Dominic v. Creek Nation

Dominic v. Creek Nation
1997 OK 41
936 P.2d 935
68 OBJ 1279
Case Number: 86740
Decided: 04/08/1997
Mandate Issued: 05/08/1997
Supreme Court of Oklahoma

 
PATRICIA DOMINIC, Petitioner,
v.
CREEK NATION, STATE INSURANCE FUND, and the WORKERS' COMPENSATION COURT, Respondents.
ON CERTIORARI TO THE COURT OF CIVIL APPEALS, DIV. 3

¶0 Patricia Dominic ( Dominic or claimant ) sought in the Workers' Compensation Court, Terry A. Pendell, trial judge, an award for her accidental injury sustained in a fall while employed by the Creek Nation ( Nation ). After payment of temporary total disability, the State Insurance Fund ( Fund ), qua Nation's insurer, challenged the trial tribunal's cognizance of the proceeding. The trial judge ruled that the court "does not have jurisdiction" of the claim. The Court of Civil Appeals affirmed. On certiorari sought by Dominic's petition,

THE COURT OF CIVIL APPEALS' OPINION IS VACATED, THE ORDERS OF THE WORKERS' COMPENSATION COURT AND OF THE THREE-JUDGE REVIEW PANEL ARE VACATED AND THE CAUSE IS REMANDED FOR FURTHER PROCEEDINGS CONSISTENT WITH THIS PRONOUNCEMENT

Steven S. Smith The Bell Law Firm Norman, OK For Petitioner

Gary W. Sleeper State Insurance Fund Oklahoma City, OK For Respondents

Opala, J.

[936 P.2d 937]

¶1 We are asked to decide whether an insurer who has accepted workers' compensation policy premiums computed on the claimant's salary may contest before the Workers' Compensation Court the insured's status as a covered employer. We answer in the negative.

¶2 Patricia Dominic ( Dominic or claimant ) sought workers' compensation benefits after an on-the-job injury while employed by the Creek Nation ( Nation ). Nation had secured her insurance coverage through the State Insurance Fund ( Fund ). After Dominic's claim was filed, Fund first paid temporary total disability and then challenged the jurisdiction of the trial tribunal, claiming Nation's tribal court was the proper forum. The trial court agreed. The three-judge review panel and the Court of Civil Appeals affirmed. According to the appellate court's reasoning, because an Indian Nation is not an "employer" within the meaning of the Workers' Compensation Act,

¶3 We hold that Fund is statutorily estopped to deny Nation's covered-employer status and escape liability for payment of benefits after 1 ) issuing a worker's compensation policy and 2 ) accepting premiums computed upon Dominic's salary.

THE ANATOMY OF LITIGATION

¶4 Dominic was a ten-year employee of the Creek Nation, who occupied the position of recreation director. She was injured on August 4, 1993 when she slipped on a wood fragment and fell on a step. Her injuries were to the back, neck, legs, and hands. After medical treatment, Dominic filed a claim on August 15, 1994. The Creek Nation had obtained compensation coverage with the State Insurance Fund. Forms filed by Fund in the compensation case confirmed Dominic was employed by Nation, she was covered by workers' compensation, and she was injured in the course of her employment. Dominic was paid temporary total disability for 21 weeks.

¶5 It was not until October 30, 1995 that Fund first challenged the court's cognizance over the proceedings by denying that her employer was covered by the provisions of the compensation act. Five days before the jurisdictional objection was interposed, Fund had moved to terminate the temporary compensation, but did not question the legality of prior disability payments to Dominic. On December 8, 1995 the trial tribunal determined its lack of jurisdiction over the claim. This ruling is rested on the conclusion that Nation does not "fit the definition of an employer."

¶6 The appellate court declared Nation to be a "domestic" and "dependent" Indian authority. It noted that Nation neither (a) unequivocally waived its sovereign immunity for workers' compensation liability, nor (b) could be considered an "employer" within the meaning of 85 O.S. § 3 ( 3 ).

I.

¶7 QUESTIONS CONCERNING EMPLOYERS' STATUS FOR COVERAGE UNDER WORKERS' COMPENSATION LAW ARE ELIMINATED BY THE INTERPOSITION OF STATUTORY ESTOPPEL; AN INSURER WHO COLLECTS PREMIUMS UNDER AN ISSUED COMPENSATION POLICY(COMPUTED ON CLAIMANT'S WAGES) IS ESTOPPED TO DENY THE INSURED'S STATUS AS A COVERED EMPLOYER

¶8 Nation's status as a covered employer

¶9 The claimant who, like Dominic, relies upon estoppel must show 1 ) an injury that occurred during the time her employer maintained a compensation liability policy, 2 ) the insured employer's payment of premiums based on the claimant's salary, and 3 ) claimant's injury occurred in and arose out of her employment with the insured employer.

[936 P.2d 939]

¶10 The rationale of the "estoppel act" is that an insurer who accepts premiums should not evade liability for benefits due under compensation law.

¶11 Although § 65.2 appears to require an employee to be engaged in a hazardous occupation,

¶12 Because it is undisputed here that a policy was in force at the time of claimant's injury and premiums were paid on her salary, and it is undenied that the harm for which compensation was sought occurred in and arose out of her employment, no issue was joined between the carrier and the claimant concerning the insurer's legal liability for benefits that may be due.

¶13 There is an added basis for today's conclusion. Before Fund sought first to terminate temporary total disability ( TTD ) and to question the compensation court's jurisdiction, TTD payments had been made to Dominic for 21 weeks. Fund's payment of TTD sans contest of the employment-related nature of the claimant's harm constitutes a waiver of its defenses against liability .

SUMMARY

¶14 The "estoppel act," 85 O.S. 1991 §§ 65.2 and 65.3, makes insurers liable regardless of the insured's status as a covered employer [936 P.2d 940] when it is shown that premiums computed on a claimant's wages were accepted under a policy insuring the employer against liability under the Workers' Compensation Act.

¶15 The purpose of statutory estoppel is to prevent both an employer's and an employee's ensnarement in the false belief that compensation has been provided, only later to discover the protection to be unavailable.

¶16 When Dominic's employment status and her injury in the course of and arising out of employment stood unchallenged and her temporary benefits were paid without objection, claimant's employment by the insured and her injury's compensability became waived as litigable issues in the case.

ON CERTIORARI SOUGHT BY DOMINIC'S PETITION,THE COURT OF CIVIL APPEALS' OPINION IS VACATED, THE ORDERS OF THE WORKERS' COMPENSATION COURT AND OF THE THREE-JUDGE REVIEW PANEL ARE VACATED AND THE CAUSE IS REMANDED FOR FURTHER PROCEEDINGS CONSISTENT WITH THIS PRONOUNCEMENT.

¶17 KAUGER, C.J., SUMMERS, V.C.J.

¶18 HARGRAVE, J

FOOTNOTES

1 The provisions of 85 O.S. 1991 § 3 (3) are:

" 'Employer', except when otherwise expressly stated, means a person, partnership, association, limited liability company, corporation, and the legal representatives of a deceased employer, or the receiver or trustee of a person, partnership, association, corporation, or limited liability company, departments, instrumentalities and institutions of this state and divisions thereof, counties and divisions thereof, public trusts, boards of education and incorporated cities or towns and divisions thereof, employing a person included within the term 'employee' as herein defined."

" 'Employee' means any person engaged in the employment of any person, firm, limited liability company or corporation covered by the terms of the Workers' Compensation Act."(Emphasis supplied.)

"Every employer and every insurance carrier who schedules any employee as a person employed by the employer for the purpose of paying or collecting insurance premiums on a Workmen's Compensation insurance policy or who pays, receives or collects any premiums upon any insurance policy covering the liability of such employer under the Workmen's Compensation Law by reason of or upon the basis of the employment of any such employee shall be estopped to deny that such employee was employed by the employer in a hazardous employment subject to and covered by the Workmen's Compensation Law if such person receives an accidental personal injury arising out of and in the course of his employment, during the period for which such premium was so received, regardless of the type of business in which the employer was engaged or the type of employment in which the employee was engaged at the time of such injury."

The provisions of 85 O.S. 1991 § 65.3 are:

"Every contract of insurance issued by an insurance carrier for the purpose of insuring an employer against liability under the Workers' Compensation Act shall be conclusively presumed to be a contract for the benefit of each and every person upon whom insurance premiums are paid, collected, or whose employment is considered or used in determination of the amount of premium collected upon such policy for the payment of benefits as provided by the Workers' Compensation Act regardless of the type of business in which the employer of such person is engaged or the type of work being performed by the employee at the time of any injury received by such employee arising out of and in the course of his employment, which contract may be enforced by such

employee as the beneficiary thereof."