JOURNEY OPERATING, LLC VS. COMPENSATION ZURICH AMERICAN INSURANCE COMPANY , ET AL.
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RENDERED: NOVEMBER 6, 2009; 10:00 A.M.
TO BE PUBLISHED
Commonwealth of Kentucky
Court of Appeals
NO. 2009-CA-000279-WC
JOURNEY OPERATING, LLC
v.
APPELLANT
PETITION FOR REVIEW OF A DECISION
OF THE WORKERS’ COMPENSATION BOARD
ACTION NOS. WC-05-00151 & WC-06-00341
ZURICH AMERICAN INSURANCE COMPANY;
ANGELA JEFFERS, INDIVIDUALLY AND AS
ADMINISTRATRIX OF THE ESTATE OF PATRICK
JEFFERS, DECEASED; SUSIE BELL, INDIVIDUALLY
AND AS ADMINISTRATRIX OF THE ESTATE
OF WILLIAM BELL, DECEASED; MYERS
COMPLETION, INC.; HON. DONNA H. TERRY,
CHIEF ADMINISTRATIVE LAW JUDGE; AND
WORKERS' COMPENSATION BOARD
APPELLEES
OPINION
REVERSING
** ** ** ** **
BEFORE: CLAYTON AND THOMPSON, JUDGES; LAMBERT,1 SENIOR
JUDGE.
1
Senior Judge Joseph E. Lambert sitting as Special Judge by assignment of the Chief Justice
pursuant to Section 110(5)(b) of the Kentucky Constitution and Kentucky Revised Statutes
(KRS) 21.580.
LAMBERT, SENIOR JUDGE: This appeal requires an examination of the
authority of a Workers’ Compensation Administrative Law Judge to reopen a final
decision to prevent an insurer from carrying out a constructive fraud on the
tribunal. As KRS 342.125 provides authority for reopening in such circumstances,
we reverse the Workers’ Compensation Board (Board) and reinstate the decision of
the Chief Administrative Law Judge (CALJ).
The tragic facts giving rise to these proceedings occurred when
Patrick Jeffers and William Bell suffered fatal injuries in a work-related accident
while providing service on a well in Bulan, Kentucky. Jeffers and Bell, Tennessee
residents, were employed by Myers Completion, Inc. (Myers), a Tennessee
corporation that provides general maintenance for oil and gas wells primarily in
Kentucky and Tennessee. Journey Operating, LLC, (Journey) a Kentucky
corporation, had contracted with Myers to service the well in question.
Upon the deaths of Jeffers and Bell, the employer’s, Myers, workers’
compensation insurance carrier, Zurich American Insurance Company (Zurich),
commenced payment of benefits to the estates and families of Jeffers and Bell
pursuant to Tennessee workers’ compensation law. Because Jeffers and Bell were
residents of Tennessee and were employed by Myers, Zurich determined that
Tennessee benefits were due pursuant to its policy.
Despite Zurich’s payment of Tennessee benefits, the decedents’
widows also sought benefits under Kentucky workers’ compensation law. Zurich
denied the Kentucky benefits claim. As explained in the final administrative order,
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“Zurich-American admit[ted] its liability for payments made pursuant to Tennessee
law but contests its liability for any additional benefits under the Kentucky
Workers’ Compensation Act.” Journey Operating, the Kentucky corporate well
operator, and its workers’ compensation insurance carrier were also named as
parties due to Journey’s status as an up-the-ladder employer in the event coverage
was unavailable from the direct employer. KRS 342.610(2)(b).
After hearing the evidence, the CALJ determined that the decedents’
widows were entitled to benefits under Kentucky Workers’ Compensation law.
Upon concluding that Zurich’s policy did not provide benefits under Kentucky
law, the CALJ determined that “in the absence of compensation secured by Myers,
Journey is a deemed contractor pursuant to KRS 342.610(2)(b) and is liable for
compensation for the . . . injury.” The CALJ further found that “while Journey’s
workers’ compensation carrier shall be responsible for payment of income benefits
provided in KRS 342.750(6), it shall be entitled to a credit for benefits paid and
owing under the Tennessee policy issued to Myers by Zurich-American or its
subsidiary.”
Journey petitioned for reconsideration of the ruling and for specificity
as to the monetary credit to which it was entitled by virtue of benefits paid under
the Tennessee policy. Denying the petition, the CALJ stated, “the amounts of
payments under the Tennessee policy will change and vary with time as children
become emancipated or in the event of a remarriage. The award provides a credit
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for benefits paid and owing and this provides sufficient protection and explanation
of Journey’s rights and responsibilities.”
Although a party to the Kentucky proceeding, Zurich did not object to
language in the CALJ’s order that acknowledged Zurich’s admission of liability for
benefits under Tennessee law, nor did it object to the corresponding finding that
Zurich was liable for payment of benefits under Tennessee law under the terms of
its policy. And, although the reconsideration order referenced continuing benefit
payments under the Tennessee policy and noted that Journey’s credit for these
amounts was protected by the language “paid and owing” in the original ruling,
Zurich did not object or raise any issues before the CALJ or the Board with respect
to its continuing liability for benefits under Tennessee law. The Board affirmed
the administrative decision and the case became final.
Despite all of the foregoing, upon finality of the Board’s decision,
Zurich terminated payment of benefits in reliance upon an election of remedies
doctrine in Tennessee law. Journey then filed a motion to reopen, relying in part
on Wheatley v. Bryant Auto Service, 860 S.W.2d 767 (Ky. 1993), a case in which
an ALJ was held to have properly reopened a case after having limited benefits to
425 weeks when the law in effect at the time of the injury provided for lifetime
benefits. Even though res judicata applied in the Wheatley case, reopening was
held proper pursuant to KRS 342.125 because of the mistake. As with mistake,
fraud is a ground for reopening under KRS 342.125, and on that basis, Journey’s
motion was granted, and the CALJ deemed Zurich’s actions to have been a
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constructive fraud. The CALJ determined that Zurich was estopped from
terminating benefits, reiterated that Journey was entitled to a credit for amounts
that Zurich paid or was obligated to pay, and further directed Zurich to continue
payments pursuant to the Tennessee policy.
Zurich appealed to the Board from that decision, arguing that the
CALJ had neither authority to reopen nor jurisdiction to decide the issues raised.
The Board agreed and reversed the decision accordingly. This appeal followed.
At the outset, we observe that KRS 342.125 provides that “[u]pon
motion by any party or upon an administrative law judge’s own motion, an
administrative law judge may reopen and review any award or order on any of the
following grounds: (a) Fraud; . . . (c) Mistake[.]” The CALJ found that reopening
was proper on the basis of both mistake and fraud. Specifically, the ruling upon
reopening reiterated that “[a]t all times during the underlying claim litigation,
Myers and Zurich continued to pay benefits under Zurich’s Tennessee policy and,
through [several] witnesses, represented that benefits were due and owing . . .
under the Tennessee policy and were being paid pursuant to that obligation.” The
ruling also cited to the numerous references in the original ruling that confirmed or
resulted from these representations, and specifically noted that despite the certainty
in the original CALJ ruling as to Zurich’s liability for continuing payments, Zurich
failed to object or appeal. We note that the same evidence that constituted
constructive fraud also supported the CALJ’s finding of equitable estoppel. Based
on its statements and conduct, Zurich was equitably estopped from terminating
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benefits because it not only concealed its intention to do so but also made
affirmative representations to the contrary.
Although the Board accepted Zurich’s contention that the CALJ
lacked authority to reopen and to order continued payment of benefits, we deem
the CALJ’s reasoning to be superior. In reversing the decision on reopening, the
Board pointed out that the CALJ had initially determined that Myers/Zurich was
not liable for benefits pursuant to Kentucky law; therefore, it reasoned that the
CALJ had no authority to order the Tennessee payments on reopening. However,
if Zurich believed that its payments under Tennessee law were not required or were
not within the CALJ’s jurisdiction, it had a duty to object to the CALJ’s initial
ruling, and to the ruling denying reconsideration, as both clearly considered and
affirmed Zurich’s ongoing liability under Tennessee law. Instead, Zurich neither
objected before the CALJ nor raised the issue on appeal to the Board.
For its decision, the Board relied on Custard Ins. Adjusters, Inc. v.
Aldridge, 57 S.W.3d 284 (Ky. 2001). In Custard, the Kentucky Supreme Court
explained that where a dispute is solely between insurance carriers and does not
affect the rights of an employee in a pending claim, jurisdiction lies with the circuit
court, not the ALJ, because issues of subrogation or reimbursement do not involve
provisions of KRS Chapter 342. In the instant case, however, far more was at
issue in the reopening determination as the decision affected liability for future
payments to the widows. It was not simply a “settling up” between insurers for
benefits already paid. Nor was the reopening a straightforward enforcement of the
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initial ruling that would have been appropriate for circuit court. Instead, as the
CALJ concluded, the reopening did not arise from a mere attempt to enforce the
prior judgment but was necessary to determine whether Zurich had committed
constructive fraud in the original proceeding. The critical distinction is that none
of the authorities relied upon by Zurich or the Board contained elements of fraud.
It is fundamental that an administrative or judicial decision-maker
must have authority to protect the integrity of the proceeding. With respect to
Kentucky courts, this principle was boldly articulated in Potter v. Eli Lilly and Co.,
926 S.W.2d 449, 453 (Ky. 1996), abrogated on other grounds by Hoskins v.
Maricle, 150 S.W.3d 1 (Ky. 2004):
Once the trial judge had reason to believe that
there was some absence of accuracy in its judgment so
that the judgment did not properly conform to the true
facts of the case, the trial judge had a duty, as well as a
right, to investigate by means of a hearing to determine
that the judgment accurately reflected the truth. The trial
judge has inherent power to execute this responsibility.
KRS 342.125 similarly authorizes a Workers’ Compensation ALJ to act in
protection of the verity of the administrative proceeding. In workers’
compensation cases, insurers occupy a pivotal role and when they engage in
duplicitous conduct, it must be discovered and corrected. Where an ALJ believes
that fraud has infected the proceeding, the statute grants authority to reopen for the
very purpose of finding the facts and formulating remedies where fraudulent
conduct is found. The CALJ appropriately utilized statutory authority in the
instant case.
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Accordingly, we reverse the Workers’ Compensation Board and
reinstate the administrative decision on reopening in its entirety.
ALL CONCUR.
BRIEF FOR APPELLANT:
W. Barry Lewis
Hazard, Kentucky
BRIEF FOR APPELLEE, ZURICH
AMERICAN INSURANCE
COMPANY:
A. Stuart Bennett
Lexington, Kentucky
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