Summary
The Oklahoma Supreme Court held that a workers' compensation claimant must obtain certification under Oklahoma Statutes title 85, section 42(A), and Workers' Compensation Court Rule 58 that awarded benefits were not provided as ordered before pursuing a bad-faith claim against the workers' compensation insurer. The certification requirement applies to both monetary and non-monetary benefits, including court-ordered medical treatment. Because the Workers' Compensation Court's order functionally satisfied the certification requirement, the district court's summary judgment for Zurich was reversed.
Topics
Practice areas
Questions Presented
- Whether a claimant alleging bad faith by a workers' compensation insurer for refusing to provide court-ordered benefits must first obtain certification under Okla. Stat. tit. 85, § 42(A) and Rule 58 that the benefits remain unpaid or were not provided as ordered.
- Whether the certification requirement recognized in Sizemore v. Continental Casualty Co. applies to non-monetary workers' compensation benefits, including court-ordered medical treatment.
- Whether the October 16, 2007 Workers' Compensation Court order functionally satisfied the certification requirement and permitted Summers to pursue a district-court bad-faith action.
Holdings
- A claimant seeking to pursue a district-court bad-faith claim based on an insurer's failure to provide benefits awarded in a final Workers' Compensation Court order must first obtain certification under Okla. Stat. tit. 85, § 42(A) and Rule 58 that the award remains unpaid or that the ordered benefits were not provided as ordered.
- The certification requirement applies to both monetary benefits and non-monetary benefits ordered in a final Workers' Compensation Court order, including authorization and provision of court-ordered medical treatment.
- The October 16, 2007 Workers' Compensation Court order was the functional equivalent of a certification order and satisfied the requirements of section 42(A) and Rule 58, allowing Summers to proceed with her district-court bad-faith claim.
Key quotations
“The decision encompasses an insurer's bad faith refusal to provide any benefits which (1) have been ordered in a final order of the Workers' Compensation Court and (2) have been certified as having not been provided as ordered.” (213 P.3d at 568)
“A claimant who has obtained an order certifying that non-monetary benefits have not been provided as ordered does not have the option of enforcing the award as a judgment in the district court.” (213 P.3d at 569)
“Although the order in this matter did not use the term "certification," as referenced in section 42(A) and Rule 58, it was the functional equivalent of such an order and it satisfied the requirements stated in this opinion for such an order.” (213 P.3d at 570)
Factual background
Summers suffered a compensable work-related injury to her back, head, neck, and jaw while employed by Walgreens and insured under Zurich's workers' compensation policy. The Workers' Compensation Court entered multiple final orders requiring medical treatment, wage benefits, and related payments, including treatment for dental and jaw conditions. Summers alleged that Zurich continued to refuse or delay authorization of court-ordered medical treatment, and the Workers' Compensation Court's October 16, 2007 order required reasonable measures to facilitate the treatment within thirty days. Summers then filed a district-court bad-faith action, and the record contained evidence creating a factual dispute about Zurich's compliance.
Procedural history
Summers filed a district-court action alleging that Zurich breached its duty of good faith and fair dealing by refusing to authorize medical treatment ordered by the Workers' Compensation Court. The district court granted Zurich summary judgment, and a divided Court of Civil Appeals affirmed. The Oklahoma Supreme Court granted certiorari, vacated the Court of Civil Appeals' opinion, and reversed the trial court.
Remand instructions
The district court must proceed with Summers's tort claim for alleged bad faith arising from Zurich's continuing failure to authorize or provide the overdue court-ordered medical treatment.