VERONICA JEWELL V. KENTUCKY SCHOOL BOARD ASSOCIATION
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RENDERED : JANUARY 21, 2010
TO BE PUBLISHED
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2008-SC-000244-DG
ON REVIEW FROM COURT OF APPEALS
CASE NO. 2006-CA-001995-MR
WHITLEY CIRCUIT COURT NO. 04-CI-00106
KENTUCKY SCHOOL BOARD ASSOCIATION
APPELLEE
OPINION OF THE COURT BY JUSTICE VENTERS
AFFIRMING IN PART AND REVERSING IN PART
This case arises from a motor vehicle collision where the injured party, at
work when the collision occurred, pursued her remedies against her underinsured motorist insurer. Among other issues, we address the question of
whether an injured worker, as assignee of her workers' compensation carrier's
subrogation rights, may enforce those rights against her underinsured motorist
insurance provider. Although prior decisions have addressed separate
elements of the issue, we find none that have application to the combination of
factors present here.
RELEVANT FACTS
Appellant, Veronica Jewell, while working as a school bus monitor for
Williamsburg Independent School System, injured her left knee when the
school bus she was riding was struck by another vehicle. The driver of the
other vehicle caused the collision. Appellee, Kentucky School Board
Association (KSBA), administered a liability selfinsurance trust for the school
system, and thereby provided motor vehicle insurance coverage for Appellant
that included $20,000 .00 in basic reparation benefits (BRB) and underinsured
motorist (UIM) protection .
The school system's workers' compensation carrier paid $17,734 .55 in
medical benefits on behalf of Appellant, mainly for knee surgery. She also
received temporary disability income benefits of $784 .55 . Appellant later had
total knee replacement surgery . The workers' compensation carrier denied
payment for that surgery, based on its assessment that the need for the
surgery did not arise from the work-related accident. Ultimately, the knee
replacement surgery was paid for by Appellant's health care insurer, whose
right to subrogation was preserved .
Eventually, Appellant settled the dispute with her workers' compensation
insurer for $25,000.00, from which $8307.45 was paid to the health insurer to
satisfy its right of subrogation . As part of the settlement, the workers'
compensation carrier and the health care insurer assigned to Appellant their
third-party subrogation rights .
The only BRB payments paid by KSBA to, or on behalf of, Appellant was
$333 .45 for lost wages not paid by workers' compensation .
After settling her tort claim against the negligent driver for his liability
policy limits of $25,000, Appellant filed suit against Appellee, KSBA, for the
available UIM coverage . The case was tried in the Whitley Circuit Court by a
jury which found that Appellant suffered the following damages as a result of
the accident:
Medical expenses to date
Future medical expenses
Lost wages or income
Future lost wages
Pain and Suffering
TOTAL
$70,558.77
.00
$5,544 .00
.00
$25,000 .00
$101,102 .77
Before entering final judgment, the trial court reduced the award by the
$25,000 .00 paid by the tortfeasor's liability carrier and $333 .45 previously paid
to Appellant by KSBA as basic reparation benefits .
On appeal, the Court of Appeals held: 1) that Appellant's UIM carrier was
entitled to an offset for workers' compensation benefits paid on Appellant's
behalf; 2) that Appellant's judgment could not be credited with the attorney's
fees and expenses she incurred; and, 3) that Appellant's judgment should have
been reduced by the full $20,000 of available BRB, rather than $333 .45 in
benefits actually paid .
We affirm the Court of Appeals with respect to the first two issues . On
the third issue, we reverse the Court of Appeals.
ANALYSIS
I . APPELLANT, AS ASSIGNEE OF HER WORKERS' COMPENSATION
CARRIER'S SUBROGATION RIGHTS, MAY NOT ENFORCE THOSE RIGHTS
AGAINST HER UIM PROVIDER .
Appellant challenges the Court of Appeals' decision that barred her claim
against KSBA's UIM coverage in the amount of the workers' compensation
award, arguing the KRS 342 .700(1)'s prohibition against double recovery does
not apply to her because she is exercising her -own rights as the injured,
employee and her rights as assignee of her workers' compensation provider.
KRS 342 .700(1) provides, in part:
Whenever an injury for which compensation is payable under this
[workers' compensation] chapter has been sustained under
circumstances creating in some other person than the employer a
legal liability to pay damages, the injured employee may either
claim compensation or proceed at law by civil action against the
other person to recover damages, or proceed both against the
employer for compensation and the other person to recover
damages, but he shall not collect from both . . . . If compensation
is awarded under this chapter [the workers' compensation
provider] . . . may recover . . . from the other person in whom legal
liability for damages exists, not to exceed the indemnity paid and
payable to the injured employee, less the employee's legal fees and
expense ."
KRS 342 .700(l) plainly states that a workers' compensation insurance
provider has a right of recovery against the tortfeasor for the liability it incurred
on behalf of an injured worker . Appellant correctly relies on the holding of
Weinberg v. Crenshaw, 896 S .W.2d 22, 24 (Ky. App. 1995) that a provider of
workers' compensation benefits may assign that right to the injured worker,
and that the injured worker may enforce that right against a person "other
than the employer" who is legally liable for the damages. Doing so does not
offend KRS 342 . 700(1)'s rule against double recovery. Weinberg is solidly
grounded on the principle that as assignee, the injured employee "step(s) into
the shoes" of the insurance carrier and his claim against the tortfeasor exists
as a derivative action based on the assignment rather than an independent
claim of tort victim in his own right . Id. at 24 . There is no "double recovery"
when , the injured employee/ assignee recoups from the tortfeasor what the
insurance carrier/ assignor had a right to recover. Nor, does the tortfeasor or
his insurer pay the same damage twice. What is paid to the injured employee
as tort victim compensates different damages than funds paid to recompense
the workers' compensation provider.
In Krahwinkel v. Commonwealth Aluminum Corp., 183 S .W.3d 154 (Ky.
2005), citing decisions dating back to the initial enactment of the workers'
compensation statutes, I we held that KRS 342 .700(1) precludes a plaintiff from
recovering from a tortfeasor the same elements of damages for which he had
already been compensated by way of workers' compensation benefits ; and that
the tortfeasor is entitled to an offset or credit against the judgment for those
damages awarded by the jury that duplicate workers' compensation benefits.
183 S .W.3d at 160 . The workers' compensation carrier's apparent
abandonment of its subrogation rights against the tortfeasor does not effect a
transfer of those rights to the injured worker. The result may be a "windfall"
1 S. Quarries & Contracting Co. v. Hensley, 232 S.W.2d 999 (Ky. 1950) ; Dillman v. John
Diebold & Sons Stone Co., 44 S.W.2d 58 1(Ky. 1931) ; Napier v. John P. Gorman Coal
Co., 45 S .W.2d 1064 (Ky .1931) ; Berry v. Irwin, 6 S .W.2d 705 (Ky. 1928) ; Williams v.
Brown, 265 S .W. 480 (Ky. 1924) ; Book v. City ofHenderson, 197 S.W . 449 (Ky.
1917) .
for the tortfeasor,2 but such is the case any time a cause of action goes
unpursued . Krahwinkel, however, did not arise from a motor vehicle accident
and therefore does not address the liability of a UIM provider.
Cincinnati Ins. Co. v.. Samples, 192 S.W .-3d 311 (Ky. 2006), did, involve the
liability of an UIM carrier. In Samples, we applied the Krahwinkel holding to a
plaintiff who was seeking to recover from his UIM carrier the same elements of
damages for which he had already been compensated by way of workers'
compensation benefits . We held that because the UIM carrier "stands in the
wrongdoer's shoes for purposes of paying damages," and since under
Krahwinkel, the tortfeasor had no liability to the injured employee to the extent
of workers' compensation benefits, the UIM carrier had no liability for the same
damages . Id. at 316 .
Appellant distinguishes herself from the plaintiffs in Krahwinkel and
Samples because, unlike those parties, she holds a valid assignment of the
workers' compensation insurer's subrogation rights against the tortfeasor,
which she may under Weinberg v. Crenshaw clearly enforce . The question she
raises now is whether that claim may be enforced, not against the tortfeasor or
his liability insurance carrier (whose liability was extinguished by paying
Appellant the policy limits), but against KSBA, her own UIM provider.
KRS 342 .700(1) permits Appellant's workers' compensation carrier to
recover from "the other person in whom legal liability for damages exists ."
2 Three justices dissented, expressing concern that the windfall arising from the failure
of the workers' compensation carrier to assert its subrogation rights should not go
to the undeserving tortfeasor.
Appellant urges us to enunciate a construction of that phrase broad enough to
include KSBA in its role as a UIM provider . Such a construction would require
that we overrule the long-standing precedent established by this Court in State
Farm- Mutual Ins. -Co. v.- Fireman's Fund Am. Ins. Co -550 S:W..2d 554 (Ky.
1977), and more recently followed by the Court of Appeals in G & J Pepsi-Cola
Bottlers, Inc. v. Fletcher, 229 S .W .3d 915 (Ky . App . 2007). State Farm Mutual
Ins. Co. v. Fireman's Fund Am. Ins. Co holds :
A payment made in performance of a contractual obligation is not
a payment of "damages ." Hence the liability of an insurance
company under its uninsured motorist coverage cannot be the
"legal liability for damages" mentioned in KRS 342 .055 [now
codified as KRS 342 .700(l)] . Moreover, the satisfaction of an
injured party's claim by his own insurance company under its
uninsured motorist coverage does not inure to the benefit of the
uninsured motorist. His liability is not extinguished, and it may be
enforced by both the carrier which has paid workmen's
compensation benefits and the carrier which has paid under the
uninsured motorist coverage . . . .
To hold that the contractual rights of an insured party under the
uninsured motorist clause of an automobile liability insurance
policy must inure to the benefit of a workmen's compensation
carrier . . . would confer upon the compensation carrier an
additional right which it does not have under the subrogation
statute . The injured party, or the person under whose insurance
policy he is defined as an "insured," has no obligation to his
employer's compensation carrier to carry any automobile liability
insurance whatever . In the absence, therefore, of a statute or
agreement to the contrary, what can be the source of the
compensation carrier's right to have the benefits of such
insurance? The answer, we think, is that there is none.
Id., 550 S.W. 2d at 557 .
We find no reason now to depart from that opinion . In Samples, we
suggested that in appropriate circumstances persons other than the tortfeasor
himself may fall within the range of "the other person in whom legal liability for
damages exists ." Specifically, we mentioned "the tortfeasor's employer, his
parents-(if he is minor and the parent had signed for his-driver's license, his
insurer (if permitted), or anyone else who could be held liable because of the
tortfeasor's negligence ." Samples, 192 S .W . 3d at 315 . That language refers to
persons or entities (or their liability insurer) that under traditional tort law may
be vicariously liable for another's conduct. The UIM carrier's responsibility to
its insured does not arise from any relationship with the tortfeasor; it arises
because of a contractual relationship with the tort victim to provide insurance
for what the tortfeasor has failed to insure. In providing Appellant's UIM
coverage, KSBA undertook to insure damages owed by the tortfeasor to
Appellant in her own right . It did not insure the damages the tortfeasor may
owe to her workers' compensation provider. The assignment of its subrogation
rights to Appellant did not expand the UIM carrier's contractual obligation or
expose it to liability that did not exist prior to the assignment . The rights she
acquired by taking the assignment are no greater than the rights of her
assignor. Because it had no right to recover from the UIM carrier, Appellant
had no right to do so. The Court of Appeals opinion in this regard is affirmed.
II . APPELLANT IS NOT ENTITLED TO AN OFFSET AGAINST THE DEDUCTIONS
FROM THE JURY VERD ICT FOR ATTORNEY'S FEES AND EXPENSES
INCURRED IN PURSUING HER CLAIMS
Appellant further claims that the Court of Appeals erred by declining to
apply to the facts present here our decision in AIK Selective Self Insurance Fund
v. Minton, 192 S .W.3d 415 (Ky. 2006) . Appellant notes that based on the
contingent fee contract with her counsel, her ultimate recovery will be
burdened with attorney's fees of $30,307 .72 and -expenses of $x- ;781 .-73 . Under
Minton, attorney's fees and expenses incurred by the injured worker must be
deducted from the workers' compensation carrier's subrogation credit, even
though doing so may totally subsume the subrogation claim. Minton is based
on the portion of KRS 342.700(l) which reads, "If compensation is awarded
under this chapter [the workers' compensation provider] . . . may recover . . .
from the other person in whom legal liability for damages exists, not to exceed
the indemnity paid and payable to the injured employee, less the employee's
legal fees and expense ." [Emphasis added] . Appellant would have us interpret
Minton so that her attorney's fees and expenses are offset against the deduction
from the jury award for KSBA's offset for workers' compensation benefits of
$26,826 .55 (medical benefits of $26,042 plus wage benefits of $784 .55) .
Notwithstanding the fairness to be found in Appellant's position, we agree with
the Court of Appeals that the rationale for the holding in Minton is guided
exclusively by the language of the statute quoted above, and that by its terms
the statute is limited to offsetting the recoupment due to the workers'
compensation carrier. We see no authority that would justify the extension of
Minton allowing an offset against the UIM provider's credits for Appellant's
attorney's fees and expenses .
Accordingly, we affirm the Court of Appeals' denial of a credit for
Appellant's attorney's fees and expenses .
III. THE COURT OF APPEALS ERRED REVERSING THE TRIAL COURT'S
RULING REGARDING THE DEDUCTION OF BRB FROM THE JUDGMENT
The trial court deducted from the damages awarded by the jury only the
$333.45 of BRB actually paid to Appellant, rather than the full amount of
$20,000 in available BRB . It is not clear from the record why KSBA, as
reparation obligor, paid only $333 .45 in BRB, but there is no doubt that a
substantial factor was the controversy over whether all of Appellant's injuries
were caused by the bus accident. The jury verdict resolved that issue in
Appellant's favor and found damages in a sum far exceeding the available BRB .
The Court of Appeals held that the judgment must be offset by the entire
$20,000.00 in available BRB. Its decision was based upon KRS 304 .39-060(2),
which provides :
Tort liability with respect to accidents occurring in this
Commonwealth and arising from the ownership, maintenance, or
use of a motor vehicle is "abolished" for damages because of bodily
injury, sickness or disease to the extent the basic reparation
benefits provided in this subtitle are payable therefor, or that
would be payable but for any deductible authorized by this
subtitle, under any insurance policy or other method of security
complying with the requirements of this subtitle, except to the
extent noneconomic detriment qualifies under paragraph (b) of this
subsection .
Citing several authoritative decisions3 in support of its interpretation of the
statute, the Court of Appeals held that KRS 304 .39-060(2) abolishes
3 State Farm Mut. Ins. Co. v. Fletcher, 578 S.W.2d 41,44 (Ky.1979) ; Dudas v.
Kaczmarek, 652 S .W.2d 868 (Ky. App. 1983) ; Bohl v. Consolidated Freightways
Corp. ofDelaware, 777 S .W . 613, 615 (Ky. App . 1989) ;
10
Appellant's tort claim to the extent that reparations benefits are "payable
therefor."
The Court of Appeals also concluded Appellant could not avail herself of
.relief which may be found in Slone v, Caudill, 734 S.W .2d 480 (Ky. App . 1-987)
and Henson v. Fletcher, 957 S .W.2d 281 (Ky . App. 1997) (holding in certain
circumstances the judgment should be reduced only by the amount of BRB
actually paid rather than the total amount of BRB "payable"), because she had
presented "insufficient evidence" of KSBA's refusal to pay her BRB claims, that
she had provided "no evidence" that workers' compensation had not covered
those claims, and had presented no evidence that KSBA had failed to pay BRB
after the exhaustion of her workers' compensation benefits.
Much is made in the arguments of the parties about whether KSBA
denied payment of Appellant's BRB claim and whether Appellant failed to
submit claims for coverage . Appellant asserts that she sought payments of
additional medical expenses under BRB, but KSBA denied them because of the
active issue over whether the injuries she claimed, including the knee
replacement surgery, were caused by the bus accident. KSBA contends that
Appellant failed to pursue her claim to the maximum available BRB under the
KSBA policy. "If the appropriate reparation obligor is not forthcoming in paying
basic reparation benefits to the statutory maximum, the injured party has a
remedy under the Act to collect them ." Dudas, 652 S.W.2d at 870 . See KRS
304 .39-210, KRS 304 .39-220, and KRS 304 .39-160 .
If such evidence (i.e., whether Appellant: requested payments and
whether KSBA denied them) was essential to the factual findings needed to
resolve the BRB offset issue, the trial court was the proper place to present it.
It is not. within the province of this Court, . or the Court. of _Appeals, to resolve
factual disputes material to the resolution of a claim . See Whicker v. Whicker,
711 S .W.2d 857 (Ky. App. 1986) (Where the trial court fails to make required
findings and no request is made for such findings, the issue will not be
considered on appeal) .
The issue did not arise until KSBA moved under CR 59 .05 to amend the
judgment to deduct the remaining available BRB. In response, Appellant
asserted, that under Slone and Henson, the offset was properly limited to
$333 .45 . Neither party requested the opportunity to present evidence . The trial
court denied the motion without an evidentiary hearing and without rendering
findings of fact. What the Court of Appeals has characterized as "insufficient
proof" is, in effect, the absence of factual findings by the trial court needed to
resolve the issue . Regardless of which party had the burden of proof on the
issue of the proper amount of the offset, once the trial court entered its order
on that issue with no findings of fact, it became the burden of the party
aggrieved by that order to request that the court make a recitation of the
essential facts upon which it based its decision . KSBA did not do so . CR
52 .04 provides :
A final judgment shall not be reversed or remanded because of the
failure of the trial court to make a finding of fact on an issue
essential to the judgment unless such failure is brought to the
attention of the trial court by a written request for a finding on that
issue .
KSBA's argument that Appellant cannot: rely upon Slone and Henson,
depends, in, .this Court . as in the Court of Appeals, upon a finding of fact that
was never made by the trial court - whether Appellant followed the correct
process to claim the full measure of BRB available to her. CR 52 .04 does not
permit the trial court to be reversed for failure to make a finding on an
essential fact unless a party has expressly requested such a finding. The Court
of Appeals erred in reversing the trial court's decision on the BRB because of a
disputed issue of fact, when the matter was never brought to the attention of
the trial court. We therefore reverse the Court of Appeals on that point and
reinstate the decision of the trial court to deduct from the judgment the actual
BRB payment of $333 .45 rather than the full $20,000 .00 of available BRB .
CONCLUSION
For the forgoing reasons, we reverse the opinion of the Court of Appeals
insofar as it directs the trial court to deduct from the judgment the entire
$20,000 .00 of available BRB . Otherwise, we affirm the Courts of Appeals in
remanding this case to the trial court for recalculation of damages consistent
with this opinion.
All sitting. Minton, C .J., Abramson, Cunningham, Noble and Schroder
concur. Scott, J ., concurs in result only by separate opinion.
SCOTT, JUSTICE, CONCURRING IN RESULT ONLY OPINION : I concur
in the result of the majority's opinion, but would add as to Issue III, that the
amount of any offset is limited to the BRB actually "paid or payable" - meaning
it has been, or will be paid . There is no offset for amounts that will not be
paid . Such an effect was never the intention of .KRS.,304 .39-.060(2) . - See Slone
v. Caudill , 734 S .W.2d 480 (Ky. App. 1987) ; and Henson v. Fletcher, 957
S .W.2d 281 (Ky. App. 1997) .
COUNSEL FOR APPELLANT:
John E. Anderson
Dennis L. Nagle
Cole, Cole, Anderson 8s Nagle
P O Box 250
Barbourville, Kentucky 40906
W. Patrick Hauser
P O Box 1900
Barbourville, Kentucky 40906
COUNSEL FOR KENTUCKY SCHOOL BOARD ASSOCIATION:
John Steven Harrison
83 C . Michael Davenport Blvd.
Suite #3
Frankfort, Kentucky 40601
COUNSEL FOR KENTUCKY JUSTICE ASSOCIATION:
Jeanie Owen Miller
Jeanie Owen Miller Law Offices, PLLC
214 W. 3rd Street
P O Box 712
Owensboro, Kentucky 42302-0712
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