FOR PUBLICATION
ATTORNEYS FOR APPELLANT: ATTORNEY FOR APPELLEE:
MARK D. GERTH PATRICK R. RAGAINS
Kightlinger & Gray, LLP Smith & Ragains
Indianapolis, Indiana Anderson, Indiana
IN THE
COURT OF APPEALS OF INDIANA
PINKERTONS INC., )
)
Appellant-Defendant, )
)
vs. ) No. 48A04-0407-CV-364
)
RITA A. FERGUSON, )
)
Appellee-Plaintiff. )
APPEAL FROM THE MADISON CIRCUIT COURT
The Honorable Fredrick Spencer, Judge
Cause No. 48C01-0304-PL-338
April 4, 2005
OPINION - FOR PUBLICATION
VAIDIK, Judge
Case Summary
Pinkertons, Inc., appeals the trial courts declaratory judgment, which concluded that Pinkertons was
not entitled to a workers compensation lien on proceeds paid to Rita Ferguson
under the uninsured motorist provision of her personal automobile insurance policy and that
Pinkertons liability to provide workers compensation benefits was not terminated by Fergusons receipt
of those proceeds. Because we find that it would contravene public policy
to permit Pinkertons to assert a lien on Fergusons insurance proceeds and that
termination of benefits is not appropriate where claims against the third-party tortfeasor have
not been extinguished by collecting proceeds under a personal insurance policy, we affirm.
Facts and Procedural History
Ferguson was injured in an automobile collision, which occurred during the course and
within the scope of her employment with Pinkertons. Consequently, Ferguson received workers
compensation and medical benefits from Pinkertons. In all, Pinkertons paid $321,308.33 for
medical services rendered to Ferguson and $8,057.42 in temporary total disability benefits.
As a result of the collision, Ferguson sustained a forty percent loss of
use of her whole person, and her projected total damages were estimated to
be in excess of one million dollars.
The driver who caused the collision, Daniel Sims, had no insurance coverage.
Ferguson, however, was covered by a personal insurance policy issued in her husbands
name. The Fergusons policy included uninsured motorist coverage with a limitation of
$50,000 per person. Ferguson entered into a settlement with her insurer for
the uninsured motorist policy limits. Ferguson and Pinkertons were unable to reach
an agreement as to whether and to what extent Pinkertons may be entitled
to receive a portion of the uninsured motorist proceeds recovered by Ferguson.
Thus, Ferguson filed a complaint for declaratory relief. The trial court determined:
The Plaintiff, Rita A. Ferguson is awarded the proceeds of the uninsured motorist
policy in the sum of $50,000.00 less costs and attorney fees payable to
Smith and Ragains, and the Court further specifically finds as a matter of
[law] that she is not precluded from . . . further recovery under
her Workers Compensation claim because of this Courts [D]eclaratory Judgment in her favor.
Appellants App. p. 23. Pinkertons now appeals.
Discussion and Decision
Pinkertons argues that it is entitled to a lien on uninsured coverage proceeds
recovered from Fergusons personal automobile insurance policy. When a trial court enters
special findings, as is the case here, we review issues of fact for
sufficiency of the evidence and look to the record only for evidence favorable
to the judgment. Ind. Trial Rule 52; City of Fort Wayne v.
Certain Southwest Annexation Area Landowners, 764 N.E.2d 221, 224 (Ind. 2002), rehg denied.
We do not set aside findings and judgments unless they are clearly
erroneous. T.R. 52. We review questions of law de novo.
City of Fort Wayne, 764 N.E.2d at 224.
Pertinent to this appeal is the following excerpt from Indiana Code § 22-3-2-13:
Whenever an injury or death, for which compensation is payable under chapters 2
through 6 of this article shall have been sustained under circumstances creating in
some other person than the employer and not in the same employ a
legal liability to pay damages in respect thereto, the injured employee . .
. may commence legal proceedings against the other person to recover damages notwithstanding
the employers or the employers compensation insurance carriers payment of or liability to
pay compensation under chapters 2 through 6 of this article.
In that case, however, if the action against the other person is brought
by the injured employee . . . and . . . settlement is
made with the other person, either with or without suit, then from the
amount received by the employee . . . there shall be paid to
the employer or the employers compensation insurance carrier, subject to its paying its
pro-rata share of the reasonable and necessary costs and expenses of asserting the
third party claim, the amount of compensation paid to the employee . .
. plus the medical, surgical, hospital and nurses services and supplies . .
. paid by the employer or the employers compensation insurance carrier and the
liability of the employer or the employers compensation insurance carrier to pay further
compensation or other expenses shall thereupon terminate. . . .
* * * *
If the injured employee . . . shall agree to receive compensation from
the employer or the employers compensation insurance carrier or to accept from the
employer or the employers compensation insurance carrier, by loan or otherwise, any payment
on account of the compensation, or institute proceedings to recover the same, the
employer or the employers compensation insurance carrier shall have a lien upon any
settlement award, judgment or fund out of which the employee might be compensated
from the third party.
(emphasis supplied). Put succinctly, this statute allows an employer or its workers
compensation insurance carrier to assert a lien against proceeds due to an employee
as a result of a compensable injury or death under the Workers Compensation
Act from some other person legally liable to pay those damages.
Pinkertons relies primarily on Ansert Mechanical Contractors, Inc. v. Ansert, 690 N.E.2d 305,
310 (Ind. Ct. App. 1997), in arguing its entitlement to a lien against
Fergusons uninsured motorist policy proceeds. In Ansert, this Court held that an
employer or its workers compensation insurance carrier may secure a lien on proceeds
payable to an injured worker from underinsured motorist coverage paid for by the
employer. In reaching this holding, we found that a recovery from an
employer-paid uninsured motorist policy was a recovery from some other person with a
legal liability to pay damages. Id. at 308-09 (citing Ind. Code §
22-3-2-13). Our supreme court reiterated the Ansert holding in Walkup v. Wabash
National Corp., 702 N.E.2d 713, 715 (Ind. 1998). However, our supreme court
explicitly reserved the question presented today:
See footnote
whether a workers compensation provider can
assert a lien on proceeds from an employees personal uninsured motorist policy pursuant
to Indiana Code § 22-3-2-13. We now decide that some other person
under the Workers Compensation Act does not include an employee-paid uninsured motorist policy.
Pinkertons asserts that there is nothing in the Workers Compensation Statute which would
justif[y] drawing a distinction between uninsured motorist proceeds paid under a policy issued
to an employer as opposed to a policy issued to an employee or
an employees family member. Appellants Br. p. 4. This ignores the
public policy articulated by our supreme court regarding Indianas workers compensation scheme:
Workmens compensation statutes are in derogation of the common law and provide, for
those covered, an exclusive remedy for injuries sustained in the course of and
arising out of ones employment. The basic policy behind such legislation is
to shift the economic burden for employment connected injuries from the employee to
the employer.
One of the purposes of the Workmens Compensation Act is to transfer from
the worker to the industry in which he is employed and ultimately to
the consuming public a greater portion of economic loss due to industrial accidents
and injuries. (authorities omitted)
Workmens compensation is for the benefit of the employee. Accordingly, it is
well-established that the Act be liberally construed in favor of the employee so
as to not negate the Acts humane purposes.
Frampton v. Cent. Ind. Gas Co., 260 Ind. 249, 251, 297 N.E.2d 425,
427 (1973) (internal citations and footnote omitted); see also Sims v. U.S. Fidelity
& Guar. Co., 782 N.E.2d 345, 351 (Ind. 2003) (The basic policy underlying
the [Workers Compensation] Act was to shift the economic burden for employment connected
injuries from the employee to the employer[.]).
To construe the Workers Compensation Act to permit a lien on an employees
personal uninsured motorist coverage would undermine the public policy articulated in Frampton and
Sims. Stated otherwise, to rule as Pinkertons suggests would shift part of
the economic burden back from the employer or industry to the employee.
See 6 Arthur Larson, Larsons Workers Compensation Law, Ch. 110, § 110.05[8], at
110-24 (2004) ([T]he uninsured motorist proceeds were the product of insurance paid for
by the employee. There is no conceivable reason why a compensation carrier
should have any claim on them.); see also Adams v. Delmarva Power &
Light Co., 575 A.2d 1103, 1107 (Del. 1990) (determining that an employers workers
compensation insurer is not entitled to a set-off under Delaware law for payments
made to the employee by the employees own underinsured motorist insurer because it
would contravene the public policy of promoting individuals to contract for additional funds
to protect themselves and their families in case of accidents with uninsured/underinsured drivers),
rehg denied. Such a construction undercuts the Acts humane purpose and essentially
dilutes the employees compensation benefits. See Johnson v. Firemans Fund Ins. Co.,
425 So. 2d 224, 229 (La. 1982) (citing statutory provision that protects employees
against the dilution of their compensation benefits by prohibiting direct and indirect collections
from employees to reimburse the employers, their insurers, or any person for the
cost of workers compensation insurance), rehg denied. Where, however, an employer pays
for the uninsured/underinsured motorist coverage, there are not these same concerns about shifting
the cost of injury back to the employee and dilution of benefits.
Thus, in public policy lies the justification for distinguishing between employer-paid and employee-paid
uninsured/underinsured motorist coverage.
Moreover, the primary policy reason for allowing workers compensation liensto prevent double recovery,
see Waldridge v. Futurex Indus., Inc., 714 N.E.2d 783, 786 (Ind. Ct. App.
1999), trans. deniedis not implicated here because Fergusons damages far exceeded the amount
she received in workers compensation benefits, medical benefits, and uninsured motorist coverage proceeds.
See Larsons Workers Compensation Law, Ch. 110, § 110.05[8], at 110-23 (There
can be no conceivable policy objection to allowing an injured person to retain
two recoveries that, when combined, still do not make him or her whole.).
Consequently, we find that the trial court correctly determined that Pinkertons was
not entitled to a lien on Fergusons uninsured motorist coverage proceeds.
See footnote
Pinkertons additionally argues that by settling with her insurer for the policy limits
of her uninsured motorist coverage, Ferguson terminated any further liability that Pinkertons had
to pay workers compensation benefits to Ferguson. Section thirteen of the Workers
Compensation Act provides that if the injured employee enters into a settlement and
release with a third party, the liability of the employer or the employers
compensation carrier to pay further compensation terminates.
Ansert, 690 N.E.2d at 307.
We have already determined that recovery from an employee-paid uninsured motorist policy
is not a recovery from some other person under the Workers Compensation Act,
and thus Pinkertons is not entitled to a lien against the insurance proceeds.
Additionally, we note that as set forth in Ansert, the apparent purpose behind
the termination provision of section thirteen is to prevent injured employees from settling
with a third party, thereby cutting off the opportunity of a workers compensation
carrier to pursue the liable party to recover any benefits it has paid.
Id. Here, Fergusons acceptance of the $50,000 policy limit from her
uninsured motorist coverage carrier did not in any way preclude Pinkertons from pursuing
Sims in recovering any workers compensation benefits it pays to Ferguson. See
also, e.g., Stewart v. Auto-Owners Ins. Co., 495 S.E.2d 882, 885 (Ga. Ct.
App. 1998) ([P]ayments made by the insurance company under [an uninsured motorist] policy
are not payments by or on behalf of the uninsured-motorist tortfeasor, and do
not affect the uninsured motorists liability to pay the damages recovered in the
lawsuit against him.). Therefore, we conclude that the trial court correctly determined
that, under Indiana Code § 22-3-2-13, Ferguson had not settled her claim against
Sims such that her entitlement to any further workers compensation benefits terminated.
Affirmed.
KIRSCH, C.J., and NAJAM, J., concur.
Footnote:
Specifically, our supreme court stated, We express no opinion as to
this analysis if the uninsured motorist coverage is purchased by the employee.
Walkup, 702 N.E.2d at 715.
Footnote:
To the extent that Pinkertons argues that the uninsured motorist policy
is not Fergusons personal policy because it was issued in her husbands name,
we note that Ferguson raised the policy ownership issue in her post-trial brief,
but Pinkertons failed to respond to this argument until appeal. Thus, we
find that Pinkertons has waived such a challenge by failing to lodge such
an objection before the trial court. See Mahl v. Aaron, 809 N.E.2d
953, 958 (Ind. Ct. App. 2004). Furthermore, we are not able to
determine from the record whether Ferguson was a named insured under the policy
as a result of her spousal relationship to her husband.