Opinion ID: 2606344
Heading Depth: 1
Heading Rank: 2

Heading: questions concerning an employer's status for coverage under workers' compensation law stand eliminated by statutory estoppel; an insurer who collects premiums under an issued compensation policy (computed on claimant's wages) is estopped to deny the insured's status as a covered employer

Text: Nation's status as a covered employer of the injured worker within the meaning of Oklahoma's compensation law is not implicated in the consideration of the case before us. Nor is at issue here Nation's claimed sovereign immunity from suit. Rather, our focus must be on the rights of the injured claimant against Nation's insurer. These rights are statutory rather than purely contractual. [7] Every employer's compensation policy is treated as a guarantee that the insured entity's employee is protected by the provisions of the Workers' Compensation Act. Once the existence of insurance covering the claimant is established, jurisdictional requirements for the prosecution of a proceeding before the trial tribunal are deemed met. [8] Controversies between the employer and the insurer do not divest the trial tribunal of its power to entertain a worker's claim. [9] A compensation claimant who, like Little, may be entitled to the benefits of estoppel must show three elements: (1) an injury that occurred during the time his employer maintained a compensation liability policy, (2) the insured employer's payment of premiums based on the claimant's salary and (3) claimant's accidental injury occurred in and arose out of his employment with the insured employer. [10] This proof brings the claimant under the protection of the estoppel act. [11] The rationale of the estoppel act is that an insurer who accepts premiums under a compensation policy may not evade liability for benefits that are legally due. [12] By long-settled case law, the estoppel act bars the insurer from interposing any challenge to the employer's status as an entity covered by the compensation law. [13] Although § 65.2 appears to require an affected employee to be engaged in a hazardous occupation, [14] proof of the hazardous nature of the employment has been declared wholly immaterial when the claim is based upon statutory estoppel. [15] What triggers estoppel's application is the employer's payment of insurance premiums computed on claimant's wages. [16] Once that proof is adduced, a compensation insurance policy is conclusively presumed to be for the benefit of the insured's employee, regardless of the type of business in which the employer is engaged or the nature of the employee's work, whether hazardous or otherwise. [17] By the act of insuring the employee under the policy, the employer and the insurer decide by their contract what is to be deemed covered employment. [18] Even though the language of the estoppel statute appears to bar only the insurer-initiated contests over the hazardous nature of the insured's business, the intended purpose of the word quoted from that enactment has been uniformly construed to extend the estoppel act's ambit to all disputes spawned by the insurer's denial of its insured's status as an employer affected by workers' compensation liability. [19] The precise outer reach of estoppel's application is clearly demonstrated by those reported cases in which the servant of an insured employer, whose hired personnel did not comprise the minimum number of employees required to bring him within the law's coverage, was nonetheless held entitled to the estoppel's bar. [20] Fund's answer to Little's claim admits that, at the critical time, Nation had a compensation policy with Fund. This concession establishes the first probative element required by the estoppel act. Fund's stipulation as to Little's rate of compensation (should its jurisdictional objection be overruled) is its admission that premiums were paid on Little's salary. The latter proof meets the second element of the estoppel act. [21] Fund's denial that Little's accident is employment-related leaves the third element to be settled. Should that element be established on remand and the issue decided in claimant's favor, the proof will be complete. [22]