in Wisconsin: one in Juneau and one in West Bend. Brown’s office was located at the West Bend location, but he was often required at both locations. The morning of the accident, Brown attended a meeting at the Juneau plant and remained at the Juneau plant until approximately 2:00 p.m.

¶3 The accident occurred at approximately 2:47 p.m. as Brown was traveling east on Highway 33, which is the most direct route to his office at the West Bend plant. Brown claims that he left the Juneau plant to enjoy a motorcycle ride on a beautiful day and to have lunch as he had already put in an eight-hour day. He explained that he “just started meandering” on the roads and at some point he ended up back on Highway 33. When asked whether he was planning on going back to his office, Brown responded, “I don’t know to be honest with you. I don’t know if I was…. The concept would be let’s just go for a ride.”

¶4 Five days after the accident, Gardner Pet Group submitted a claim to the Wisconsin Department of Workforce Development’s Worker’s Compensation Division, indicating that Brown was “driving from one work location to another” when the accident occurred. Thereafter, Travelers Property Casualty Company of America (Travelers)—Gardner Pet Group’s worker’s compensation carrier— opened a file and began its claims investigation. Travelers completed its

2 No. 2018AP1799

investigation on November 12, 2015, and determined that Brown’s claim was compensable and that “[t]he accident arose out of and in the course of [Brown’s] employment.” When Brown discovered the claim had been filed, he refused the worker’s compensation checks he received from Travelers and instructed Gardner Pet Group to withdraw the claim,1 arguing that he was not working at the time of his accident.

¶5 Muskego Norway School District Group Health Plan (the Plan)— Brown’s health insurer—also investigated whether it owed coverage and sent a standard questionnaire to Brown, which included the question, “Was treatment required as the result of a work related Injury or Illness,” and the box was marked, “No.” The form was signed on February 11, 2016, by Brown’s attorney. Relying on the questionnaire, the Plan paid $482,099.61 for Brown’s medical care and treatment as a result of the accident.

¶6 Brown filed this action on February 22, 2016, against the driver and insurer of the vehicle that hit him, alleging negligence.2 The amended complaint also named the Plan as a subrogated party for the health care payments that it made and Travelers in the event it made payments. On July 17, 2017, the Plan filed an amended answer and counterclaim seeking a declaration under WIS. STAT.

1 The first indication that Brown did not want his claims paid under his worker’s compensation coverage was a November 11, 2015 e-mail from Gardner Pet Group to Travelers, which stated that “Brown would like to put the workers comp claim on hold for now. He has an attorney and will be going down another avenue at this point.” Brown’s personal injury attorney also sent an e-mail to Gardner Pet Group on November 13, 2015, stating that “Brown is not making a workers compensation claim at this time, and we acknowledge that the company has offered him the opportunity to do so. In the event that a claim has been made to your company’s workers compensation carrier, please rescind that claim.” 2 The other driver and her insurer were dismissed from the suit under a settlement on January 23, 2017.

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§ 806.04 (2017-18)3 that the Plan was not obligated to pay any claims arising from the accident pursuant to the Plan language as Brown was covered by worker’s compensation benefits. The circuit court agreed and granted the Plan’s motion for summary judgment and entered a judgment in the amount of $514,551.28, which included costs and interest against Brown in favor of the Plan. Brown appeals from both the order granting summary judgment as well as the judgment awarding interest and costs.

DISCUSSION

¶7 We review a circuit court’s grant of summary judgment utilizing the same methodology as the circuit court. Green Spring Farms v. Kersten, 136 Wis. 2d 304, 314-16, 401 N.W.2d 816 (1987). “[S]ummary judgment is appropriate when there is no genuine issue of material fact and the moving party is entitled to judgment as a matter of law.” M & I First Nat’l Bank v. Episcopal Homes Mgmt., Inc., 195 Wis. 2d 485, 496-97, 536 N.W.2d 175 (Ct. App. 1995); see also WIS. STAT. § 802.08(2). Summary judgment presents a question of law that we review de novo. M & I First Nat’l Bank, 195 Wis. 2d at 497. Interpretation of an insurance contract is a question of law we review de novo. Varda v. Acuity, 2005 WI App 167, ¶7, 284 Wis. 2d 552, 702 N.W.2d 65.

Plan Language

¶8 We begin with the plain language of the policy. Section 6 of the Plan indicates that “[t]he Plan does not provide benefits”

3 All references to the Wisconsin Statutes are to the 2017-18 version unless otherwise noted.

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[f]or any … injury arising out of and in the course of employment if benefits are available under any Workers’ Compensation Act or other similar law…. This exclusion also applies whether or not you claim the benefits or compensation. It also applies whether or not you recover from any third party.

Further, under general provisions, the Plan provides that

All money paid or owed by Workers’ Compensation for services provided to a Member shall be paid back by, or on behalf of, the Member to the Plan if the Plan has made or makes payment for the services received.

Similarly, under the “Right of Recovery,” the Plan provides: “Whenever payment has been made in error, the Plan will have the right to recover such payment from you ….” To determine whether the Plan’s exclusion applies, we apply Wisconsin’s worker’s compensation law to the facts of this case.

Worker’s Compensation Law: “Traveling Employees”

¶9 WISCONSIN STAT.

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William C. Brown v. Muskego Norway School District Group Health Plan, Counsel Stack Legal Research, https://law.counselstack.com/opinion/william-c-brown-v-muskego-norway-school-district-group-health-plan-wisctapp-2019.