Lead Opinion
Appellant, The Travelers Indemnity Company (“Travelers”), is the workers’ compensation insurance carrier for Appel-lee Deborah L. Reker’s employer, Amick <& Kreider Associates, Inc. Reker filed a workers’ compensation claim for injuries that she sustained on May 18, 1987. On November 21, 1997, an administrative law judge (ALJ) found that the injuries were work-related and that she had sustained a 50% permanent partial disability as a result. She was awarded benefits accordingly. The employer and Travelers appealed and the award was affirmed by the Workers’ Compensation Board on May 22, 1998. Meanwhile, in March 1998, Reker filed a motion to reopen her claim, KRS 342.125, seeking additional payments of $353.38 in unpaid medical and prescription bills and payment of a $468.78 motel bill. Reker’s entire workers’ compensation claim was ultimately settled in June 2000 for a lump sum payment of $125,000.00. The settlement agreement recites that the dispute as to medical expenses was submitted to an arbitrator and resolved in September 1999.
On June 8, 1998, Reker filed this civil action in the Boone Circuit Court seeking payment of the then-unpaid medical expenses and motel bill, totaling $822.16, that were the subject of the March 1998 motion to reopen her claim. She also sought compensatory damages for “worry and anguish” and “embarrassment” endured as a result of being dunned by medical providers for payment of the unpaid bills and as a result of Travelers’ alleged “bad faith” refusal to settle her workers’ compensation claim. Although Reker characterizes both Travelers’ defense of her claim and its appeal to the Workers’ Compensation Board as frivolous and in bad faith, the
This continues to be a case of contested and disputed liability on issues of work relationship and causation and existence of continuing medical treatment needs arising from the subject accident. These agreements represent a compromised settlement of all potential claims and defenses between the parties.
The Boone Circuit Court entered a summary judgment in favor of Travelers premised upon the “exclusive remedy” provision of the Workers’ Compensation Act, KRS 342.690(1), and our decision in Zurich Insurance Co. v. Mitchell, Ky.,
I. KRS 342.690(1).
The first sentence of KRS 342.690(1) provides:
If an employer secures payment of compensation as required by this chapter, the liability of such employer under this chapter shall be exclusive and in place of all other liability of such employer to the employee, his legal representative, husband or wife, parents, dependents, next of kin, and anyone otherwise entitled to recover damages from such employer at law or in admiralty on account of such injury or death.
The fourth sentence of the statute extends the same “exclusive remedy” shield to the employer’s workers’ compensation insurance carrier.
The exemption from liability given an employer by this section shall also extend to such employer’s carrier, and to all employees, officers, or directors of such employer or carrier, provided the exemption from liability given an employee, officer or director of an employer or carrier shall not apply in any case where the injury or death is proximately caused by the willful and unprovoked physical aggression of such employee, officer or director. [Emphasis added.]
In Zurich Insurance Co. v. Mitchell, supra, wé held that these provisions preclude a civil action against a workers’ compensation insurer for an alleged “bad faith” refusal to settle a claim. Id. at 344. (Reker does not assert that her assailant was an employee, officer or director of Travelers.)
The “exclusive remedy” provision has been a part of the Workers’ Compensation Act since its enactment in 1916. K.S. § 4882 (1916 Ky. Acts, ch. 33, § 3, repealed KRS 447.025, 1942 Ky. Acts, ch. 208, § 20); replaced by KRS 342.015(1) (1942 Ky. Acts, ch. 208, §§ 1, 2, repealed 1972 Ky. Acts, ch. 77, § 36, eff. January 1,1973); replaced by KRS 342.690(1) (1972 Ky. Acts, ch. 78, § 9, eff. January 1, 1973). In addition, KRS 342.395(3) provides that until and unless an employee files a written notice of rejection of the Act, i.e., “opts out,” “the measure of liability of the em
It is elementary that “[wjorkers’ compensation is a creature of statute, and the remedies and procedures described therein are exclusive.” Williams v. Eastern Coal Corp., Ky.,
In Brown Badgett, Inc. v. Calloway, Ky.,
II. KRS 342.267.
Reker asserts and the Court of Appeals agreed that the 1996 enactment of KRS 342.267 authorized a civil cause of action against a workers’ compensation insurer for an alleged unfair claims settlement practice and, thus, abrogated the holdings in Mitchell and Blank, supra. In fact, KRS 342.267 is completely silent on that issue, viz:
*761 If an insurance carrier, self-insurance group, or self-insured employer providing workers’ compensation coverage engages in claims settlement practices in violation of this chapter, or the provisions of KRS 304.12-230, the commissioner of the Department of Workers’ Claims shall fine the insurance company, self-insurance group, or self-insured employer the sum of one thousand dollars ($1,000) to five thousand dollars ($5,000) for each violation and if they have a pattern of violations, the commissioner may revoke the certificate of self-insurance or request the commissioner of insurance to revoke the certificate of authority of the insurance carrier.
The General Assembly knows how to authorize private civil actions for violations of the Workers’ Compensation Act. It has done so by clear and unambiguous language in three separate statutes. KRS 342.690(2) authorizes an injured worker to “maintain an action at law or admiralty” for damages against an employer who has failed to secure payment of compensation as required by KRS 342.340. KRS 342.197(3) authorizes a civil action for damages against an employer who has discriminated against an employee for filing and pursuing a lawful workers’ compensation claim or because the employee suffers from early stage pneumoconiosis, viz:
Any individual injured by any act in violation of the provisions of subsection (1) or (2) of this section shall have a civil cause of action in Circuit Court to enjoin further violations, and to recover the actual damages sustained by him, together with the costs of the law suit, including a reasonable fee for his attorney of record.
KRS 342.035(2) prohibits a medical provider from attempting to collect directly from the injured worker any charge for treatment of a work-related injury or occupational disease, and:
In addition to the penalty imposed in KRS 342.990 for violations of this subsection, any individual who sustains damages by any act in violation of the provisions of this subsection shall have a civil cause of action in Circuit Court to enjoin further violations and to recover the actual damages sustained by the individual, together with the costs of the lawsuit, including a reasonable attorney’s fee.
This statutory remedy is interrelated to KRS 342.020(1), which requires the insurance carrier to pay the medical bills directly to the provider within certain specified time periods, subject to penalties set forth in KRS 342.990(7)(b). Thus, any dispute over the payment of a medical bill is between the provider and the carrier, not the provider and the patient. If Reker has a claim for “worry and anguish” and “embarrassment” because she was dunned by her medical providers, her cause of action is against those providers, not Travelers, and KRS 342.035(2) specifically authorizes such an action.
Note that none of these three statutes creates an exception to the exclusive remedy provision of KRS 342.690(1). KRS 342.690(2) authorizes a civil cause of action against an employer who has not “se-eure[d] ... payment of compensation” by either procuring insurance coverage or qualifying as a self-insured pursuant to KRS 342.340(1), whereas KRS 342.690(1) shields only an employer who has “secure[d] payment of compensation.” KRS 342.197(3) authorizes a civil cause of action because of discrimination, not because of a work-related accident or occupational disease. KRS 342.035(2) authorizes a civil cause of action by the employee against a medical provider, not against the employer or insurer.
In summary, KRS 342.267 does not facially authorize a civil action for a bad faith refusal to settle, or for a delay in payment of benefits, or for failing, sua sponte, to pay benefits during the pendency of an appeal. It only authorizes, in addition to the remedies available to the worker under KRS 342.040, KRS 342.300, and 342.310(1), supra, punitive action against the insurer or self-insurer by the commissioner of the Department of Workers’ Claims.
III. KRS 446.070.
Realizing that the language of KRS 342.267 does not, itself, authorize a civil cause of action for a “bad faith” refusal to settle a workers’ compensation claim, Reker asserts and the Court of Appeals agreed that the cause of action is authorized by KRS 446.070. That statute provides:
A person injured by the violation of any statute may recover from the offender such damages as he sustained by reason of the violation, although a penalty or forfeiture is imposed for such violation.
In State Farm Mutual Automobile Insurance Co. v. Reeder, Ky.,
Here, although a civil remedy for a “bad faith” refusal to settle is not specified within the confines of KRS 342.267, it is specified in those interrelated provisions of the Workers’ Compensation Act discussed supra, i.e., KRS 342.040, KRS 342.300, and 342.310(1). The UCSPA, which was being interpreted in Reeder, supra, is a part of the Kentucky Insurance Code, a statutory
Workers’ compensation insurance is different from other forms of liability insurance. The KÚCSPA is part of the Insurance Code, whereas the Workers’ Compensation Act is part of the labor and human rights statutes.
Farmland Mut. Ins. Co. v. Johnson, Ky.,
The Court of Appeals’ opinion asserts that “we can reasonably assume that the legislature was aware of KRS 446.070 when it enacted KRS 342.267.” No doubt; but we can also reasonably assume that the legislature was equally aware of both KRS 342.690(1) and Simmons v. Clark Construction Co., Ky.,
First, if two statutes are irreconcilable, the later enactment prevails. Butcher v. Adams,
Second, when two statutes are in conflict, one of which deals with the subject matter in a general way and the other in a specific way, the more specific provision prevails. E.g., Commonwealth v. Phon, Ky.,
IV. LEGISLATIVE INTENT.
“The seminal duty of a court in construing a statute is to effectuate the intent of the legislature.” Commonwealth v. Plowman, Ky.,
Though confronted here with complete statutory silence (if we disregard KRS 342.690(1)), we are not confined to mere conjecture in determining whether the legislature intended to authorize a private civil action for damages for a violation of KRS 342.267; for here, as in Roberts, supra, “the legislature specifically rejected the alternative of tort liability.” Id. at 636. Our only task is to recognize and give effect to that specific rejection.
KRS 342.267 was enacted on December 12, 1996. 1996 Ky. Acts (1st Ex.Sess.), eh. 1, § 80, eff. December 12, 1996. The legislation was introduced as House Bill 1, section 80, and never included a provision authorizing a private civil action in tort for its violation. However, on December 11, 1996, floor amendment number 5 to section 80 was introduced on the Senate floor. That amendment would have added the following language as a proposed subsection (2) of the statute:
An employee shall retain the right to bring a cause of action against a workers’ compensation insurer, self-insured, or group self-insured for the violation of any of the acts or omissions set forth in subsection (1) of this section.
1996 Ky. Senate Journ. (1st Ex.Sess.) 125.
On December 12,1996, floor amendment number 5 was called to a vote and was initially passed by a vote of 20 to 17. Id. at 197. Later that same day, the Senate voted to reconsider its vote on the amendment. Id. at 198. A new vote was taken and floor amendment number 5 was defeated by a vote of 21 to 17. Id. In view of this legislative history, it is not even arguable that the Senate did not intend by its second vote to reject a proposed amendment to KRS 342.267 that would have accomplished by specific provision what Reker would have us hold was accomplished by implication.
If the 1996 defeat of floor amendment number 5 were not proof enough of a legislative intent not to authorize a private right of recovery by an employee for a violation of KRS 342.267, the 2000 General Assembly rejected two more proposed amendments of KRS 342.267 that were intended to accomplish that result. Section 6 of House Bill 992 would have provided for the imposition of penalties for its violation payable directly to the employee. 2000 Ky. House Journ. 2584, 2591-92. Although House Bill 992 initially passed the House of Representatives with section 6 intact, that section was deleted from the Senate Committee Substitute, 2000 Ky. Senate Journ. 3204-28, 3215, that was ultimately adopted by the full Senate. Id. at 3251. The bill was then referred to a free conference committee and subsequently reported back to the House and Senate with section 6 still deleted. Both houses then passed the bill with section 6 deleted. 2000 Ky. House Journ. 5321-24; 2000 Ky. Senate Journ. 3540. During that same 2000 session of the General Assembly, the House Labor and Industry Committee reported House Bill 188 (Committee Substi
Reker urges us to ignore this incontrovertible evidence of legislative intent and declare the language of KRS 342.267 to be “clear and unambiguous” in authorizing a tort action for its violation, thus obviating any requirement to apply rules of statutory construction or to examine legislative history. In other words, even though we know from the legislative history of KRS 342.267 that the legislature did not intend to authorize a private cause of action for its violation, Reker claims we are precluded from considering that legislative history because the words used in the statute clearly and unambiguously provide otherwise. Griffin v. City of Bowling Green, Ky.,
In fact, the applicable rule of construction with respect to matters not expressed in a statute is that “a court must refer to ‘the words used in enacting the statute rather than surmising what may have been intended but was not expressed.’ ” Hale v. Combs, Ky.,
Reker’s claim that the language of KRS 342.267 clearly and unambiguously expresses a legislative intent to create a cause of action in tort for its violation is premised upon the reference in the statute to the UCSPA, KRS 304.12-230. However, that reference to KRS 304.12-230, when read in context, obviously was intended only to define what constitutes a violation of KRS 342.267, not to authorize a private civil action for such violation. Remember, KRS 304.12-230, itself, does not authorize a private civil action for its violation. The only authority for a cause of action premised upon a violation of the UCSPA is KRS 446.070 which we have previously held does not apply to violations of the Workers’ Compensation Act. Simmons v. Clark Const. Co., supra. Nevertheless, at the same 1996 legislative session at which KRS 342.267 was enacted and Senate floor amendment number 5 thereto rejected, floor amendment number 6 to House Bill 1
An employee shall retain the right to bring a cause of action pursuant to KRS 304.12-230 against a workers’ compensation insurer or individual and group workers’ compensation self-insurers.
The amendment was introduced on December 5, 1996, 1996 Ky. House Journ. (1st Ex.Sess.) 204, and voted down the next day. Id. at 226. The defeat of this proposed amendment, which would have specifically applied the “cause of action pursuant to KRS 304.12-230” to a violation of a workers’ compensation statute, clearly indicates that the reference to KRS 304.12-230 in KRS 342.267 was not intended to authorize a private cause of action against a workers’ compensation insurer for a violation of either statute.
Finally, even if the literal language of KRS 342.267 did suggest an intent to depart from the “exclusive remedy” provision in KRS 342.690(1), such would require, not obviate, an inquiry into the legislative history.
Of course, the courts should not resort to legislative history for the purpose of construing a statute where there could be no question as to the intent of the legislature, but where the literal meaning of a statute makes it a substantial departure from the long-established legislative policy on the subject, known to the court, the doubt thereby arising as to the legislative intent requires an examination of available information bearing on the purpose desired to be accomplished by the legislation in question.
Swift v. Southeastern Greyhound Lines, 294 Ky. 137,
If, indeed, “[wjorkers’ compensation is a creature of statute,” Williams v. Eastern Coal Gorp.,
Accordingly, we reverse the Court of Appeals and reinstate the judgment of the Boone Circuit Court.
which he believes to be an unnecessary analysis.
Dissenting Opinion
dissenting.
The Court of Appeals below held that, by virtue of KRS 446.070, an individual injured by a violation of KRS 342.267 may pursue a civil action in circuit court for damages. Since I find no error in the judgment rendered by the Court of Appeals, I disagree with the opinion of the majority.
KRS 342.267 is a provision of the Workers’ Compensation Act that sets forth pen
If an insurance carrier, self-insurance group, or self-insured employer providing workers’ compensation coverage engages in claims settlement practices in violation of this chapter, or the provisions of KRS 304.12-230, the commissioner of the Department of Workers’ Claims shall fine the insurance company, self-insurance group, or self-insured employer the sum of one thousand dollars ($ 1,000) to five thousand dollars ($ 5,000) for each violation and if they have a pattern of violations, the commissioner may revoke the certificate of self-insurance or request the commissioner of insurance to revoke the certificate of authority of the insurance carrier.
The Unfair Claims Settlement Practices Act (“UCSPA”), KRS 304.12-230, a provision of the Insurance Code, is specifically referenced by KRS 342.267. Subsection six of the UCSPA provides that it is an unfair claims settlement practice for one to not attempt “in good faith to effectuate prompt, fair and equitable settlements of claims in which liability has become reasonably clear.”
KRS 446.070 provides that a penalty assessed for violation of a statute is no bar to recovery in a civil action. It states that “[a] person injured by the violation of any statute may recover from the offender such damages as he sustained by reason of the violation, although a penalty or forfeiture is imposed for such violation.”
KRS 446.070 has been a part of Kentucky’s statutory law for over a hundred years. It can reasonably be inferred that the General Assembly was aware of this provision when it enacted KRS 342.267. It necessarily follows that the General Assembly must have been aware KRS 446.070 would be applicable to KRS 342.267, since it incorporates the UCSPA. As noted, KRS 342.267 reveals that it provides a penalty. The Commissioner of the Department of Workers’ Claims can impose a fine upon any workers’ compensation insurance carrier that engages in claims settlement practices in violation of the UCSPA. This statute alone provides an individual with a mechanism to penalize a workers’ compensation carrier for not acting in good faith in claims settlement, but no remedy is specifically provided.
The majority takes the position that the General Assembly did not intend to allow a civil remedy because proposed amendments to KRS 342.267, which would have specifically provided such a remedy, were defeated. I do not find this to be a declaration of the General Assembly’s intent. ‘Where the words used in a statute are clear and unambiguous and express the legislative intent, there is no room for construction and the statute must be accepted as it is written.” Griffin v. City of Bowling Green, Ky.,
It is argued by the appellant, Travelers, that the Workers’ Compensation Act under KRS 342.690 makes all remedies arising out of work-related injuries exclusive to the remedies and procedures proscribed thereunder. I agree that any claims related to an injury that occurred within the
Travelers cites to a number of prior decisions from both this Court and the Court of Appeals, which purportedly hold that injured workers, who elect to be covered by workers’ compensation, are limited to only those remedies provided in the Workers’ Compensation Act, and as a consequence, are not entitled to maintain a civil action in circuit court.
Travelers relies on Zurich Insurance Co. v. Mitchell, Ky.,
Travelers also cites to Simmons v. Clark Construction Co., Ky.,
Finally, I fail to see how the public policy underlying the existence of the workers’ compensation system would be jeopardized if the Court of Appeals’ judgment was affirmed. The instant matter concerns only KRS 342.267, not the entire Workers’ Compensation Act. Contrary to the opinion of the majority, upholding the decision of the Court of Appeals would not “emasculate” the long-standing legislative public policy embodied within this state’s system of workers’ compensation. The enactment of KRS 342.267 simply recognized the need for workers’ compensation carriers to act promptly, and in good faith, where the claim of an injured worker, perhaps the sole support of a family, was concerned.
For the foregoing reasons, I would affirm the judgment of the Court of Appeals.
GRAVES and WINTERSHEIMER, JJ., join this dissent.
