Wagner v. Workers' Compensation Appeal Board, 2012 Pa. Commw. LEXIS 167

Claimant Anthony Wagner petitions for review of a Board denial of workers’ compensation benefits alleging exemption from coverage under Section 104 of the Act.
Wagner was an executive officer and sole shareholder of Anthony Wagner Auto Repairs & Sales, Inc., a Subchapter S corporation; the business previously operated as a sole proprietorship before incorporation in 2004–2005.
Insurance agent sent forms LIBC-509 and LIBC-513 to exclude Wagner from coverage; Wagner signed them without reading, informing the insurer he would be excluded.
The insurer later did not attach an executive officer exclusion endorsement to the policy; payroll information used for premium did not include Wagner’s wages, reflecting his exclusion.
The WCJ found Wagner intentionally and knowingly elected exclusion; the Board affirmed; the petition challenges whether the LIBC forms constitute a valid waiver and whether Rating Manual endorsements were required.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Validity of the LIBC forms as a waiver	Wagner argues the LIBC forms were not part of the contract and are insufficient to waive coverage.	Employer/Insurer argues the forms, executed by Wagner, validly waived coverage under the Act.	Forms LIBC-509 and 513 constitute a valid waiver.
Effect of missing executive officer endorsement	Waiver was defective because the rating manual endorsement was not issued.	Rating Manual endorsement not mandatory; absence does not equate to coverage.	Endorsement absence does not defeat valid exclusion.
Role of rating manual and regulatory enforcement	Insurer was required to comply with Rating Manual instructions and regulatory scheme.	WCJ/Board should not adjudicate regulatory compliance; issues regulated by rating bureau/Insurance Department.	Regulatory compliance challenges lie outside WCJ adjudication; not a basis to deny exclusion on this record.

Standard Venetian Blind Co. v. American Empire Insurance Co., 503 Pa. 300 (Pa. 1983) (limitation on coverage must be clear and conspicuous; contract interpretation principles apply)
Lehigh County Vocational-Technical School v. Workmen's Compensation Appeal Board (Wolfe), 539 Pa. 322 (Pa. 1995) (standards for reviewing WCJ findings; substantial evidence and statutory scope)