Palmer v. Georgia Insurers Insolvency Pool

• Decision Date: 03 November 2021
• Docket Number: A21A0903
• Citation: 361 Ga.App. 803,865 S.E.2d 623
• Parties: PALMER v. GEORGIA INSURERS INSOLVENCY POOL.
• Court: Georgia Court of Appeals

361 Ga.App. 803

865 S.E.2d 623

PALMER

v.GEORGIA INSURERS INSOLVENCY POOL.

A21A0903

Court of Appeals of Georgia.

November 3, 2021

Todd K. Maziar, Atlanta, for Appellant.

Michael J. Gorby, Amy C. Meyer Burns, Atlanta, Whitney Brooke Arp, for Appellee.

Pipkin, Judge.

Victoria Palmer appeals the grant of summary judgment to the Georgia Insurers Insolvency Pool (the "Insolvency Pool") which relieved the Insolvency Pool of its obligation to issue payments on her pending claim for workers’ compensation benefits and required Palmer to refund all amounts paid by the Insolvency Pool on that claim. Because we conclude that the State Board of Workers’ Compensation has jurisdiction over the Insolvency Pool's claims at this time, we vacate the judgment of the superior court and remand this case for dismissal.

In July 2017, Palmer sustained injuries as a result of an automobile collision that occurred while she was on the job. Palmer thereafter filed a formal claim for workers’ compensation benefits with the State Board of Workers’ Compensation. In November 2017, the workers’ compensation insurer for Palmer's employer became insolvent,¹ and pursuant to the Georgia Insurers Insolvency Pool Act, OCGA § 33-36-1 et seq. (the "Insolvency Pool Act"), the Insolvency Pool became responsible for her claim. The Insolvency Pool has issued payments on Palmer's claim totaling $24,604.63; $21,400.04 was issued to medical providers on Palmer's behalf, and $3,204.59 was issued to Palmer for weekly indemnity disability benefits.

Palmer also submitted claims to the at-fault driver's automobile liability insurer and to her own automobile liability insurer pursuant to her policy's underinsured motorist provision. In January 2019, Palmer settled her claim with the at-fault driver's insurer for the policy limits of $25,000. In late April 2019, Palmer's insurer tendered the policy limits of $50,000 to Palmer. On May 9, 2019, Palmer's counsel informed the Insolvency Pool of the funds recovered by Palmer, and eight days later, on May 17, 2019, the Insolvency Pool filed the instant suit against Palmer in the superior court.

In its complaint, the Insolvency Pool sought a set-off of $75,000, which represented the total amount Palmer received from the at-fault driver's insurer and her own insurer, a ruling that it is not obligated to issue any payments on Palmer's workers’ compensation claim until the set-off amount is reached, and a refund from Palmer for all amounts it has paid on her workers’ compensation claim.² The Insolvency Pool argued that OCGA §§ 33-36-14 (a) and (b), as well as this Court's recent decision in Georgia Insurers Insolvency Pool v. DuBose , 349 Ga. App. 238, 825 S.E.2d 606 (2019), authorized the requested relief. The superior court agreed and granted the Insolvency Pool's motion for summary judgment. Palmer appeals.

To resolve the issue underlying this appeal, that is, whether the superior court was authorized to grant the relief requested by the Insolvency Pool, we must consider the interplay between the Insolvency Pool Act and the Workers’ Compensation Act, as well as the principles underlying these complex statutory schemes. We turn first to the Insolvency Pool Act, which governs the Insolvency Pool. OCGA § 33-36-1 et seq. Pursuant to the Insolvency Pool Act, when an insurance company is placed into liquidation, the Insolvency Pool becomes responsible for the handling and administration of the insolvent insurer's claims, and the Insolvency Pool is deemed the insurer to the extent that such claims constitute "covered claims" within the meaning of the Insolvency Pool Act. OCGA § 33-36-9. A claim under a workers’ compensation insurance policy, like the claim at issue here, may fall within the meaning of a "covered claim," as defined by the Insolvency Pool Act. OCGA § 33-36-3 (4) (B) (v).

Because the Insolvency Pool is "intended to be a safety net for those whose insurers go out of business" and thus provides benefits "only when there is no other insurance available," a claimant may not necessarily "receive the exact recovery [from the Insolvency Pool] that [she] would have received from a solvent insurer." (Citation and punctuation omitted.) DuBose , 349 Ga. App. at 246 (1) (b), 825 S.E.2d 606. Indeed, the Insolvency Pool is authorized to bring an action to recover "[a]ny amount paid a claimant in excess of the amount authorized" by the Insolvency Pool Act, OCGA § 33-36-14 (b), and various provisions in the Insolvency Pool Act limit the Insolvency Pool's liability on covered claims.³ The limiting provision at issue in this case is frequently referred to as the set-off provision:

[A]ny person having a claim against a policy or an insured under a policy issued by an insolvent insurer, which claim is a covered claim and is also a claim within the coverage of any policy issued by a solvent insurer, shall be required to exhaust first his or her rights under such policy issued by the solvent insurer. The policy of the solvent insurer shall be treated as primary coverage and the policy of the insolvent insurer shall be treated as secondary coverage and his or her rights to recover such claim under this chapter shall be reduced by any amounts received from the solvent insurers.

OCGA § 33-36-14 (a).

We recently considered the set-off provision in DuBose , but our holding in that case was limited to establishing what amounts received by a claimant from a solvent insurer may be considered in ascertaining the proper set-off amount pursuant to OCGA § 33-36-14 (a). See 349 Ga. App. at 241 (1) (a), 246 (1) (b), 825 S.E.2d 606. Contrary to both the Insolvency Pool's arguments and the superior court's ruling, nothing in DuBose authorized the Insolvency Pool to bring a parallel action in the superior court to obtain a refund of benefits paid in connection with a pending workers’ compensation claim or to alter the payment obligations imposed on the Insolvency Pool by the Workers' Compensation Act.⁴ See Wolfe v. Bd. of Regents of Univ. System of Ga. , 300 Ga. 223, 231 (2) (d), 794 S.E.2d 85 (2016) ("Questions which merely lurk in the record, neither brought to the attention of the court nor ruled upon, are not to be considered as having been so decided as to constitute precedents.") (citation and punctuation omitted).

Nor do the relevant provisions of the Insolvency Pool Act support the Insolvency Pool's position. By its plain language, OCGA § 33-36-14 (a) does not create an independent cause of action allowing the Insolvency Pool to file suit in order to enforce the set-off provision.⁵ See Somerville v. White , 337 Ga. App. 414, 417 (1), 787 S.E.2d 350 (2016) ("In the absence of ... textual support, a cause of action does not exist and courts may not create one, no matter how desirable that might be as a policy matter, or how compatible with the statute.") (citation and punctuation omitted); Best Jewelry Mfg. Co. v. Reed Elsevier Inc. , 334 Ga. App. 826, 833 (1) (b), 780 S.E.2d 689 (2015) ("[T]he statutory text must expressly provide a private cause of action.") (citation and punctuation omitted). And while OCGA § 33-36-14 (b) may create such an independent cause of action, the statutory language limits the Insolvency Pool's recovery to "[a]ny amount paid a claimant in excess of the amount authorized" by the Insolvency Pool Act. (Emphasis supplied.) However, according to the record before us, Palmer's claim appears to be pending before the Board, and without a decision from the Board as to the amount of benefits to which Palmer is entitled, the Insolvency Pool cannot yet establish that the payments it has issued in connection with Palmer's claim exceed the amount authorized by the Insolvency Pool Act.⁶ In short, the Insolvency Pool does not cite, and we have not found, any authority permitting the Insolvency Pool to bring the action it did in this case, that is, a parallel action in the superior court that directly implicates a pending workers’ compensation claim. See OCGA § 33-36-6 (e) ("The [Insolvency Pool] as a legal entity ... shall have no cause of action against the insured of the insolvent insurer for any sums it has paid out except such causes of action as the insolvent insurer would have had if such sums had been paid by the insolvent insurer and except as otherwise provided in this chapter.").

That the Insolvency Pool's action in its present form was not authorized by law does not mean that the Insolvency Pool is without a remedy. While it is well settled that the State Board of Workers’ Compensation (the "Board") "has exclusive original jurisdiction of claims under the Workers’ Compensation [Act]," Royal Indem. Co. v. Ga. Insurers Insolvency Pool , 284 Ga. App. 787, 789, 644 S.E.2d 279 (2007), we have also acknowledged the Board's jurisdiction to resolve ancillary issues relating to the determination of an employee's rights under the Workers’ Compensation Act, even where the claim is clearly not one between an employer and an employee within the provisions of the Workers’ Compensation Act.⁷ See Aetna Workers' Comp Access, LLC v. Coliseum Med. Center , 322 Ga. App. 641, 644-645 (1), 746 S.E.2d 148 (2013) ; Builders Ins. Group v. Ker-Wil Enterprises , 274 Ga. App. 522 (2), 618 S.E.2d 160 (2005). Indeed, the Workers’ Compensation Act "is intended to provide a complete and exclusive system for the resolution of disputes between employers and employees who are subject to this chapter." (Emphasis supplied.) OCGA § 34-9-23. As we have previously explained,

[A] complete and exclusive system for the resolution of disputes between employers, their workers’ compensation insurers, and their employees does, of necessity, include the power to resolve workers’ compensation insurance coverage issues that bear upon the payment of benefits to an injured employee claimant. Vesting the power to resolve these ancillary coverage issues with the Board and its administrative law judges protects the interests of the insurer, the employer, and the employee and

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