Gulf States Underwriters of La. Inc.

The Workers' Compensation Board lacked jurisdiction to consider plaintiff's claim against an insurance agent who sold the underlying accident policy to plaintiff's employer since no statutory authority allowed the Board to adjudicate a fraud claim or assess damages.

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Jimmy Bennett filed a workers’ compensation claim against his employer, Northwest Georgia Personal Care Home “Northwest Georgia”, Gulf States Underwriters of Louisiana, Inc./National Association of Employers “Gulf States”,1 and A. B. Thomas, the insurance agent that sold Northwest Georgia the policy. Following a hearing, the Administrative Law Judge “ALJ” held Gulf States and Thomas liable for payment of workers’ compensation benefits and assessed attorney fees. The award was affirmed, and both Gulf States and Thomas filed applications for discretionary appeal. In Case Number A02A1858, we granted Gulf States’ application; and in Case Number A02A1859, we granted Thomas’ application. For reasons that follow, we reverse. The facts in this case are essentially undisputed. In 1995, Joann Blevins, the owner of Northwest Georgia, sought workers’ compensation insurance, but had difficulty obtaining insurance due to the expense. At some point, Blevins met with Thomas, an insurance agent representing Gulf States. According to Blevins, Thomas told her that “he could help her with obtaining insurance, that he had something just like workers’ comp,” but less expensive. Thomas then sold Blevins an “Employers Blanket Accident Group Policy” that expressly provided that it was not a workers’ compensation policy. The policy was issued by American Pioneer Life Insurance Company and administered by Gulf States.

Although purportedly not a workers’ compensation policy, the policy at issue shared many characteristics of a workers’ compensation policy. Specifically, it insured against “occupational injuries,” which it defined as “accidental injury occurring during the usual and customary performance of duties required by the insured person’s normal work.” The policy paid, among other amounts, total disability benefits up to $250 per week for a maximum of 60 weeks and medical expenses up to $5,000 per accident.

Gulf States Underwriters of La. Inc.

The Workers' Compensation Board lacked jurisdiction to consider plaintiff's claim against an insurance agent who sold the underlying accident policy to plaintiff's employer since no statutory authority allowed the Board to adjudicate a fraud claim or assess damages.

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