GAASCH v. ST. PAUL FIRE AND MARINE INSURANCE CO., 412 P.3d 1151

Background

Troy Gaasch, a worker with prior gastric bypass, was hospitalized after a work-related injury; clinicians recommended nutritionist consults and a nurse case manager repeatedly requested them.
Dispute arose whether the nutritional consults were related to the work injury; insurer (St. Paul) initially declined, then approved the consult one day before Troy died. A Form 9 requesting the consult was filed three days before his death.
The Workers' Compensation Court later found Troy died as a direct result of his work injury (with consequential injuries) and awarded death benefits; that award was affirmed in part and modified on appeal.
Stacey Gaasch, as personal representative, sued St. Paul in district court alleging breach of the insurer’s contractual duty/good faith in failing to timely provide court-ordered medical treatment and sought wrongful-death/consequential damages against the carrier.
St. Paul moved for summary judgment arguing (inter alia) that plaintiff needed a Workers' Compensation Court certification order before suing the insurer in district court and that the Workers' Compensation Act provided the exclusive remedy; the district court granted summary judgment for St. Paul.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether plaintiff could bring a district-court breach/wrongful-death action against a WC insurer without a WCC certification order	Gaasch: claim is breach of contract/wrongful death; certification rule applies only to bad-faith torts, not contract claims or delays	St. Paul: WCC certification is jurisdictional for actions asserting failure to provide previously-ordered WC benefits; WC Act is exclusive remedy	Held: Certification by the Workers' Compensation Court is required before pursuing such district-court claims; WC remedies are exclusive
Whether delay (as opposed to complete denial) of a previously-ordered benefit falls outside WCC jurisdiction for certification	Gaasch: WCC lacks jurisdiction to adjudicate "unreasonable delay," so district court is proper	St. Paul: WCC procedure covers failure or delay to provide previously-ordered benefits and affords insurer notice and opportunity to show good cause	Held: WCC certification procedure encompasses delay claims; insurer entitled to WCC adjudication first
Whether wrongful-death/consequential damages against insurer are barred when WC death benefits were paid	Gaasch: wrongful-death remedies differ and insurer is not the employer; separate recovery permitted	St. Paul: WC Act provides exclusive remedy for deaths covered by Act; allowing district claims would undermine exclusivity	Held: The workers' compensation remedy is the exclusive procedure for death-related claims arising from workplace injuries
Whether lack of a WCC certification order was cured by insurer later approving the consult	Gaasch: approval negates need for certification	St. Paul: approval does not remove jurisdictional requirement to obtain certification before suing for alleged failure/delay	Held: Subsequent approval does not relieve plaintiff of the pre-suit WCC certification requirement

Key Cases Cited

Summers v. Zurich Am. Ins. Co., 213 P.3d 565 (Okla. 2009) (requires WCC certification before district-court bad-faith suit over failure to provide benefits ordered by WCC)
Meeks v. Guarantee Ins. Co., 392 P.3d 278 (Okla. 2017) (reaffirmed Summers; explained Rule 58 certification elements and notice to employer/insurer)
Sizemore v. Continental Cas. Co., 142 P.3d 47 (Okla. 2006) (bad-faith claim against WC insurer arises only after award and is distinct from employment-related remedies)
Stewart v. Mercy Health Ctr., Inc., 341 P.3d 70 (Okla. 2014) (held WCC certification is a jurisdictional prerequisite to filing a district-court bad-faith claim for unpaid awards)
Roberts v. Merrill, 386 P.2d 780 (Okla. 1963) (discussed constitutional amendment making WC compensation exclusive remedy for work-related deaths)