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All opinions are subject to modification and technical correction prior to official publication in the North Carolina Reports and North Carolina Court of Appeals Reports. In the event of discrepancies between the electronic version of an opinion and the
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NO. COA02-814
NORTH CAROLINA COURT OF APPEALS
Filed: 3 June 2003
HAROLD E. SMITH,
Employee, Plaintiff-Appellee,
v
.
FIRST CHOICE SERVICES,
Employer,
and
STATE FARM INSURANCE COMPANY,
Carrier, Defendants-Appellants.
Appeal by defendants from opinion and award entered 6 March
2002 by the North Carolina Industrial Commission. Heard in the
North Carolina Court of Appeals 20 February 2003.
John J. Korzen and Ling & Farran, by Jeffrey P. Farran,
for plaintiff-appellee.
Brooks, Stevens & Pope, P.A., by Michael C. Sigmon and Matthew
P. Blake, for defendants-appellants.
McGEE, Judge.
State Farm Insurance Company (State Farm) appeals from the
opinion and award of the Industrial Commission awarding disability
compensation to Harold E. Smith (plaintiff).
State Farm filed a Form 61 dated 30 July 1997 denying
plaintiff's workers' compensation claim, stating that plaintiff was
"not a covered employee under the Workers' Compensation Act."
Plaintiff filed a Form 33 request for hearing dated 27 October
1997. State Farm filed a Form 33R response to request for hearing
dated 15 December 1997 stating that defendants were not liable for
benefits claimed by plaintiff. The evidence before the Industrial Commission tended to show
that First Choice Services (First Choice) was a small family-owned
company in the business of insurance restoration work. Plaintiff
was vice-president and secretary of First Choice and was
responsible for sales, marketing and estimations. While trying to
reach some cartons on 17 April 1997, plaintiff fell off a ladder
onto a concrete warehouse floor and fractured both his femur and
his left wrist. Plaintiff's average weekly wage was $581.40 at
that time.
State Farm began providing First Choice with workers'
compensation insurance coverage in 1991. Initially, First Choice
elected to exclude its officers from coverage under the policy.
Peggy Smith (Mrs. Smith), plaintiff's wife and an employee of First
Choice, testified that officers were excluded from coverage to save
money because the officers' job requirements made it less likely
they would be injured.
Mrs. Smith later revisited the issue of officer coverage with
Richard Kepler (Kepler), an independent agent of State Farm. Mrs.
Smith testified that when she asked Kepler if adding the officers
would "shoot [her] premiums sky high," he responded "not really"
because there had been no previous workers' compensation claims
against First Choice. Mrs. Smith claimed that Kepler explained
that workers' compensation would pay two-thirds of an officer's
salary if an officer was injured and unable to work. She also
testified that when the policy was renewed, she asked Kepler to "go
ahead and add the officers on." Mrs. Smith testified that after plaintiff was injured, she
called Kepler and asked if First Choice should submit a workers'
compensation claim. Mrs. Smith said Kepler asked whether there was
an officer's exclusion on First Choice's policy, and Mrs. Smith
responded that there was not. Mrs. Smith also stated that Kepler
then checked his computer to confirm whether there was an
exclusion. Upon finding no officer exclusion, Kepler told Mrs.
Smith to file a claim for workers' compensation.
Plaintiff was disabled due to the accident and was unable to
return to work. Mrs. Smith stated that First Choice voluntarily
paid plaintiff one-third of plaintiff's salary. Mrs. Smith
testified that First Choice made the payments because she was under
the impression that workers' compensation would pay the other two-
thirds of plaintiff's salary. Four months after plaintiff's
accident, First Choice stopped paying any salary to plaintiff
because business had declined in plaintiff's absence and money had
become very tight.
Mrs. Smith testified that in July 1997 she received a letter
from State Farm denying coverage to plaintiff. Upon receipt of the
letter, she went to Kepler's office to inquire about why plaintiff
was denied coverage. Kepler said he did not remember a prior
conversation between Kepler and Mrs. Smith about adding the
officers to the policy because "he talked to so many people he
couldn't remember . . . individual conversations."
Although Kepler testified that First Choice's policy did not
include officer coverage, he also testified that it was possiblethat the conversation in which Mrs. Smith requested officer
inclusion had occurred. Kepler admitted that his hard copy of the
policy contained no exclusions. He later testified that an oral
request was sufficient to change policy coverage. Kepler also
testified that the premium statements did not indicate who was
covered and that he was not accusing plaintiff or Mrs. Smith of
fraud or misrepresentation. Furthermore, when Kepler was asked, "as
far as you know, [there] was a unilateral mistake by State Farm,"
he responded, "I can't dispute that."
State Farm employee Elise Cobb (Cobb) testified that all First
Choice's premiums were current and that the workers' compensation
policy in effect did not contain an officer exclusion as of 17 April
1997.
State Farm audit supervisor Michael Chesnet (Chesnet) testified
that during a 1995-1996 audit meeting, Mrs. Smith indicated that
First Choice's officers were excluded from coverage. However, he
admitted that he was not aware of what coverage Mrs. Smith requested
from Kepler. Chesnet admitted that First Choice's annual premium
had increased between 1996 and 1997, from $3,800 to $6,100 per year.
Chesnet stated he was not the auditor in 1997 and did not speak with
Mrs. Smith at that time. Chesnet testified that a computer system
error during automatic renewal time accounted for the officer
inclusion on First Choice's policy.
A deputy commissioner, in a bifurcated hearing, filed an
opinion and award on 15 December 1998, finding that Mrs. Smith's
testimony was "very credible" and that evidence indicated that aunilateral mistake was made by State Farm. The deputy commissioner
concluded that plaintiff proved that "plaintiff was an 'employee'
of the corporate employer for purposes of the Worker's Compensation
Act." A deputy commissioner filed another opinion and award on 15
June 2000 and awarded compensation to plaintiff in the amount of
$387.60 per week.
State Farm appealed to the Full Commission arguing that the
findings of fact were not supported by the evidence. Plaintiff also
requested attorney's fees, reimbursement to plaintiff for medical
bills, and retroactive interest on the compensation award.
The Full Commission filed an opinion and award on 6 March 2002
which modified in part and affirmed in part the deputy
commissioner's decisions. The opinion awarded plaintiff $387.60 per
week for temporary total disability compensation, all medical
expenses incurred as a result of the injury, and attorney's fees.
State Farm appeals.
When reviewing an Industrial Commission decision, our Court
is "limited to reviewing whether any competent evidence supports the
Commission's findings of fact and whether the findings of fact
support the Commission's conclusions of law." Deese v. Champion
Int'l Corp., 352 N.C. 109, 116, 530 S.E.2d 549, 553 (2000). The
Industrial Commission is the finder of fact and this Court may not
reweigh the evidence presented but must restrict its review to
determining whether there is "'any evidence tending to support the
finding.'" Adams v. AVX Corp., 349 N.C. 676, 681, 509 S.E.2d 411,
414 (1998) (quoting Anderson v. Construction Co., 265 N.C. 431, 434,144 S.E.2d 272 (1965)). Therefore, the findings of the Industrial
Commission are conclusive on appeal when supported by competent
evidence "'even though there be evidence that would support findings
to the contrary.'" Id. (quoting Jones v. Desk Co., 264 N.C. 401,
402, 141 S.E.2d 632, 633 (1965)).
I.
State Farm first argues that the Industrial Commission lacked
jurisdiction to apply the Workers' Compensation Act to plaintiff's
claim as plaintiff was not considered an employee under the
insurance contract in question and was therefore not subject to the
Act's provisions. State Farm claims there was no enforceable
contract for insurance coverage of First Choice's officers because
the policy inclusion was due to draftsman's error and mutual mistake
on the part of defendants. State Farm seeks reformation of the
insurance policy under which plaintiff claims coverage.
The North Carolina Supreme Court has determined that the
Industrial Commission has jurisdiction "to hear 'all questions
arising under' the [Workers'] Compensation Act. . . . This
jurisdiction under the statute ordinarily includes the right and
duty to hear and determine questions of fact and law respecting the
existence of insurance coverage and liability of the insurance
carrier." Greene v. Spivey, 236 N.C. 435, 445, 73 S.E.2d 488, 495-
96 (1952).
The record shows that plaintiff worked for First Choice as an
officer until his accident. The accident arose out of and occurred
during the course of his employment with First Choice. Plaintiffis therefore considered an employee for the purpose of the Workers'
Compensation Act, even if First Choice opted to exclude workers'
compensation coverage for officers in its contract with State Farm.
Since the Industrial Commission has "exclusive original jurisdiction
to hear . . . matters of compensation for personal injury," subject
to review by our appellate Courts on matters of law, the Industrial
Commission had jurisdiction to determine whether plaintiff was
entitled to insurance coverage at the time of the accident. Cooke
v. Gillis, 218 N.C. 726, 728, 12 S.E.2d 250, 251-52 (1940). The
Industrial Commission did not exceed its jurisdiction in hearing
plaintiff's claim.
State Farm further argues that the policy's officer inclusion
was a result of mutual mistake, and that State Farm is therefore
entitled to reformation of the policy. A mutual mistake exists when
both parties to a contract proceed "'under the same misconception
respecting a material fact, the terms of the agreement, or the
provisions of the written instrument designed to embody such
agreement.'" Sudds v. Gillian, 152 N.C. App. 659, 662, 568 S.E.2d
214, 217 (2002) (quoting Metropolitan Property and Cas. Ins. Co. v.
Dillard, 126 N.C. App. 795, 798, 487 S.E.2d 157, 159 (1997)). A
party seeking reformation must prove the existence of mutual
mistake. Id. However, "[a] unilateral mistake by a party to a
contract, unaccompanied by fraud, imposition, undue influence, or
like circumstances of oppression is insufficient to avoid a
contract." Lowry v. Lowry, 99 N.C. App. 246, 252, 393 S.E.2d 141,
144 (1990). Mrs. Smith testified that she requested officer inclusion upon
renewal of First Choice's policy. Kepler stated that he did not
recall talking with Mrs. Smith about including officer coverage,
although he also admitted that the request may have been made. When
asked if there "was a unilateral mistake by State Farm," Kepler
admitted that he could not dispute that. Mrs. Smith, Cobb and
Kepler all testified that at the time of plaintiff's accident, the
policy included coverage for plaintiff as an officer of First
Choice. Chesnet testified that officers were included due to a
computer error during automatic renewal. State Farm argues that the
computer error should be regarded as draftsman's error and should
be considered as evidence that the parties were mutually mistaken
in their beliefs about the change in the officers' inclusion within
the insurance policy.
Our case law supports the argument that "reformation on grounds
of mutual mistake is available only where the evidence is clear,
cogent and convincing." Light v. Equitable Life Assurance Society,
56 N.C. App. 26, 32-33, 286 S.E.2d 868, 872 (1982) (quoting Durham
v. Creech, 32 N.C. App. 55, 59, 231 S.E.2d 163, 166 (1977)).
Findings of fact by the Industrial Commission are binding on appeal
if they are supported by competent evidence. Adams, 349 N.C. at
681, 509 S.E.2d at 414. Upon weighing all the facts presented, the
Industrial Commission found that "[d]efendants [did not meet] their
burden in showing . . . mutual mistake." Since the Industrial
Commission found that defendants did not show mutual mistake, and
competent evidence exists to uphold such a finding, State Farm'sclaim for reformation of the contract fails. This argument is
therefore overruled.
II.
State Farm also argues that this case should be remanded to the
Industrial Commission due to insufficient findings of fact. State
Farm argues that the Industrial Commission was required to make more
detailed findings in consideration of State Farm's claim that the
officer inclusion was a result of mutual mistake by both State Farm
and First Choice. We disagree.
When a party seeks to reform a contract due to an affirmative
defense such as mutual mistake, misrepresentation or fraud, the
burden of proof lies with the moving party. See Metropolitan
Property & Cas. Ins. Co., 126 N.C. App. at 799, 487 S.E.2d at 160
(holding that the insurance company had the burden of proving
misrepresentation in the enforcement of an insurance contract). The
evidence presented to prove mutual mistake must be "clear, cogent
and convincing," and the question of reformation on that basis is
a matter to be determined by the fact finder. Durham, 32 N.C. App.
at 59, 231 S.E.2d at 166. The Industrial Commission is the ultimate
fact finder. Fennell v. N.C. Dep't of Crime Control and Pub.
Safety, 145 N.C. App. 584, 590, 551 S.E.2d 486, 490-91 (2001), cert.
denied, 355 N.C. 285, 560 S.E.2d 800 (2002).
State Farm argues that the Industrial Commission was required
to make specific findings concerning the insurance application, the
renewal audit reports and the witnesses' differing testimony before
reaching a conclusion regarding mutual mistake and draftsman'smistake. The Industrial Commission found that State Farm failed to
satisfy its burden of proof of mutual mistake. The Commission was
not required to make further detailed findings of fact regarding
every disputed issue. See Hansel v. Sherman Textiles, 304 N.C. 44,
54, 283 S.E.2d 101, 107 (1981) (denying compensation due to the
failure of the claimant, who had the burden of proof, to prove any
one of the elements of compensation). Our Court need only determine
if competent evidence exists to support the Industrial Commission's
findings, as remand is only necessary if "the findings of fact of
the Commission are insufficient to enable the court to determine the
rights of the parties upon the matters in controversy." Id. at 59,
283 S.E.2d at 109. This Court is not permitted to reevaluate
evidence that may support a contrary conclusion and make a decision
based on the weight of the evidence. Adams, 349 N.C. at 681, 509
S.E.2d at 414. We have already held that competent evidence existed
to support the Industrial Commission's finding of fact that there
was no mutual mistake between State Farm and First Choice. We hold
that the Industrial Commission made findings on all ultimate facts
in this case and that no additional findings of fact were required.
This assignment of error is overruled.
III.
State Farm argues that the Industrial Commission erred by
denying State Farm a credit for salary paid to plaintiff by First
Choice after plaintiff's injury. State Farm contends that it should
be credited for payments made to plaintiff by First Choice after
plaintiff's injury. N.C. Gen Stat. § 97-42 (2001) states:
Payments made by the employer to the injured
employee during the period of his disability,
or to his dependents, which by the terms of
this Article were not due and payable when
made, may, subject to the approval of the
Commission be deducted from the amount to be
paid as compensation.
"Payments are due and payable under section 97-42 when the
employer has accepted the plaintiff's injury as compensable and
initiated payment of benefits."
Thomas v. B.F. Goodrich, 144 N.C.
App. 312, 318, 550 S.E.2d 193, 197,
disc. review denied, 354 N.C.
228, 555 S.E.2d 276 (2001). When payments made by an employer are
due and payable, the employer is not entitled to receive a credit
for payments under the statute.
Id. at 318-19, 550 S.E.2d at 197;
see also Moretz v. Richards & Associates, 316 N.C. 539, 542, 342
S.E.2d 844, 846 (1986).
The evidence in the record shows that First Choice considered
plaintiff's claim to be compensable and paid plaintiff one-third of
his salary, the portion of salary that was not covered under the
insurance policy, for four months following plaintiff's injury.
First Choice stopped paying plaintiff because business declined in
plaintiff's absence and First Choice could not afford to continue
the payments. There is also evidence in the record that State Farm
indicated to First Choice that State Farm considered plaintiff's
claim to be compensable and instructed First Choice to file a
workers' compensation claim. Since defendants accepted plaintiff's
claim as compensable and First Choice initiated payment of partial
benefits, the payments were considered due and payable under thestatute.
See Moretz, 316 N.C. at 541-42, 342 S.E.2d at 846.
Accordingly, State Farm is not entitled to a credit under the
statute.
Additionally, there is no evidence in the record that State
Farm made any payment of benefits to plaintiff following his injury.
N.C.G.S. § 97-42 allows the employer to receive credit when the
employer makes payment of benefits, the purpose of which is "to
encourage voluntary payments by the employer during the time of the
worker's disability."
Effingham v. Kroger Co., 149 N.C. App. 105,
119, 561 S.E.2d 287, 296-97 (2002). However, the statute does not
provide for the insurance carrier to receive a credit for payments
made by the employer. State Farm has failed to point us to any
authority that would support such an interpretation of the statute.
This assignment of error is without merit.
We have reviewed defendant's remaining assignments of error and
find them to be without merit.
Affirmed.
Judges HUDSON and STEELMAN concur.
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