On February 27, 2009 the Kentucky Court of Appeals issued a ruling that should be taken into consideration in any case that involves both workers' compensation and automobile negligence. The case, State Farm Mutual Automobile Insurance Company v. Carlene Susher, as Administratix of the Estate of Ronald Slusher, Deceased, concerns whether a person can have both a workers' compensation claim and a claim for underinsured or motorist benefits when the at-fault party is a co-worker.
In this case a coal truck driver, Donald Slusher, was killed when a co-worker's truck rolled into the building he was occupying. An investigation by the Mine Safety and Health Administration (MSHA) determined that the accident was caused because the coworker negligently failed to apply the parking break before exiting the truck. The victim's estate received worker's compensation benefits. The estate also claimed benefits under the UM (uninsured motorist) and/or UIM (underinsured motorist) coverage purchased by the victim on his own personal vehicle. One is generally entitled to benefits under a UM policy when the at-fault driver has no insurance and to UIM benefits if the at-fault driver has insufficient insurance.
State Farm moved to dismiss the case because the victim did not have an automobile negligence claim against the co-worker. The victim did not have a claim against the co-worker because, generally, if you are covered by workers' compensation insurance the only claim you can bring against your employer or a co-worker is under the workers' compensation system (See KRS 342.690). The co-workers truck was insured by Progressive and that policy did not apply because of this "exclusive remedy" rule.
The court first examined the language of the State Farm policy and found that the terms were ambiguous in that State Farm established coverage when one is "legally entitled to collect from the driver of an uninsured motor vehicle". The court held that the negligence of the co-worker was stipulated and the damages exceeded the workers' compensation recovery. Basically, the workers' compensation plan rendered the at-fault party underinsured. The Court also applied the "reasonable expectations" test and held that a person who purchases additional coverage has a reasonable expectation that he will be additionally compensated under his own insurance policy if the compensation from insurance sources is not adequate.
One of the most important reasons to secure legal counsel after an accident is to make sure that all available coverage is sought. As the Susher case illustrates, applicable coverage is not always obvious and you cannot count on the insurance company to provide the correct and final answer as to whether your policy applies.
In this case a coal truck driver, Donald Slusher, was killed when a co-worker's truck rolled into the building he was occupying. An investigation by the Mine Safety and Health Administration (MSHA) determined that the accident was caused because the coworker negligently failed to apply the parking break before exiting the truck. The victim's estate received worker's compensation benefits. The estate also claimed benefits under the UM (uninsured motorist) and/or UIM (underinsured motorist) coverage purchased by the victim on his own personal vehicle. One is generally entitled to benefits under a UM policy when the at-fault driver has no insurance and to UIM benefits if the at-fault driver has insufficient insurance.
State Farm moved to dismiss the case because the victim did not have an automobile negligence claim against the co-worker. The victim did not have a claim against the co-worker because, generally, if you are covered by workers' compensation insurance the only claim you can bring against your employer or a co-worker is under the workers' compensation system (See KRS 342.690). The co-workers truck was insured by Progressive and that policy did not apply because of this "exclusive remedy" rule.
The court first examined the language of the State Farm policy and found that the terms were ambiguous in that State Farm established coverage when one is "legally entitled to collect from the driver of an uninsured motor vehicle". The court held that the negligence of the co-worker was stipulated and the damages exceeded the workers' compensation recovery. Basically, the workers' compensation plan rendered the at-fault party underinsured. The Court also applied the "reasonable expectations" test and held that a person who purchases additional coverage has a reasonable expectation that he will be additionally compensated under his own insurance policy if the compensation from insurance sources is not adequate.
One of the most important reasons to secure legal counsel after an accident is to make sure that all available coverage is sought. As the Susher case illustrates, applicable coverage is not always obvious and you cannot count on the insurance company to provide the correct and final answer as to whether your policy applies.
