Gibson v. National Ben Franklin Ins. Co.
| Decision Date | 01 June 1978 |
| Citation | 387 A.2d 220 |
| Parties | Louise GIBSON v. NATIONAL BEN FRANKLIN INSURANCE COMPANY and Underwriters Adjusting Company. |
| Court | Maine Supreme Court |
Reef & Mooers by Stephen A. Johnson (orally), Norman S. Reef, Portland, for plaintiff.
Hewes, Culley & Feehan by Richard D. Hewes (orally), Portland, for defendant.
Before DUFRESNE, C. J., and POMEROY, WERNICK, ARCHIBALD, DELAHANTY and GODFREY, JJ.
Plaintiff-appellant, Louise Gibson, brought suit against her employer's workmen's compensation carrier and its Maine agent seeking damages that she claimed resulted from their withholding and refusing benefit payments, especially refusing to make prompt payment of medical expenses she had incurred. In 1971, Ms. Gibson had been injured physically and suffered emotional problems because of a work-related injury. The carrier had paid some benefits and medical expenses under a duly approved agreement. When it refused to provide further compensation and medical treatment, Ms. Gibson brought a tort action in three counts against the carrier and its agent alleging that, in violation of their duty to continue payment of benefits and medical expenses, they willfully refused to pay them and thereby caused her severe mental distress. The defendants moved to dismiss the complaint under Rule 12(b)(6), M.R.Civ.P., for failure to state a claim upon which relief can be granted. The trial court dismissed the complaint.
Count I of the complaint states that appellant was injured in the course of her employment in such a manner as to entitle her to benefits under appellee carrier's policy and that the carrier entered into an agreement with her in accordance with 39 M.R.S.A. § 51 to pay benefits on account of such injury; that appellees wrongfully withheld and refused to pay benefits, with the result that she was effectively prevented from obtaining necessary and critical medical care and treatment and became afflicted with severe emotional distress, aggravating her mental and physical condition. Count II adds a charge that defendants acted knowingly and maliciously for the purpose of gaining an advantage for defendants to plaintiff's detriment. Count III of the amended complaint alleges that defendants acted with intent to cause such mental distress maliciously and as part of a calculated program of harassment, intimidation and delay in order to cause plaintiff to settle her claim to the detriment of the plaintiff and advantage of the defendants.
Appellant asserts a right to recover in tort. 1 The appellees' motion to dismiss was based explicitly on the ground that the Maine Workmen's Compensation Act provides exclusive remedies for the injuries appellant alleges she suffered. The appellees advance two arguments to support their assertion: first, that the Act makes remedies under the Act against the employer and carrier exclusive; second, that the provisions of the Act for enforcing claims, sections 91 to 109, and especially the penalty provision, section 104-A, establish the exclusive means for enforcing the duties of compensation carriers. Neither argument is persuasive. If the facts alleged in this complaint constitute tortious conduct a question we do not decide but leave to the Superior Court, on remand, to determine in the first instance if required to do so the Workmen's Compensation Act would not necessarily bar recovery on the theory of exclusivity of the Act relied upon by the appellees. The court erred in granting appellees' motion to dismiss on the grounds that appellees asserted.
With exceptions not here pertinent, the Maine Workmen's Compensation Act imposes liability upon employers for injuries suffered by employees arising out of and in the course of their employment and makes liability under the Act exclusive for injuries within its coverage. See 39 M.R.S.A. §§ 4, 28. From subsection (6) of 39 M.R.S.A. § 2, extending the definition of "employer" to include the employer's compensation carrier for most purposes, it must be inferred that the general immunity from common law suit provided by the workmen's compensation system is available to the carrier as well as to the actual employer. Thus, if appellant's complaint were a civil action for damages for injuries "arising out of and in the course of" her employment, the action would be barred by the Act.
On a motion to dismiss under Rule 12(b)(6), the court must construe the allegations of the complaint in a light favorable to the plaintiff. Following that approach here, we may conclude that appellant alleges she had established a remedial right under the Act to benefits and reasonable medical expenses which the compensation carrier and its agent deliberately proceeded to withhold from her. On this view of the complaint, the case arises not out of appellant's original employment relationship but out of her relationship to the insurance carrier after her basic remedies as an injured employee had been settled through...
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