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If you’re injured at work, can you sue your employer for damages? p3

Thu Dec 18th, 2014 on     Insurance Claims,    

We are finishing up our series about a Florida Supreme Court decision that the appellate court said could clear up some confusion about workers’ compensation coverage. The issue was whether an employee’s widow can file a workers’ comp claim as well as a wrongful death lawsuit.

The employer carries two types of insurance for employee matters: workers’ comp and employer’s liability insurance. The latter is a “gap filler,” according to industry experts, but the widow argued that the language of the latter policy allowed for both remedies.

When we left off, the widow had been awarded a $9.5 million settlement in the wrongful death suit. However, she also received a workers’ comp settlement. Florida law dictates that workers’ comp cover an employee’s death in a work-related accident.

Can she keep both? Not according to the Supreme Court. The court looked to the language of the employer’s liability policy and noted that it specifically excluded claims that workers’ comp could cover.

Courts make coverage decisions based on the language of the insurance policy — remember, the policy is a contract, so contract law applies. Courts look at the plain meaning of the terms and only exclude ambiguous language or provisions if the meaning cannot be gathered by looking at the entire policy. If that provision is ambiguous even when read in context, then and only then will a court rule against the insurer.

The court’s decision means that the widow will not be collecting the $9.5 million from the wrongful death claim. Woirkers’ comp is her exclusive remedy for a work-related injury or death. What it will not cover are so-called employment practices — wrongful termination, sexual harassment or discrimination, for example. Those are the gaps filled by the employer’s liability coverage.

Reviewing the court’s decision, it is clear that the law gives the insurance company the upper hand in policy disputes. That, however, is a topic for another series of posts.

Sources:

Business Insurance, “Florida workers comp exclusive remedy rule bars wrongful death payout to family,” Sheena Harrison, Dec. 5, 2014

Morales v. Zenith Ins. Co., No. SC13-696, 2014 WL 6836320 (Fla. Dec. 4, 2014), via WestlawNext

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