Miss. Ins. Guar. Ass'n v. Blakeney, 2008–CT–01840–SCT.

• Decision Date: 03 January 2011
• Docket Number: No. 2008–CT–01840–SCT.,2008–CT–01840–SCT.
• Citation: 54 So.3d 203
• Parties: MISSISSIPPI INSURANCE GUARANTY ASSOCIATIONv.Bridgette BLAKENEY.
• Court: Mississippi Supreme Court

54 So.3d 203

MISSISSIPPI INSURANCE GUARANTY ASSOCIATION

v.Bridgette BLAKENEY.

No. 2008–CT–01840–SCT.

Supreme Court of Mississippi.

Jan. 3, 2011.

Clifford C. Whitney, III, Vicksburg, attorney for appellant.S. Wayne Easterling, Hattiesburg, John Raymond Tullos, Raleigh, attorneys for Appellee.EN BANC.

ON WRIT OF CERTIORARI

DICKINSON, Justice, for the Court:

¶ 1. When the workers' compensation carrier making payments to Bridgette Blakeney was declared insolvent, its claims were transferred to the Mississippi Insurance Guaranty Association (MIGA),¹ which, upon discovering Blakeney had received a settlement of $60,000 from her employer's uninsured motorist (UM) carrier,² petitioned the Workers' Compensation Commission (“Commission”) for an offset of $100,000—the full UM policy limits. The workers' compensation administrative law judge (ALJ) found MIGA's credit was limited to the $60,000 actually paid, but the full Commission noted that MIGA stood in the shoes of a compensation carrier, relied on caselaw that exempts UM benefits from a compensation carrier's subrogation rights, and held that MIGA was entitled to no credit. The circuit court and the Court of Appeals affirmed the Commission, but we reverse, finding that MIGA must comply with a statute that requires it to offset the $60,000 actually paid.

BACKGROUND

¶ 2. After she was injured in an automobile accident, Blakeney collected the $10,000 policy limits of the other driver's liability policy, settled for $60,000 of the $100,000 policy limits of her employer's UM policy, and because the accident was work-related, began receiving workers' compensation (“comp”) benefits from her employer's comp carrier, Coregis Insurance Company. After Coregis was declared insolvent, its claims, including Blakeney's, were assumed by MIGA.

¶ 3. After it started paying Blakeney's comp benefits, MIGA learned of the $70,000 she had collected from the two insurance companies, prompting it to petition the Commission to allow it to suspend paying her benefits until her accrued claims exceeded the $70,000 she already had collected. Upon reflection, MIGA amended its petition, claiming that, rather than the $70,000 the two insurance companies had paid, it actually was entitled to a credit of $110,000—their combined policy limits.

¶ 4. The ALJ held that, rather than a credit for the full policy limits, MIGA was entitled to offset the $70,000 actually paid, but the full Commission reversed, holding that MIGA was entitled to full credit for the $10,000 paid by the liability policy (less $4,000 in collection costs), but it was not entitled to any credit for the UM policy. Both the circuit court and Court of Appeals ³ affirmed the Commission's order, and we granted MIGA's petition for certiorari.

ANALYSIS

¶ 5. Because most Commission decisions are fact-based, the appellate standard of review for those decisions is deferential.⁴ But when the essential facts are undisputed and the issues presented turn on legal questions, we must apply our own interpretation of the law.⁵

I. MIGA was created by the Legislature, and its responsibilities are controlled by statute.

¶ 6. An insurance policy is a contract with an insurance company, whose duty to pay claims ordinarily is contractual. But when the insurance company becomes insolvent, its policyholders face a substantial risk that their legitimate claims will be delayed or not paid at all. To address this problem, the Legislature enacted the Mississippi Insurance Guaranty Association Law (the “MIGA Act”), creating MIGA.⁶

¶ 7. MIGA's statutory purpose is to “cover claimants who would otherwise not be fully compensated as a result of the insolvency of an insurer.” ⁷ As noted by the Commission and the Court of Appeals, the MIGA Act provides that MIGA shall be

deemed the insurer to the extent of the obligation on the covered claims and to such extent shall have all rights, duties, and obligations of the insolvent insurer as if the insurer had not become insolvent.⁸

¶ 8. This “deemed the insurer” language has produced the aphorism: “MIGA stands in the shoes of an insolvent insurer.” ⁹ But an insolvent insurer's shoes are not always a perfect fit. Just as surely as the insolvent insurer's “duties and obligations” pass to MIGA under one subsection of the statute, they are limited under another subsection that says MIGA may pay covered claims only “to the extent of the association's obligation.” ¹⁰

¶ 9. The “association's obligation” often does not equal the insolvent insurer's obligations under the policy. For instance, MIGA is statutorily prohibited from paying punitive damages,¹¹ and its authority to pay claims is limited to claims of Mississippi residents, or concerning Mississippi property.¹² And regardless of the limits of the underlying policy, MIGA's liability for most claims is capped at $300,000.¹³

¶ 10. MIGA's duty and authority to pay claims—including Blakeney's—must be filtered through these, and all other MIGA Act limitations, and we must respect and apply those limitations, even where they would not have applied to the insurance company.¹⁴ We now turn to the statutory limitation most pertinent to this case.

II. The MIGA Act's exhaustion provision requires MIGA to offset Blakeney's UM benefits.

¶ 11. The MIGA Act states:

Any person having a claim against an insurer under any provision in an insurance policy other than a policy of an insolvent insurer, which is also a covered claim, shall be required to exhaust first his right under such policy. Any amount payable on a covered claim under this article shall be reduced by the amount of any recovery under such insurance policy.¹⁵

¶ 12. This statute—often called MIGA's “exhaustion provision”—seems clear enough: “Any person having a claim against an insurer under any provision in an insurance policy other than a policy of an insolvent insurer, which is also a covered claim” defines the policyholders to whom the statute applies; “shall be required to exhaust first his right under such policy” defines the policyholder's duty; and “Any amount payable on a covered claim under this article shall be reduced by the amount of any recovery under such insurance policy” establishes MIGA's duty when the statute applies.

¶ 13. Applying the statute to the facts of this case: Blakeney had a claim against her employer's solvent UM carrier for the same loss (the damages she suffered from the automobile accident) being paid by MIGA; she was required to “exhaust” her right under the UM policy—which she did by settling for $60,000 and signing a release; and MIGA was required to reduce its “amount payable” on Blakeney's claim “by the amount of [Blakeney's] recovery” under the UM policy which, as correctly concluded by the ALJ, was the $60,000 actually recovered, not the $100,000 policy limits demanded by MIGA.

¶ 14. The dissent proposes an interesting interpretation of the statute, one which would require the claim against the solvent insurer to meet the statutory definition of “covered claim” ¹⁶—a requirement that would be difficult to meet, since MIGA's “covered claims” come only from insolvent insurers. We decline to adopt such a reading, because it is plainly contradicted by the statute. By definition, a “covered claim” can be only a claim against an “insolvent insurer.” ¹⁷ It is therefore impossible for the claim against the solvent insurer to meet the statutory definition of “covered claim,” which requires that the insurer be insolvent. The statute's clear meaning is that MIGA may reduce its obligation to pay a “covered claim” (which must have come from an insolvent insurer) where the beneficiary recovers on the same claim from a solvent insurer. Here, the “claim” is for injuries and lost wages caused by an accident; so the claim against the workers' compensation carrier (for reimbursement of those losses) was the same legal claim as the one against the UM carrier. Our reading and conclusion today is in complete harmony with our prior holding in Leitch v. Mississippi Insurance Guaranty Association.¹⁸

III. The MIGA Act has no exceptions for UM policies, workers' compensation policies, or the Workers' Compensation Law.

¶ 15. The question of whether UM benefits are off limits to MIGA was answered in Leitch, decided in 2010, in which MIGA assumed the claims of Reliance Insurance Company, the tortfeasor's insolvent liability carrier. ¹⁹ MIGA paid Leitch under the liability policy, and then asserted it was entitled to an offset for Leitch's UM benefits.²⁰ Leitch argued that his UM benefits did not reduce MIGA's obligation to pay Reliance's claims. ²¹ We held that MIGA was entitled to the offset because the MIGA Act included no exemption for UM coverage.²²

¶ 16. In appealing the ALJ's decision to the full Commission, Blakeney successfully argued that Leitch was distinguishable because, in her case, MIGA stood in the shoes of a comp carrier, bringing into play the Workers' Compensation Law's subrogation provision, which says:

The commencement of an action by an employee ... against a third party for damages by reason of the injury ... shall not affect the right of the employee ... to recover compensation, but any amount recovered by the injured employee ... from a third party shall be applied as follows: reasonable costs of collection as approved and allowed ... by the commission ... shall be deducted; the remainder ... shall be used to discharge the legal liability of the ... insurer.... ²³

¶ 17. The Commission found that MIGA was not entitled to any credit under the UM policy, citing as its authority our decision in Cossitt v. Nationwide Mutual Insurance Co., in which we held that, although Section 71–3–71 does allow comp carriers to subrogate against liable third parties, it does not allow them to subrogate against UM carriers, who are not liable “third parties” within the meaning of the subrogation provision.²⁴ We find no connection between a comp carrier's Section 71–3–71 subrogation rights and...