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MEDALLION TRANSPORT & LOGISTICS, LLC v. AIG CLAIMS

2018 WL 3249708

United States District Court, E.D. Texas, Marshall Division.
MEDALLION TRANSPORT & LOGISTICS, LLC, Plaintiff,
v.
AIG CLAIMS, INC., Granite State Insurance Co., and Jay Carman, Defendants.
No. 2:16-CV-01016-JRG-RSP
|
Signed 06/27/2018
Attorneys and Law Firms
Glenn Allen Perry, Sloan Bagley Hatcher & Perry, Longview, TX, Amanda Aline Abraham, Carl R. Roth, The Roth Law Firm, P.C., Marshall, TX, for Plaintiff.
Christopher Weldon Martin, Paul Wayne Pickering, Martin Disiere Jefferson & Wisdom, LLP, Houston, TX, Andy Tindel, Mann, Tindel & Thompson—Attorneys at Law, Tyler, TX, for Defendants.

REPORT AND RECOMMENDATION
ROY S. PAYNE, UNITED STATES MAGISTRATE JUDGE
*1 In this insurance case, Medallion Transport & Logistics, LLC asserts three causes of action: (1) breach by Granite State of its duty under Stowers to settle a third party claim; (2) a violation of the Texas Insurance Code by all Defendants; and (3) breach of an insurance contract against Granite State. Second Am. Compl [Dkt. # 62] at 10–14. Defendants move the Court for summary judgment on all of Medallion’s claims. Defs.’ Mot. for Summ. J. [Dkt. # 47]. For the reasons that follow, the motion should be GRANTED IN PART.

I. BACKGROUND

A. The Parties
Medallion is a North Carolina limited liability company with its principal place of business in Mooresville, North Carolina. Joint Pre-Trial Order [Dkt. # 75] at 7. Defendant AIG Claims, Inc. is a subsidiary and the claims servicing company of American International Group, Inc.’s property casualty insurance product lines. Id. Defendant Granite State Insurance Company is a fire and casualty company, organized under the laws of the State of Illinois, with its principal place of business in New York. Id. at 8. Defendant Jay Carman was an AIG Claims employee with the title “Complex Director.” Id. at 8, 9. At all times material to this case, AIG Claims and Carman were acting on behalf of Granite State. Id. at 8.

B. The Williams Litigation
In April 2011, Brandi Williams was driving when her vehicle was struck by a longdistance tractor-trailer carrying cargo for Medallion. Id. That same day, Medallion provided notice of the accident to Granite State. Id. At the time of the accident, Granite State insured Medallion for up to $2 million of liability. Id. Granite State accepted coverage for the accident two days later. Id.

AIG Claims quickly concluded Medallion was likely to be found liable. By August 2011, AIG Claims had determined that Medallion’s driver was primarily at fault for causing the accident and paid 90% of Williams’s property damage. Id. at 10. AIG Claims later entered activity notes commenting: “Liability: 90% against the insured for failing to yield the ROW and for making an illegal U-turn.” Id.

In February 2012, Williams sued Medallion to recover for personal injuries sustained in the accident. Id. at 9. Williams alleged that Medallion was negligent in the supervision and training of the driver. Id. Williams also alleged the accident caused severe injuries to her spine, which led to numerous medical procedures, hospitalizations, and a spinal surgery. Id. Williams claimed she could never return to nursing, her chosen profession. Id. at 9–10.

Medallion reported the suit to Granite State, which hired legal counsel to defend Medallion. Id. at 9. By reason of an arrangement between Granite State and AIG Claims, AIG Claims and Carman had authority to act as Granite State’s agents in managing the Williams litigation on Granite State’s behalf. Id. This included authority to adjust the Williams claim, including with respect to the investigation, evaluation, hiring counsel, and managing the defense, and potential resolution and settlement of the Williams claim. Id. By reason of this arrangement between Granite State and AIG Claims, all duties and obligations of Granite State to Medallion were to be performed by AIG Claims. Id.

*2 In the three months before trial, it became clearer that Medallion was likely to lose. On September 24, 2013, AIG Claims’s adjuster acknowledged the “case has a potential for serious exposure.” Id. at 10. On October 2, 2013, AIG Claims informed Medallion that Williams had submitted $122,231.75 in medical bills, had not worked since the accident, and showed very well in her deposition in that she was articulate and, as a registered nurse, able to describe her injuries well. Id. at 10.

On October 17, 2013, AIG Claims received a first Stowers demand from Williams’s counsel. Id. The demand included an offer to settle for $2 million, an amount within the liability limits of Medallion’s insurance policy with Granite State. Id. at 10–11.

On October 21, 2013, Medallion’s defense counsel (hired by AIG Claims) prepared an evaluation of the case at AIG Claims’s request. Id. at 11. That evaluation noted the collision was a severe impact, this was a serious case, there was no chance of a directed verdict or defense verdict, and the jury verdict could be $1.75 million to $3.3 million. Id. Defense counsel recommended that AIG Claims try to settle the case. Id.

After receiving the evaluation, Medallion hired counsel of its own, and at its own expense, to monitor the Williams litigation and the settlement discussions. Id. That attorney also encouraged AIG to accept the offer to protect Medallion from an excess verdict. Id. But AIG Claims rejected the first Stowers demand and made a counteroffer of $250,000. Id.

In early December 2013, AIG Claims and Carman received a second Stowers demand. Id. at 12. Two days later, AIG Claims and Carman rejected that demand on behalf of Granite State and made a counteroffer of $350,000, despite that by then Medallion was precluded from retaining any experts to testify at trial. Id.

The case was tried later that month. Id. After Williams’s treating physician testified, AIG Claims and Carman offered $500,000 to settle the case. Id. Williams rejected the offer but advised Carman that the previous offer to settle all claims—i.e., the second Stowers demand—was still available. Id.

On December 19, 2013, the jury rendered a verdict of $3,865,101 against Medallion and its co-defendants. Id. Two months later, the trial court found Medallion and its co-defendants jointly and severally liable to Williams and entered a judgment of $3,865,101 plus pre-judgment interest and taxable costs. Id. at 13.

In April 2014, AIG Claims and Carman offered to settle Williams’s claim for $1.975 million, the amount remaining under the policy, which Williams rejected. Id. The next month, Medallion appealed the Williams verdict. A year later, the appellate court reversed the trial court’s judgment and ordered a new trial. Id.

Before the case could be retried, the parties settled Williams’s claims for $3 million. Id. AIG paid $2.8 million towards the settlement. Medallion paid $200,000. Id.

C. Defendants’ Motion for Summary Judgment
First, Medallion contends Granite State violated its Stowers obligation to settle a third-party claim after receiving a proper demand to do so. Second, Defendants allegedly breached Tex. Ins. Code § 541.060(a)(2)(A) by “failing to attempt in good faith to effectuate a prompt, fair, and equitable settlement of … a claim with respect to which the insurer’s liability has become reasonably clear,” and § 541.060(a)(7) by “refusing to pay a claim without conducting a reasonable investigation with respect to the claim.” Third, Medallion alleges Granite State breached its contractual obligations under the insurance policy.

*3 Defendants’ motion challenges all three claims. First, Defendants contend Medallion never had a mature Stowers claim because there was never a final judgment in the Williams litigation. As for the alleged statutory violations, Defendants argue Medallion has not and cannot present any evidence that Defendants engaged in unfair or deceptive acts or practices, which Defendants contend is necessary for this cause of action. As for Medallion’s breach-of-contract claim, Defendants contend the evidence shows that Granite State complied with its obligations under the policy.

II. APPLICABLE LAW
“A party may move for summary judgment, identifying each claim or defense—or the part of each claim or defense—on which summary judgment is sought. The court shall grant summary judgment if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed. R. Civ. P. 56(a). The moving party has the initial burden of demonstrating the absence of a genuine issue of material fact. Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). In resolving the motion, the court should construe all facts and inferences in favor of the non-moving party. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 255 (1986).

III. DISCUSSION

A. Medallion’s Stowers Claim
In Texas, “[t]he common law imposes a duty on liability insurers to settle third-party claims against their insureds when reasonably prudent to do so.” Phillips v. Bramlett, 288 S.W. 876, 879 (Tex. 2009) (citing G.A. Stowers Furniture Co. v. Am. Indem. Co., 15 S.W.2d 544 (Tex. 1929) ). “For the duty to arise, there must be coverage for the third-party’s claim, a settlement demand within policy limits, and reasonable terms ‘such that an ordinarily prudent insurer would accept it, considering the likelihood and degree of the insured’s potential exposure to an excess judgment.’ ” Id. (quoting Am. Physicians Ins. Exch. v. Garcia, 876 S.W.2d 842, 849 (Tex. 1994) ). “When these conditions coincide and the insurer’s negligent failure to settle results in an excess judgment against the insured, the insurer is liable under the Stowers Doctrine for the entire amount of the judgment, including that part exceeding the insured’s policy limits.” Id. (citing Stowers, 15 S.W.2d at 548).

Here, the parties dispute whether Medallion had a ripe Stowers claim. Relying on Street v. Honorable Second Court of Appeals, 756 S.W.2d 299 (Tex. 1988), Defendants contend that a Stowers claim only accrues when a judgment is final. Thus, because there was never a final judgment in the Williams litigation, no Stowers claim ever accrued. Medallion, however, asserts a Stowers claim accrues as soon as the trial court disposes of all the issues and the trial court’s power to alter the judgment has ended. Pl.’s Resp. [Dkt. # 53] at 9 (citing Street, 756 S.W.2d at 301).

For a Stowers claim, “[t]he injury producing event is the underlying judgment in excess of policy limits.” Murray v. San Jacinto Agency, Inc., 800 S.W.2d 826, 829 (Tex. 1991); see also Linkenhoger v. Am. Fidelity & Cas. Co., 260 S.W.2d 884, 887 (Tex. 1953) (concluding the insured “could not have maintained this present suit until such time as his liability and the extent thereof had been determined by a final judgment in the former case. Until then … the tort was not complete.”). Thus, “[a] Stowers cause of action does not accrue until judgment in the underlying case becomes final.” Street, 756 S.W.2d at 301; see also, e.g., In re Davis, 253 F.3d 807, 809 (5th Cir. 2001) (concluding a debtor’s bankruptcy estate did not include a Stowers claim because judgment in the underlying case never became final and no such claim ever accrued); One Beacon Ins. Co. v. T. Wade Welch & Assocs., No. H-11-3061, 2012 WL 2403500, at *5 (S.D. Tex. June 25, 2012) (concluding the Stowers claim was not ripe because there was no final judgment).

*4 In Street, the Texas Supreme Court held “a judgment is final for the purposes of bringing a Stowers action if it disposes of all issues and parties in the case, the trial court’s power to alter the judgment has ended, and execution on the judgment, if appealed, has not been superseded.” Street, 756 S.W.2d at 301 (emphasis added). Thus, the question is not just disposition of issues in the underlying litigation, but the ability of the third party to execute on the judgment. Execution was never an issue here, as Defendants filed both a supersedeas bond and a timely notice of appeal. Accordingly, Medallion’s Stowers claim was never ripe and Defendants are entitled to judgment in their favor.

B. Defendants’ Alleged Violation of Texas Insurance Code § 541.060(a)
In its second count, Medallion alleges all three defendants violated Tex. Ins. Code § 541.060(a)(2)(A) by failing to attempt in good faith to effectuate a prompt, fair, and equitable settlement of a claim for which the insurer’s liability had become reasonably clear—here, Medallion’s liability to Williams. Medallion also alleges Defendants violated § 541.060(a)(7) by refusing to pay a claim without conducting a reasonable investigation of the claim.

In Rocor Int’l, Inc. v. Nat’l Union Fire Ins. Co. of Pittsburgh, PA, 77 S.W. 253 (2002), the Texas Supreme Court held statutory liability under the language of § 541.060(a)(2)(A) requires the insured to show “that (1) the policy covers the claim, (2) the insured’s liability is reasonably clear, (3) the claimant has made a proper settlement demand within policy limits, and (4) the demand’s terms are such that an ordinarily prudent insurer would accept it.” Rocor, 77 S.W.3d at 262 (interpreting Tex. Ins. Code art. 21.21, which was the predecessor to § 541.060). Unlike a Stowers claim, the statute requires a bad-faith component. See Tex. Ins. Code § 541.060(a)(2)(A) (defining “failing to attempt in good faith to effectuate a prompt, fair, and equitable settlement of … a claim with respect to which the insurer’s liability has become reasonably clear” as “an unfair or deceptive act or practice” subject to liability (emphasis added) ). There is no separate requirement of an unfair or deceptive act, as Defendants contend. The statute defines the foregoing failure to act in good faith as an unfair or deceptive act. That means, in the context of resisting a “no evidence” motion for summary judgment, the plaintiff must show some evidence that the insurer had no reasonable basis for denying or delaying payment or settlement of a claim. See Universal Life Ins. Co. v. Giles, 950 S.W.2d 48, 50–51 (Tex. 1997) (“An insurer breaches its duty of good faith and fair dealing when ‘the insurer had no reasonable basis for denying or delaying payment of [a] claim, and [the insurer] knew or should have known that fact.’ ”) (quoting Transp. Ins. Co. v. Moriel, 879 S.W.2d 10, 18 (1994) ); Texas Farmers Ins. Co. v. Soriano, 881 S.W.2d 312, 317 (Tex. 1994) (“In this regard, the evidence presented, viewed in the light most favorable to the insured, must be such as to permit at least the logical inference that the insurer had no reasonable basis to delay or deny payment of the claim.”).1

*5 Defendants argue Medallion has no evidence of any such bad faith. Defs.’ Mot. [Dkt. # 47] at 13–14 (citing Am. Physicians Ins. Exch. v. Garcia, 876 S.W.2d 842, 847 (Tex. 1994) ). Medallion responds the record provides “ample basis” for a jury to conclude that Medallion’s liability was reasonably clear, and that a reasonable insurance carrier would have accepted a settlement offer to protect its insured from the possibility of an excess judgment. Pl.’s Resp. [Dkt. # 53] at 13–15.

Here, a reasonable jury could conclude Defendants had no reasonable basis for delaying settlement of the claim. Even before the first Stowers demand, AIG Claims’s adjuster acknowledged the “case has a potential for serious exposure.” Joint Pre-Trial Order [Dkt. # 75] at 10. Williams had not worked since the accident and showed well in her deposition. Id. After the first Stowers demand, Medallion’s defense counsel noted the seriousness of the case, that there was no chance of a defense verdict, and that the jury verdict could be $1.75 million to $3.3 million. Id. at 11. Defense counsel also recommended to AIG Claims that it try to settle the case. Id. Medallion’s independently retained attorney also encouraged AIG to accept the demand to protect Medallion from an excess verdict. Id. Still, AIG Claims and Carman rejected the second Stowers demand, even though Medallion was at that time precluded from proffering experts at trial. Id. at 12.

Notably, Defendants’ motion offers no explanation as to why their approach was reasonable. Rather, Defendants recount the steps they took during the Williams litigation in fulfilling their contractual duty to defend. Medallion’s statutory cause of action, however, is based on Defendants’ unreasonably delaying settlement. Given the stipulated facts—especially in light of no explanation by Defendants as to why their behavior was reasonable—a jury could conclude Defendants unreasonably delayed in settling the claim. Accordingly, this part of Defendants’ motion should be denied.

C. Granite State’s Alleged Breach of the Insurance Contract
In its third count, Medallion alleges Granite State breached its contractual obligations under the insurance policy in four ways. First, Medallion claims Granite State failed to adequately manage Medallion’s defense. Second Am. Compl. [Dkt. # 62] ¶ 50. Second, Medallion claims Granite State failed to perform a reasonable assessment of Medallion’s potential liability. Id. Third, Medallion claims Granite State failed to obtain expert testimony to rebut the evidence offered by Williams at trial, both as to liability and damages. Id. Finally, Medallion claims Granite State failed to accept a settlement demand within policy limits which was reasonable and should have been accepted to protect the insured from potential liability. Id.

According to Defendants, however, the policy simply requires the insurer to “pay all sums an ‘insured’ legally must pay as damages because of ‘bodily injury’ or ‘property damage’ to which this insurance applies, caused by an ‘accident’ and resulting from the ownership, maintenance or use of a covered ‘auto’.” Policy No. TP9880498 01 Truckers Coverage Form [Dkt. # 47-2] at PageID 1063. Further, the policy gives Granite State
the right and duty to defend any “insured” against a “suit” asking for such damages…. We may investigate and settle any claim or “suit” as we consider appropriate. Our duty to defend or settle ends when the Liability Coverage Limit of Insurance has been exhausted by payment of judgments or settlements.
*6 Id. at PageID 1063–64. Medallion does not contest that these paragraphs provide the basis for Granite State’s contractual obligations, but claims the policy
implicitly requires the insurer to investigate and evaluate claims made against the insured as to both liability and damages, employ counsel to defend the insured in the event of a law suit, manage the litigation, and negotiate a fair and reasonable resolution where appropriate.
Pl.’s Resp. [Dkt. # 53] at 15–16.

Under Texas insurance law, “a breach of the duty of good faith and fair dealing will give rise to a cause of action in tort that is separate from any cause of action for breach of the underlying insurance contract.” Viles v. Security Nat’l Ins. Co., 788 S.W.2d 566, 567 (Tex. 1990). Thus, “[a]n insured’s claim for breach of an insurance contract is ‘distinct’ and ‘independent’ from claims that the insurer violated its extra-contractual common-law and statutory duties.” USAA Texas Lloyds Co. v. Menchaca, 545 S.W.3d 479, 489 (Tex. 2018).

“Insurance policies are contracts and therefore are controlled by rules of construction applicable to contracts generally.” Columbia Cas. Co. v. CP Nat’l, Inc., 175 S.W.3d 339, 343 (Tex. App.—Houston [1st Dist.] 2004, no pet.). Therefore, a court must construe the policy language at issue before determining whether summary judgment is appropriate.

“The construction of an unambiguous contract is a question of law for the court.” Tawes v. Barnes, 340 S.W.3d 419, 425 (Tex. 2011). “A contract is not ambiguous simply because the parties disagree over its meaning.” Dynegy Midstream Servs., Ltd. P’ship v. Apache Corp., 294 S.W.3d 164, 168 (Tex. 2009). Rather, a contract is ambiguous only when “its meaning is uncertain and doubtful or is reasonably susceptible to more than one interpretation.” Heritage Res., Inc. v. NationsBank, 939 S.W.2d 118, 121 (Tex. 1996). “If only one party’s construction is reasonable, the policy is unambiguous and [a court] will adopt that party’s construction.” RSUI Indem. Co. v. The Lynd Co., 466 S.W.3d 113, 118 (Tex. 2015). “But if both constructions present reasonable interpretations of the policy’s language, [the court] must conclude that the policy is ambiguous.” Id.

Here, the policy language concerning Granite State’s rights and obligations is not ambiguous. Medallion urges the policy “implicitly requires the insurer to investigate and evaluate claims made against the insured as to both liability and damages,” but the policy language clearly gives Granite State the right to investigate any claim as it considers appropriate. Similarly, Medallion urges the policy “implicitly requires” Granite State to “negotiate a fair and reasonable resolution,” but the policy expressly gives Granite State the right to settle any claim as it considers appropriate. Medallion offers no good reason why the Court should change the plain and ordinary meaning of either provision or imply additional obligations. See Wayne Duddlesten, Inc. v. Highland Ins. Co., 110 S.W.3d 85, 90 (Tex. App.—Houston [1st Dist.] 2003, pet. denied) (holding “that, because the policy gives appellees the ‘right to … settle these claims, proceedings or suits,’ [the insured’s] discretion in investigating and settling claims is not contractually limited”); see also Dear v. Scottsdale Ins. Co., 947 S.W.2d 908, 911, 913–14 (Tex. App.—Dallas 1997, writ denied) (concluding similar contract language “expressly and unambiguously permitted [the insurer] to investigate and settle any covered claims against [the insured] as [the insurer] deemed expedient”). Moreover, nothing in the policy suggests an “implicit requirement” for Granite State to manage the litigation. See Univ. Health Servs., Inc. v. Renaissance Women’s Group, P.A., 121 S.W.3d 742, 748 (Tex. 2003) (noting “a covenant will not be implied simply to make a contract fair, wise, or just”).

*7 That leaves only Granite State’s “right and duty to defend” against Williams’s claims. So far as Granite State’s “duty” is concerned, without additional language in the policy as to a particular standard of care, Granite State was only required to retain counsel for Medallion. As far as the “right” to defend, that includes the authority to make decisions normally vested in the insured as the named party in the case. See Northern County Mut. Ins. Co. v. Davalos, 140 S.W.3d 685, 688 (Tex. 2004). But to the extent Medallion or its defense counsel disagreed with any such decision by Granite State—e.g., a decision not to retain a testifying expert for trial—Medallion’s defense counsel could have urged Medallion to hire an expert notwithstanding Granite State’s position and then sue Granite State to attempt to recoup the associated costs as necessary legal expenses. That Medallion did not elect that option does not lie at the feet of Granite State—at least not under Medallion’s breach-of-contract claim concerning an insurance contract that gave Granite State the right to make the decision in the first place. See State Farm Mut. Auto. Ins. Co. v. Traver, 980 S.W.2d 625, 628 (Tex. 1998) (“[B]ecause the lawyer owes unqualified loyalty to the insured, the lawyer must at all times protect the interests of the insured if those interests would be compromised by the insurer’s instructions. Under these circumstances, the insurer cannot be vicariously responsible for the lawyer’s conduct.” (citation omitted) ). The Supreme Court in Traver made this particularly clear by expressly rejecting its previous dicta from Ranger County Mutual Ins. Co. v. Guin, 723 S.W.2d 656, 659 (Tex. 1987), where it had stated that an insurer’s duty to defend “includes investigation, preparation for defense of the lawsuit, trial of the case and reasonable attempts to settle.” See also Primrose Operating Co. v. Nat’l Am. Ins. Co., 382 F.3d 546, 558 (5th Cir. 2004) (“A breach of the duty to defend entitles the insured to the expenses it incurred in defending the suit, including reasonable attorney’s fees and court costs.”). Here, the stipulated facts show Granite State performed its contractual obligations by retaining counsel through the successful appeal of the case. Accordingly, Defendants’ motion should be granted as to Medallion’s breach-of-contract claim.

IV. RECOMMENDATION
Defendants’ Motion for Summary Judgment [Dkt. # 47] should be GRANTED IN PART. Specifically, the Court should GRANT summary judgment in Defendants’ favor as to Medallion’s Stowers and breach-of-contract claims, but DENY summary judgment as to Medallion’s claims under Tex. Ins. Code § 541.060.

Note: A party’s failure to file written objections to the findings, conclusions, and recommendations contained in this report by July 2, 2018 bars that party from de novo review by the district judge of those findings, conclusions, and recommendations and, except on grounds of plain error, from appellate review of unobjected-to factual findings and legal conclusions accepted and adopted by the district court. Fed. R. Civ. P. 72(b)(2); see Douglass v. United Servs. Auto. Ass’n, 79 F.3d 1415, 1430 (5th Cir. 1996) (en banc ).

All Citations
Slip Copy, 2018 WL 3249708

Footnotes

1
Although Soriano concerned an alleged breach of the duty of good faith in failing to settle a third-party claim, the Court noted it had never held that the duty of good faith applies to the handling of third-party claims. Soriano, 881 S.W.2d at 317. Farmers, however, did not challenge the legal viability of Soriano’s position, but simply claimed there was no evidence of bad faith. Id.

Castaneda v. ALG Transport Services, 2018 WL 3320932

2018 WL 3320932
Unpublished Disposition
This decision without published opinion is referenced in the Pacific Reporter. See Kan. Sup. Ct. Rules, Rule 7.04.
NOT DESIGNATED FOR PUBLICATION
Court of Appeals of Kansas.
MARIO CASTANEDA, Appellant,
v.
ALG TRANSPORT SERVICES, INC.
and
KANSAS WORKERS COMPENSATION FUND, Appellees.
No. 118,182
|
Opinion filed July 6, 2018.
Appeal from Workers Compensation Board.
Reversed and remanded with directions.
Attorneys and Law Firms
Kip A. Kubin, of Bottaro, Kubin & Yocum, P.C., of Leawood, for appellant.
Ronald P. Wood, of Clyde & Wood, L.L.C., of Overland Park, for appellee Kansas Workers Compensation Fund.
No appearance by appellee ALG Transport Services, Inc.
Before HILL, P.J., PIERRON and MALONE, JJ.

MEMORANDUM OPINION
PER CURIAM:
*1 Mario Castaneda was injured on the job. As a result of his injury, an administrative law judge (ALJ) awarded Castaneda temporary total disability (TTD) compensation in the amount of $14,105.22. But on administrative appeal, the Kansas Workers Compensation Board (Board) reversed the TTD award because of insufficient evidence. Castaneda appeals the Board’s decision and argues that the Board lacked authority to set aside the TTD award because the respondent had failed to contest that award before the ALJ. We agree with Castaneda’s claim, reverse the Board’s decision to set aside the TTD award, and remand with directions to reinstate the TTD award.

FACTS
In December 2014, Castaneda worked for ALG Transportation Services, Inc. (ALG), a Kansas corporation, located in Overland Park, Kansas. ALG is a small trucking company that transports cargo. Alberto Lizarazo owns ALG.

On December 18, 2014, Castaneda wrecked an ALG truck while hauling a load in Johnson County, Kansas. The icy and snowy weather conditions contributed to the accident. Castaneda injured his ribs in the accident and he was taken to the emergency room for treatment. He immediately reported the accident to Lizarazo. All parties later stipulated that Castaneda was injured from the accident, the accident occurred in the scope of employment, and Castaneda and ALG were in an employee and employer relationship when the accident occurred.

On April 2, 2015, Castaneda filed an application for hearing with the Division of Workers Compensation. ALG did not carry workers compensation insurance, so Castaneda impleaded the Kansas Workers Compensation Fund (Fund). ALG did not provide Castaneda with medical care following his injury. Then, on April 28, 2015, Castaneda filed an application for a preliminary hearing.

At the preliminary hearing on June 30, 2015, Castaneda and the Fund were represented by counsel but Lizarazo appeared pro se on behalf of ALG. The ALJ directed the Fund to compensate Castaneda for his TTD and also authorized Dr. Vito Carabetta to treat Castaneda at the Fund’s expense. These orders were not contested by any of the parties. The ALJ filed a preliminary order dated July 1, 2015, that stated: “Temporary Total Disability benefits to be paid at the weekly rate of $400 commencing April 7, 2015 and continue until released to substantial, gainful employment or at MMI by Dr. Vito J. Carabetta.”

As the case progressed, the parties deposed many people, including Carabetta and Lizarazo. In addition, the ALJ conducted a regular hearing on November 22, 2016, in which Castaneda was the only witness. At the time of the regular hearing, ALG was represented by counsel. Castaneda, ALG, and the Fund all filed submission letters to the ALJ, and none of the parties indicated in their submission letters that the TTD award was an issue at the regular hearing. In fact, each submission letter stipulated “[t]hat the Fund has paid 47 weeks of temporary total compensation at the rate of $400.00 for a total payment of $18,804.00.”

*2 On March 6, 2017, the ALJ rendered a final decision. Based on Carabetta’s unrefuted testimony that Castaneda suffered a 15 percent impairment under the AMA Guides to the Evaluation of Permanent Impairment (4th ed. 1995), the ALJ awarded Castaneda permanent partial disability payments totaling $18,697.24. The ALG also awarded Castaneda TTD for 43.71 weeks at $322.70 per week for a total of $14,105.22. Because the Fund had already paid Castaneda $18,804 in TTD compensation, the ALJ ordered that the excess TTD award be deducted from the permanent partial disability award. The ALJ directed the Fund to pay the entire compensation award, as ALG could not pay.

ALG appealed the ALJ’s decision to the Board. After filing the application for review by the Board, ALG’s counsel withdrew from the case. In a pro se brief to the Board filed by Lizarazo, ALG argued that the TTD award should be reversed because of insufficient evidence. Castaneda’s brief to the Board argued that the Board should not address the TTD award because the award had not been contested before the ALJ. The Fund’s brief to the Board took no position on the TTD issue.

On August 3, 2017, the Board issued its order modifying the ALJ’s award. In the order, the Board increased the total permanent partial disability compensation from $18,697.24 to $20,088.08. The Board, however, reversed the TTD award. The Board’s order acknowledged that ALG had the opportunity to dispute Castaneda’s request for TTD, but did not do so. The Board stated that “Lizarazo knew about the preliminary hearing and proceeded on a pro se basis. Respondent had the opportunity to be heard and present arguments [about whether the claimant is entitled to compensation for TTD], consistent with K.S.A. 2014 Supp. 44-534a(a)(2), but opted not to take advantage of the chance.” Nevertheless, the Board found that Castaneda did not prove his entitlement to TTD based on the record. The Board offset Castaneda’s $20,088.08 award for permanent partial disability by $18,804 paid for TTD and $100 in unearned wages, reducing Castaneda’s final award to $1,184.08. Castaneda timely appealed the Board’s order.

ANALYSIS
On appeal, Castaneda argues that the Board lacked authority to set aside the TTD award because that award had not been contested before the ALJ. Castaneda contends that the parties stipulated that he was entitled to TTD compensation at the regular hearing before the ALJ. Castaneda further contends that under K.S.A. 2017 Supp. 44-555c(a), the Board obtains jurisdiction only over issues raised before the ALJ.

The Fund’s four-page brief does not directly address Castaneda’s argument about the language of K.S.A. 2017 Supp. 44-555c(a). After reciting the facts and the applicable standard of review, the Fund argues: “This is a difficult case for all parties involved. The Respondent did not hire an attorney even though he was told he needed one.” The Fund then states: “It is not clear whether the Respondent knew what he was stipulating to or had an idea what the stipulations meant. However, the Respondent did object to any compensation being paid to the Claimant in this case and that was made clear from the start.” Notably, ALG filed no brief in this appeal.

K.S.A. 2017 Supp. 44-556(a) directs that final orders of the Board are subject to review under the Kansas Judicial Review Act (KJRA), K.S.A. 77-601 et seq. The standard of review will vary depending on the issue raised. See K.S.A. 2017 Supp. 77-621 (defining and limiting scope of review of administrative decisions under KJRA). Resolution of the issue raised in this appeal comes down to whether the Board exceeded its jurisdictional boundaries when it reversed the TTD award. Whether jurisdiction exists is a question of law subject to unlimited review. Norris v. Kansas Employment Security Bd. of Review, 303 Kan. 834, 837, 367 P.3d 1252 (2016).

*3 As administrative agencies, like the Board, are created by statute, their authority is only as broad as the statute creating the agency specifies. Stated differently, all administrative agencies’ jurisdiction is statutorily limited. See Ft. Hays St. Univ. v. University Ch., Am. Ass’n of Univ. Profs., 290 Kan. 446, 455-56, 228 P.3d 403 (2010).

For the Board, K.S.A. 2017 Supp. 44-555c(a) grants it jurisdiction to hear appeals from decisions by the ALJ. This statute states in relevant part:
“The board shall have exclusive jurisdiction to review all decisions, findings, orders and awards of compensation of administrative law judges under the workers compensation act. The review by the appeals board shall be upon questions of law and fact as presented and shown by a transcript of the evidence and the proceedings as presented, had and introduced before the administrative law judge.” (Emphases added.) K.S.A. 2017 Supp. 44-555c(a).

Based on this statute, the Board obtains jurisdiction only over issues raised before the ALJ. See Sachs v. City of Topeka, No. 110,872, 2014 WL 5849254, at *2-3 (Kan. App. 2014) (unpublished opinion) (finding that the Board lacked jurisdiction to consider issues not raised before the ALJ); see also Linenberger v. Kansas Dept. of Revenue, 28 Kan. App. 2d 794, 797, 20 P.3d 1290 (2001) (limiting parties to raising issues on appeal to this court to issues raised at the administrative hearing).

Here, the ALJ held a preliminary hearing on June 30, 2015. Castaneda and the Fund were represented by counsel but ALG appeared pro se. At the preliminary hearing, the ALJ directed the Fund to compensate Castaneda for his TTD and also authorized Dr. Carabetta to treat Castaneda at the Fund’s expense. These orders were not contested by any of the parties.

The ALJ conducted a regular hearing on November 22, 2016. Castaneda, ALG, and the Fund all filed submission letters to the ALJ, and none of the parties indicated in their submission letters that the TTD award was an issue at the regular hearing. In fact, each submission letter stipulated that the Fund had paid 47 weeks of temporary total compensation at the rate of $400 per week for a total payment of $18,804. The ALJ modified the TTD award to $14,105.22, but only because of an adjustment in the number of weeks covered by the award and the average weekly wage.

Lizarazo’s pro se brief to the Board argued that the TTD award should be reversed because of insufficient evidence. Castaneda’s brief to the Board argued that the Board should not address the TTD award because the award had not been contested before the ALJ. The Board’s order acknowledged that ALG had the opportunity to dispute Castaneda’s request for TTD, but did not do so. Nevertheless, the Board found that Castaneda did not prove his entitlement to TTD based on the record. The Board’s order did not cite or discuss K.S.A. 2017 Supp. 44-555c(a), and the Board did not explain its jurisdiction to set aside the TTD award.

Castaneda argues that the parties stipulated that he was entitled to TTD compensation. Technically, this assertion is incorrect. The parties stipulated that the Fund had paid 47 weeks of temporary total compensation at the rate of $400 for a total payment of $18,804, but the parties did not stipulate to the legitimacy of this award.

*4 That being said, the record supports Castaneda’s assertion that the TTD award was not contested before the ALJ. The ALJ’s decision identified the “nature and extent of claimant’s disability” as an issue, referring to Castaneda’s claim for permanent partial disability. The ALJ modified the TTD award to $14,105.22, but only because of an adjustment in the number of weeks covered by the award and the average weekly wage. The ALJ made no other findings to support the TTD award because none of the parties had indicated in their submission letters that the TTD award was an issue.

On September 8, 2016, Lizarazo sent a letter to counsel of record, with a copy to the Kansas Division of Workers Compensation, stating that he completely disputed any compensation being paid to Castaneda as a result of his work-related accident. Lizarazo’s pro se brief to the Board also made it clear that he objected to any compensation being paid to Castaneda. Lizarazo argued that Castaneda should not have been driving the truck on the date of his injury because of the adverse weather conditions, so ALG was not responsible for the claims. But these general denials of any liability do not change the fact that Castaneda’s TTD award was not specifically contested before the ALJ. The Board set aside the TTD award because of insufficient evidence, but the only reason there was insufficient evidence was because the TTD award was not challenged at the regular hearing before the ALJ.

We conclude that under K.S.A. 2017 Supp. 44-555c(a), the Board lacked jurisdiction to set aside the TTD award because ALG had failed to contest that award before the ALJ. The Board’s order acknowledged as much when it found that ALG had the opportunity to dispute Castaneda’s request for TTD, but failed to do so. Thus, we reverse the Board’s decision to set aside the TTD award, and we remand with directions for the Board to reinstate Castaneda’s TTD award in the amount of $14,105.22.

Reversed and remanded with directions.

All Citations
Slip Copy, 2018 WL 3320932 (Table)

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