Burlew v. American Mut. Ins. Co.

• Decision Date: 27 November 1984
• Citation: 63 N.Y.2d 412,482 N.Y.S.2d 720,472 N.E.2d 682
• Parties: , 472 N.E.2d 682 Bernice M. BURLEW et al., Appellants, v. AMERICAN MUTUAL INSURANCE COMPANY, Respondent.
• Court: New York Court of Appeals Court of Appeals

Page 720

482 N.Y.S.2d 720

63 N.Y.2d 412, 472 N.E.2d 682

Bernice M. BURLEW et al., Appellants, v. AMERICAN MUTUAL INSURANCE COMPANY, Respondent.

Court of Appeals of New York.

Nov. 27, 1984.

Stephen D. Aronson, Canandaigua, for appellants

James C. Moore, Rochester, for respondent.

OPINION OF THE COURT

COOKE, Chief Judge.

In addition to providing relief for work-related injuries, the Workers' Compensation Law also regulates the processing of claims. Injuries allegedly occurring as a result of an employer's delay in authorizing surgery are subject to the exclusive remedies provided in that legislative plan. To the extent that an insurance carrier is merely acting in the employer's stead in processing claims, it, too, may assert the exclusivity of the statutory remedies in defense to a negligence action asserted by an injured worker.

Plaintiff Bernice Burlew was injured on July 30, 1979, when she inhaled fumes at her workplace with Voplex Corporation. ^* She began receiving workers' compensation benefits from defendant, the employer's insurance carrier. Sometime before the end of 1979, plaintiff's physician determined that surgery was necessary to correct a condition that was causally related to her industrial illness. The doctor sought an authorization from defendant, but four or five months passed before defendant granted the request in the spring of 1980.

In January 1983, this suit was commenced to recover compensatory and punitive damages on two theories. The first cause of action posited that defendant was negligent in that it breached a special duty owed to plaintiff to use reasonable care in timely deciding requests for authorizations. Plaintiff's second cause of action described defendant's conduct as "wilful, malicious, wanton and otherwise grossly negligent" so as to constitute an act of bad faith. When defendant moved to dismiss the complaint for failure to state a cause of action, plaintiff supplemented her pleadings with an affidavit. To indicate defendant's bad faith, plaintiff adverted to two matters: once, one of defendant's agents came to her home while she was awaiting the authorization and, in the course of the interview, yelled "in words or substance: 'You're crazy if you think we're going to support you for the rest of your life' "; on another occasion, defendant procured an affidavit from an individual in Voplex Corporation's personnel department that purported to give an expert opinion that plaintiff's condition was due to a pre-existing injury.

Special Term granted the motion to dismiss only as to the first cause of action. The Appellate Division, 99 A.D.2d 11, 471 N.Y.S.2d 908, modified by dismissing the remainder of the complaint. For the reasons that follow, this court agrees that plaintiff has failed to state any cause of action.

Analysis starts with the fundamental observation that workers' compensation is intended to be the exclusive remedy for work-related injuries (Workers' Compensation Law, § 11). Consequently, when a defense based on the exclusivity of the statutory remedy is interposed, no suit against an employer may be maintained for an accidental injury that may be fairly described as "arising out of and in the course of the employment" (Workers' Compensation Law, § 10; see Shine v. Duncan Petroleum Transp., 60 N.Y.2d 22, 466 N.Y.S.2d 672, 453 N.E.2d 1089; Murray v. City of New York, 43 N.Y.2d 400, 401 N.Y.S.2d 773, 372 N.E.2d 560; O'Rourke v. Long, 41 N.Y.2d 219, 391 N.Y.S.2d 553, 359 N.E.2d 1347).

The legislative scheme for workers' compensation benefits is far-reaching. It concerns itself not only with the simple fact of a work-related injury, but it provides a thorough system of regulation, administration, and, where the Legislature has deemed them appropriate, sanctions (see, e.g., Workers' Compensation Law, §§ 25, 52, 120, 220). Consequently, all employer conduct that is regulated by the Workers' Compensation Law is subject to the protection of that law's exclusivity; if the employer violates any provision of the code, an employee's remedies cannot exceed those granted in the statutes.

Subdivision (5) of section 13-a of the Workers' Compensation Law prohibits an employee from enforcing a claim for a surgical operation "unless shall have been authorized by the employer or by the board, or unless such authorization shall have been unreasonably withheld". The Workers' Compensation Board has directed that the employee "request and secure authorization from the employer or insurance carrier or the chairman" (12 NYCRR 325-1.4). By referring to the insurance carrier, the agency's regulation apparently...