Doucette v. PomesDoucette v. Pomes
- Reporters:
- , ,
- Before:
- Katz
Opinion
KATZ, J.The principal issue in this appeal is whether the intervening plaintiff, Metropolitan District Commission (Metropolitan), as a self-insurer under the Workers’ Compensation Act;
The record discloses the following facts and procedural history. On or about June 13, 1989, during the course of his employment, the plaintiff, Gerald Doucette, Jr., was a passenger in a truck operated by Frank Palmer when the truck was involved in an accident with a motor vehicle operated by the named defendant, Tamara J. Pomes, and owned by the defendant Askel Jensen, Pomes’ father. As a result of the accident, Doucette sustained personal injuries and thereafter instituted an action, against Pomes and Jensen, pursuant to
Doucette also notified his employer, Metropolitan, of the accident. Because Doucette was injured during the course of his employment, Metropolitan, which had chosen to meet its statutory workers’ compensation coverage obligation through self-insurance,6 paid Doucette’s medical expenses in the amount of $3802.72 and compensation benefits in the amount of $8995.45, for a total payment of $12,798.17. Further, Metropolitan has stipulated that Doucette’s future medical and compensation payments that may be awarded by the workers’ compensation commissioner total $2201.83.
At the time of the accident, Pomes and Jensen carried liability insurance coverage through American Universal Insurance Company (American), which subsequently was determined to be insolvent. Consequently, pursuant to
Pomes and Jensen responded to Metropolitan’s intervening complaint by asserting as a special defense that Metropolitan is an insurer within the meaning of the guaranty act and is therefore precluded from recovering from the association because
The defendants raise several issues on appeal. First, they claim that Metropolitan, as a self-insurer, is an insurer for purposes of the guaranty act and, therefore, is precluded from recovering from the association pursuant to
Before turning to the merits of the case, we set forth the well established standard of review for a denial of summary judgment. “Summary judgment ‘shall be rendered forthwith if the pleadings, affidavits and other proof submitted show that there is no genuine issue as to any material fact and that the moving party is entitled to judgment as a matter of law.’ ” Home Ins. Co. v.
I
The defendants’ first claim, that Metropolitan’s status as self-insurer of its employees’ workers’ compensation claims renders it an insurer for purposes of the guaranty act, raises an issue of first impression for this court.11 At the time of the accident in 1989, as it does today, § 31-284b (b) authorized an employer to meet its workers’ compensation obligations under chapter 568 by one of three enumerated methods, or any combination of those methods, one of which was self-insurance.12 To become a self-insured employer, an employer must provide to the chairman of the workers’ compensation commission “satisfactory proof of his solvency and financial
The defendants argue that, as a self-insurer, Metropolitan is barred from recovering from the association. Before addressing the merits of this claim, we discuss briefly the association itself. “The association was established for the purpose of providing a limited form of protection for policyholders and claimants in the event of insurer insolvency. The protection it provides is limited based upon its status as a nonprofit entity and the method by which it is funded. Specifically, the association is a nonprofit legal entity created by statute to which all persons licensed to transact insurance in the state must belong. See
“Pursuant to . . .
A
Our method of statutory interpretation is well established. “[0]ur fundamental objective is to ascertain and give effect to the apparent intent of the legislature. . . . In seeking to discern that intent, we look to the words of the statute itself, to the legislative history and circumstances surrounding its enactment, to the legislative policy it was designed to implement, and to its relationship to existing legislation and common law principles governing the same general subject matter. . . . Furthermore, [w]e presume that laws are enacted in view of existing relevant statutes . . . and that [statutes are to be interpreted with regard to other relevant statutes because the legislature is presumed to have created a consistent body of law.” (Citations omitted; internal quotation marks omitted.) Conway v. Wilton, 238 Conn. 653, 663-64, 680 A.2d 242 (1996).
We begin our analysis, therefore, with an examination of the words of the statute itself. The guaranty act does not define the term “insurer.” It merely defines “[insolvent insurer,” which provides for the circumstances in which an insurer is to be considered insolvent so that its obligations will be met by the association;
First,
Additionally,
According to one scholar, “[a]ll insurance contracts concern risk transference, but not all contracts involving risk transference are insurance.” R. Keeton & A. Widiss, supra, p. 12. In the appeal before us, Metropolitan did not purchase insurance to cover its risk. Rather, it complied with the Workers’ Compensation Act by retaining its own risk. It did not thereby become transformed into an insurer. Rather, it retained its character as an employer that simply elected to pay the expenses associated with its employees’ work-related accidents. Although this is commonly referred to as self-insuring,16 there was no transfer of risk, which is generally considered to be an essential element of an insurance relationship. Therefore, the writings of insurance scholars, in addition to the plain language of § 38a-838 (6), support the definition of insurer as exclusive of self-insurers.
We now turn our attention to the relevant legislative history of the guaranty act, which, unfortunately, is devoid of any discussion of the definition of “insurer.” As we declared in Hunnihan v. Mattatuck Mfg. Co., supra, 243 Conn. 452, “[t]he legislative history [of the guaranty act] confirms that the association was established for the benefit of consumers.” We noted that “[a]t the public hearing held prior to passage of the bill proposing the creation of the association, Peter Kelly,
Although the legislative history of the guaranty act does not contain any discussion of the definition of “insurer,” there is ample evidence that the guaranty act was “substantially the same as a model bill adopted by the National Association of Insurance Commissioners [NAIC], which is an organization of the insurance commissioners of the fifty [s]tates.” Conn. Joint Standing Committee Hearings, supra, p. 55, remarks of Peter Kelly; see also 14 S. Proc., Pt. 6, 1971 Sess., p. 2613, remarks of Senator Joseph Dinielli; 14 H.R. Proc., Pt.
In 1983, an NAIC study committee submitted a report to the NAIC concerning self-insured workers’ compensation groups. 2 NAIC Proceedings (1983) p. 742. While such groups are not identical to an individual employer like Metropolitan, they do self-insure, as a group. We therefore find the report instructive.17 The report states
In the final step of our interpretation of § 38a-838 (6), we consider the statute in question with regard to other relevant statutes, under the assumption that the legislature has enacted a consistent body of law. Conway v. Wilton, supra, 238 Conn. 664. Therefore, we consider it noteworthy that in other contexts, the legislature has chosen to define “insurer” so as to include self-insurers. See
B
The defendants rely on case law from other jurisdictions to support their contention that a self-insurer is an insurer under the guaranty act. Although only a handful of jurisdictions have considered the precise issue before us, the majority of those with guaranty acts similar to § 38a-836 et seq. hold that a self-insurer is not an insurer. See Zinke-Smith, Inc. v. Florida Ins. Guaranty Assn., Inc., 304 So. 2d 507, 509-10 (Fla. App. 1974), cert. denied, 315 So. 2d 469 (Fla. 1975) (self-insuring employer not insurer such as would prevent its claim from qualifying as “covered claim” under Florida’s guaranty act); Iowa Contractors Workers’ Compensation Group v. Iowa Ins. Guaranty Assn., supra, 437 N.W.2d 917 (self-insured workers’ compensation group not insurer for purposes of Iowa’s guaranty act); Ulwick v. Massachusetts Insurers Insolvency Fund, supra, 418 Mass. 489 (self-insuring municipal employer not insurer within language or intent of Massachusetts’ guaranty act); In re Mission Ins. Co., 112 N.M. 433, 435, 816 P.2d 502 (1991) (stating that, for purposes of New Mexico’s guaranty fund, self-insurer was not insurer); Stamp v. Dept. of Labor & Industries, supra, 122 Wash. 2d 543-44 (holding that self-insured employers not reinsurers, insurers, insurance pools or underwriting associations for purposes of Washington’s guaranty act).
The courts of only two jurisdictions have held that a self-insurer is an insurer for purposes of their guaranty acts. The defendants urge us to follow them. The relevant cases are easily distinguishable, however, and we therefore find them unpersuasive. First, in Ventulett v. Maine Ins. Guaranty Assn., 583 A.2d 1022 (Me. 1990), a Massachusetts resident was injured in a work-related
The defendants rely also on Kachanis v. United States, 844 F. Sup. 877, 889 (D.R.I. 1994), in which the United States District Court for the District of Rhode Island held that the United States, which self-insures its workers’ compensation liabilities pursuant to the statutory scheme of the Federal Employees’ Compensation Act;
We join, therefore, the majority of courts that have decided the status of self-insured employers under an insurance guaranty act, and we hold that self-insured employers are not insurers for purposes of Connecticut’s guaranty act. The defendants have advanced no other persuasive reason for holding that Metropolitan’s claim should not be considered a covered claim under § 38a-838 (6). Therefore, we conclude that Metropolitan’s claim was a covered claim as defined in that subsection.
II
The defendants’ second claim is that even if we hold that Metropolitan is not an insurer under the guaranty
In addition to allowing an employee to bring a claim against a tortfeasor, § 31-293 (a) allows an employer that has paid or become obligated to pay compensation to the injured employee under the Workers’ Compensation Act “to take action against a ‘third person’ who is legally liable to pay ‘damages’ for an injury to an employee.” Dodd v. Middlesex Mutual Assurance Co., 242 Conn. 375, 380, 698 A.2d 859 (1997). We have stated that the employer’s right of action under § 31-293 is separate and distinct from the employee’s right, noting that “it is a right vested in the employer exclusively; it is not the right of the employee.” Robinson v. Faulkner, 163 Conn. 365, 377-78, 306 A.2d857 (1972). Additionally, the statute provides that: “No compromise with the [tortfeasor] by either the employer or the employee shall be binding upon or affect the rights of the other, unless assented to by him. . . .”
The legislative history of the Workers’ Compensation Act provides additional support for this interpretation. In Dodd v. Middlesex Mutual Assurance Co., supra,
We return now to the defendants’ argument that
The defendants’ remaining arguments also rely on the applicability of
Finally, Pomes and Jensen assert an additional reason, separate and distinct from
In support of their argument, Pomes and Jensen cite Pokorny v. Getta’s Garage, 219 Conn. 439, 594 A.2d 446 (1991), in which this court held that an employer is not required to pay workers’ compensation benefits in a case in which an employee obtained recovery from another insurer and the other insurer did not assert a hen or offset pursuant to
In Pokorny, we held that an employer was not required to pay its injured employee the value of the employee’s medical expenses that had been paid previously by the employee’s medical insurance carrier, which had not filed a hen pursuant to statute. Id., 440. It does not follow from this holding, however, that, in the present appeal, Metropolitan was required to apply an offset for Shelby’s payment to Doucette. Pokorny “involve[d] only the rights and obligations between the [injured employee], on the one hand, and [the defendant
V
In conclusion, we hold that a self-insured employer is not an insurer for purposes of the guaranty act and, therefore, is not precluded from asserting an otherwise valid claim under § 38a-838 (6). Additionally, we hold that because an employer’s right to assert a claim pursuant to
The judgment is affirmed.
In this opinion the other justices concurred.
Notes
“The association is a nonprofit legal entity established by
“(b) When an injury for which compensation is payable under the provisions of this chapter is determined to be the result of a motor vehicle accident or other accident or circumstance in which a third person other than the employer was negligent and the claim is subrogated by the employer or its workers’ compensation insurance carrier, the insurance carrier shall provide a rate adjustment to the employer’s workers’ compensation policy to reflect the recovery of any compensation paid by the insurance carrier prior to subrogation. . . .”
The record does not specify the coverage limit of the Shelby policy.
This court brought a motion, sua sponte, to dismiss this appeal due to the absence of the association, an indispensable party. After a hearing on the issue, however, rather than dismiss the appeal, we elected to treat the association as a party defendant and its amicus curiae brief as the brief of a party. The association offered no objection and became a party effective June 8, 1998.
Because the defendants sometimes make different arguments, we will refer to them individually when necessary. Otherwise, references to “the defendants” will pertain to all defendants collectively.
Although Pomes and Jensen appear to be arguing against their interests by asserting that Metropolitan cannot recover from the association, thereby leaving only Pomes and Jensen potentially liable to Metropolitan, Pomes and Jensen note that
We recently addressed the issue of the obligation of a self-insured employer to provide uninsured motorist benefits under
See footnote 6 of this opinion.
See footnote 7 of this opinion.
The defendants claim that it does appear from the context that the legislature intended to include self-insurers in § 38a-1 (11). They assert that, because the purpose of the guaranty act is to protect insureds and injured claimants, and Metropolitan fits into neither category, a determination that Metropolitan is not an insurer would be contrary to the act’s purpose. Pomes and Jensen claim that if the association is required to pay Metropolitan, “the ultimate beneficiary would be an insurer [Metropolitan] and not the injured claimant, Doucette.” This tautological argument presupposes, however, that Metropolitan is an insurer. This argument fails because, as we conclude, Metropolitan is not an insurer.
The association also claims that a reading of
At least one state has avoided the confusion surrounding the term self-insurer by labeling an employer that has retained its own workers’ compensation risk an “own risk employer.” See Cities Service Gas Co. v. Witt, 500 P.2d 288 (Okla. 1971).
The NAIC report notes that there are differences between a self-insurer, which “retains and is responsible for its own workers’ compensation risk,” and a self-insured workers’ compensation group, which is a “separate entity formed by many employers to assume their workers’ compensation risks.” 2 NAIC Proceedings, supra, p. 748. A reading of the NAIC report, however, leads us to the conclusion that the report’s reasoning applies to a self-insurer with the same force as to a self-insured workers’ compensation group.
We note that
In reaching its conclusion that the United States is an insurer, the Kachanis court relied heavily on Ferrari v. Toto, 9 Mass. App. 483, 402 N.E.2d 107 (1980), aff‘d, 383 Mass. 36, 417 N.E.2d 427 (1981), an appellate court opinion that held that Massachusetts’ guaranty fund “is excused from paying claims if the ultimate beneficiary is an insurance company.” (Emphasis added.) Id., 486. In other words, Ferrari held that Massachusetts’ guaranty act precludes all members of the insurance industry from recovery, not merely member insurers. Id., 486-87. It is noteworthy, however, that when the Supreme Judicial Court of Massachusetts considered the precise issue with which we are faced, months after Kachanis was decided, that court held that a self-insurer is not an insurer for purposes of the state’s guaranty act. Ulwick v. Massachusetts Insurers Insolvency Fund, supra, 418 Mass. 489.
See footnote 4 of this opinion.
Pomes and Jensen argue that because Metropolitan’s claim is derivative of Doucette’s claim, Metropolitan’s rights are no greater than Doucette’s. Therefore, according to these defendants, any defense available to the defendants against Doucette may also be used against Metropolitan. For support, Pomes and Jensen cite Packtor v. Seppala & AHO Construction Co., 33 Conn. App. 422, 431, 636 A.2d 383, appeal dismissed, 231 Conn. 367, 650 A.2d 534 (1994), in which the Appellate Court denied an employer’s right of action in a case in which the employee’s right of action was barred by the statute of limitations, stating that “it would be illogical to grant greater rights to an employer whose rights are derivative, than to the employee from whom those derivative rights flow.” Pomes and Jensen fail to recognize, however, that the Appellate Court did not bar the employer’s action based on any failure on the employee’s part. Indeed, the court stated: “We agree with [the employer] that it would be inequitable to bar an intervention action by an employer for no other reason than that the employee failed to file his or her action within the applicable period of limitation. . . . The action is not barred, however, by the employee’s procedural failure but by the failure of the employer to bring suit in a timely manner.” (Citations omitted; emphasis in original; internal quotation marks omitted.) Id., 430-31. Likewise, in the present appeal, it would be inequitable to penalize Metropolitan for Doucette’s failure to exhaust the limits of his insurance policy. Metropolitan had no control over Doucette’s actions. It could not compel Doucette to exhaust the limits of his policy. For these reasons, the argument of Pomes and Jensen fails.
In an effort to support their argument, Pomes and Jensen also cite a case from the United States District Court for the District of Connecticut, Harbor Ins. Co. v. Connecticut Ins. Guaranty Assn., 711 F. Sup. 70, 72 (D. Conn. 1989), in which the court held that a claimant’s failure to exhaust his rights under available coverage under an uninsured motorist policy prevented any subsequent recovery against the association by the claimant or the excess insurance earner. Although the fact that the plaintiff in Harbor Ins. Co. was an insurer would preclude recovery under our holding on the first issue of the present appeal, the Harbor Ins. Co. court assumed that the insurer’s claim was a “covered claim” because it deemed the exhaustion argument to be dispositive. Id. Therefore, the court addressed the exhaustion argument, deciding against the insurer because neither the employee nor the insurer had pursued the insured’s rights under the relevant uninsured motorist policy. Id. Much of the court’s holding relies on the fact that the plaintiff excess insurer had settled with the insured. It was this settlement that precluded the plaintiffs recovery. The plaintiffs counsel conceded that it had “sought a prompt settlement . . . to avoid substantially greater exposure . . . .” Id., 74. The court in Harbor Ins. Co. noted that the plaintiff had “admittedly benefited from the decision not to proceed against [the uninsured motorist insurance carrier] nor to add this party to the settlement negotiations.” Id. The court noted that “[h]ad it not been for the settlement with [the plaintiff], [the insured] would have been able to raise a claim against the [association subject to the exhaustion of her rights under the [relevant insurance] policy.” Id. In the present appeal, Metropolitan did not settle with Doucette. Doucette settled with Shelby, its uninsured motorist insurance carrier. Metropolitan’s actions did not trigger the preclusive effect of
The defendants rely on the language of
Again, the association relies on the language of
The association did not advance this claim.
If Pomes and Jensen are concerned about double recovery, we note that “§ 38a-334-6 of the Regulations of Connecticut State Agencies allows an insurer to insert a provision in its contract with the insured mandating a setoff equal to any amounts paid to the insured by way of workers’ compensation, thereby preventing double recovery by the employee.” Dodd v. Middlesex Mutual Assurance Co., supra, 242 Conn. 387.