This is a confusing case concerning whether or not a person is an independent contractor or employee, has the right to sue the employer and whether the insurance company for the employer must provide coverage because of the confusion
Posted: May 9, 2022 Filed under: Climbing, Mountaineering, New Jersey, Release (pre-injury contract not to sue), Rock Climbing | Tags: Atain Speciality Insurance, Condition of Coverage, Insurance policy, Mountain Clmbing, Mountaineering, NE Mountain Guiding, Negligence, Northeast Mountain Guiding, Recision, Rock climbing, SAR, Search and Rescue Leave a commentThis is a long and complicated case because no one understood what was needed and no one read their insurance policy.
Atain Specialty Ins Co v Ne Mountain Guiding LLC D NJ 2020
State: New Jersey, US District Court for the District of New Jersey
Plaintiff: Atain Specialty Insurance Co.
Defendant: Northeast Mountain Guiding, LLC, et al.,
Plaintiff Claims: negligence
Defendant Defenses:
Holding: Mostly for the Plaintiff
Year: 2020
Summary
An employee or independent contractor was hurt, maybe working, and sued his employer over his injuries. The insurance company for the employer, mountain guiding company, denied coverage because he was not an employee and they did not provide coverage for independent contractors.
This case is still a mess, but the important part is make sure you are honest on your insurance applications and make sure you know what you are buying when you purchase a policy.
Facts
Vulpis is the founder and sole member of NMG, a limited liability company in the outdoor adventure and education industry Vulpis has significant training and experience, as well as multiple certifications, in the field in which NMG operates. Enberg provided administrative assistance to NMG, developed a search and rescue training for NMG to provide to clients, and served as a mountaineering guide for NMG. Manchester performed work for NMG as a Lead Backpacking Guide and Assistant Rock Guide.
Donald Pachner is the sole member of Pachner & Associates, LLC and Pachner Risk Management, LLC. Donald Pachner and Pachner & Associates, LLC possess insurance broker licenses under New Jersey law.
Vulpis retained Pachner to obtain general commercial liability insurance for NMG. As part of this process, Pachner and Vulpis worked together to fill out an application (the “Application”) for insurance. The Application required Vulpis to estimate NMG’s gross revenues for the coming year. On Pachner’s advice, Vulpis checked the “No” box when answering the Application’s question concerning whether NMG “hire[s] Concessionaires, Independent Contractors, or Subcontractors.” As part of the Application, Vulpis initialed next to a requirement NMG (1) obtain from all participants an Atain-approved waiver of liability form, and (2) maintain those forms for three years. In response to NMG’s Application, Atain issued an insurance quote (the “Quote”), which Vulpis reviewed with Pachner. Among other things, the Quote contains a summary of several of the terms the Policy would contain
Pachner procured insurance (the “Policy”) from Atain for NMG. The Policy limits coverage to “GUIDED MOUNTAINEERING INCLUDING TOP ROPE CLIMBING & RAPPELLING; GUIDED KAYAK TRIPS; GUIDED SNOWSHOEING; GUIDED HIKING/BACKPACKING INCLUDING CAMPING.” The Policy excludes coverage for injuries suffered “in the course of employment by or service to” NMG.
On November 21, 2015, Manchester suffered an injury (the “Injury”) while using certain equipment (the “Equipment”) to engage in a certain activity (the “Activity”). Much of the dispute in this case centers on the proper characterization of the Activity and the Equipment. The essence of the Activity is that the participant uses the Equipment to move between two points. The evidence conflicts concerning whether the Equipment is a “Tyrolean Traverse” or a “Clifftop Zipline.” Ziplines were derived from Tyrolean Traverses, but the differences are too fine for untrained individuals to differentiate between the two.
On November 21, 2015, three NMG guides—Christy DeMarco, Enberg, and Vulpis—went to Allamuchy State Park to test the Equipment NMG expected to offer in the future for its customers. Vulpis and the other three guides set up the Equipment. Manchester was present at the time, and engaged in the Activity by traveling on the Equipment. While engaged in the Activity, Manchester suffered the Injury.
Following his Injury, Manchester filed a state court negligence action against Vulpis, Enberg, and NMG. NMG made a claim for coverage with Pachner and Atain. When reporting the claim to Atain, Pachner described Manchester as an independent contractor for NMG.
Atain filed this coverage action against its Vulpis, Enberg, and NMG, and also joined Manchester as a defendant. Atain seeks declaratory judgments against Vulpis, Enberg, NMG, and Manchester, authorizing Atain to disclaim coverage Manchester’s Injury. Additionally, Atain seeks a declaratory judgment voiding the Policy under common law rescission principles and the New Jersey Insurance Fraud Prevention Act, N.J. Stat. Ann. § 17:33A-1 et seq.
Vulpis, Enberg, and NMG brought a third-party action against NMG’s insurance broker Pachner, alleging Pachner’s negligence caused any failure of coverage by Atain. Manchester brought a similar action against Pachner.
Analysis: making sense of the law based on these facts.
The is the second of two decisions so far in this case, and it is still on going. This decision is based on multiple motions to dismiss, and motions for summary judgment filed by everyone.
I’m not even going to cover every issue involved in this order, just a few to make some points.
Another issue is the language of mountaineering, rock climbing and guiding is not totally understood by the court, so in some cases the decisions are not made for that reason. That can be because the court was not made away of the issues or the attempt to educate the court failed on the part of the parties.
First Issue: The activity giving rise to the injury is not covered.
The first issue is whether the activity giving rise to the injury is one that is covered under the insurance policy. The injured employee/contractor was not on the trip to learn; he just tagged along. He had not paid to attend the training and was not required to be there.
Because the insurance policy is unclear as to how it is interpreting what occurred, and the court is unclear on what relationship employee/contractor had while on the trip, the court determined it could not decide the issues on a motion for summary judgement.
Second Issue: Worker’s comp exclusion
In every general liability policy, there is an exclusion, no coverage for claims that should be insured by worker’s compensation. In this case that exclusion was called Employer’s Liability Exclusion. Employees in all states must be covered by worker’s compensation for any injury they receive while on the job. Since this person was claiming, in some aspects of the case, to be an employee, the general liability insurance company based on this exclusion should not have to pay for the damages.
The court refused to rule on this saying several of the statements made by the injured employee/contractor indicate he was not an employee.
Manchester was a participant acting outside the scope of his NMG employment at the time of his Injury. Manchester testified he had come to participate in the Activity because he “thought it would be fun.” Vulpis testified similarly: Manchester “came just to travel along the Tyrolean traverse. He wanted to try it out.” Manchester testified he never informed NMG he would be attending the Activity and further testified NMG did not know he would be attending. Manchester did not consider himself an employee or representative of Vulpis or Enberg at the time of the Injury.
At the same time, the court found several issues that indicated the injured employee/contractor was an employee at the time of his injury.
Most importantly, Manchester acknowledged he performed work for NMG as a Lead Backpacking Guide and Assistant Rock Guide. Vulpis and Manchester both testified Manchester came to be at Allamuchy State Park on the date of his Injury because Vulpis posted an invitation to a Facebook group whose members consisted only of NMG guides and staff Enberg testified although Manchester was not involved in setting up the Equipment and mostly observed others do so, Manchester did help Enberg “pull tension once, so just pull on a rope for me.” Enberg also testified, “[A]s far as I know, we just there all volunteering and testing the system.”
Until a jury determines the legal classification for the injured plaintiff, what insurance coverage is available cannot be decided.
Issue three: recission of the policy
Recission of an insurance policy is a rarely seen legal argument. It is granted when there is proof of fraud when entering into the contract. When there is recission of a policy, the court places the parties back in the position they were before the policy was issued. The insured gets a full refund, and the insurance company does not have to pay a claim.
“In the field of insurance, rescission has long been recognized as an available and necessary remedy to combat fraudulent behavior by an insured” It is settled that a material factual misrepresentation made in an application for insurance may justify rescission [of the resulting insurance policy] if the insurer relied upon it to determine whether or not to issue the policy” Rescission voids the [insurance policy] ab initio, meaning that it is considered ‘null from the beginning’ and treated as if it does not exist for any purpose.”
Here the insurance company was requesting recission of the policy because of fraudulent misrepresentation.
Rescission of an insurance policy for fraudulent misrepresentation is appropriate if four conditions are satisfied: (1) the applicant must make an “untruthful” representation to the insurer, (2) the representation must be “material to the particular risk assumed by the insurer,” (3) the insurer must “actually and reasonably rel[y] upon [the representation] in the issuance of the policy,” and (4) if the “insurance application . . . calls for subjective information,” then “the insured [must] kn[o]w that the information was false when completing the application.”
Again, the court would not rule on this motion because recission takes more than a mere oversight or honest mistake. It must be based on a specific intentional act or acts to defraud the insurance company. Here the answers placed on the policy were done so with the help of the insurance agent. And the court was not sure the acts of the insured were intentional. The other issue was, did the insurance agent supply the answers or where the answers supplied by the insured.
Fourth Issue: Projected Revenues
Most insurance policies are issued based on the projected revenues of the company. In rare instances, some outdoor recreation policies are issued based on expected user days. User days are used when it is easy to verify the number of user’s days, as in a whitewater rafting company working on river controlled by a federal land management agency which is also tracking user days. User days are the number or days a client is on the river. A half day counts as a full user day.
So, an insurance policy application has a place for the applicant to enter an estimate of the projected revenues for the season or year. Your premium is based on that number. When you sign the application, in most cases, you are also agreeing to be audited to make sure the number you put on the application is what your sales or income is. In this case, those projections were lower than the prior year.
Atain argues the projected amount listed on the Application was substantially lower than NMG’s actual revenue for the year preceding the Application and disproportionately less than the revenue NMG actually received in the Policy year.
The court rejected this argument because the projection was based on several factors that made the insured believe that his income was going to be lower that year.
First, Vulpis was divorcing his spouse, which he believed would impact NMG’s ability to remain in business. Second, Vulpis had hired new guides, and expected revenues would be lower while his new guides gained experience. Third, “a chronic, life-threatening auto-immune disease” hospitalized Vulpis shortly before he filed the Application, and he was “not sure [he] would live through” the year, “much less have any revenues in NMG.” Even taking those factors into account, the revenue Vulpis projected on the Application was approximately equal to NMG’s annual revenue two years prior to the Application, and was slightly lower than the average of the revenue for the preceding three years. Taking these facts in the light most favorable to NMG, a reasonable fact-finder could determine NMG did not knowingly misrepresent its projected income.
Fifth Issue: use of independent contractors
The outfitter specifically stated on the insurance application that he did not use sub-contractors or independent contractors. Then after the accident it came to light that some people working for the outfitter might be independent contractors.
The court did not accept this motion because it was unclear what the people working for the outfitter were. Also, the outfitter had been told by the insurance agent to say no on the application about sub-contractors or independent contractors.
You had two conflicting issues that prevented the appellate court from deciding this issue. The first was further complicated because the court felt the insurance did not understand what an independent contractor was.
Sixth Issue: Knowing Misrepresentation
The insurance company argued that the policy should be rescinded because the outfitter made knowing misrepresentations, about whether or not he was hiring independent contractors or used only employees.
The court through this motion because it felt the outfitter really did not know the difference.
Given the issue’s complexity, the Court is not surprised Vulpis’s testimony suggests he had genuine difficulty distinguishing between employees and independent contractors. Vulpis’s testimony concerning his thinking at the time demonstrates his confusion. For instance, Vulpis described his guides as “1099 employees,” something of a misnomer. When completing the Application, Vulpis discussed how to answer the “independent contractor” question with Donald Pachner, whose less-than-illuminating explanation was to describe the meaning of independent contractor as a “gray area Even when answering interrogatories in this case—presumably with the assistance of counsel—Vulpis initially described his guides as independent contractors, then amended his answer to strike that characterization. The Application does not instruct the applicant on the meaning of “independent contractor,” nor does it suggest which (if any) of the legal tests an applicant should apply—missing an opportunity to dispel Vulpis’s confusion.
The court stated:
The variety of tests creates a “paradoxical truth that even when the same person performs the same acts at the same time in the same place under the same conditions,” the person “may be considered an employee for one purpose and an independent contractor for another.”
The court recognized the issue that whether or not a person working for you is an independent contractor or not is not only confusing and constantly litigated by the courts, not necessarily something a non-lawyer can understand.
Viewed in the light most favorable to non-movant NMG, a reasonable fact-finder could determine Vulpis merely failed to appreciate every nuance of the difference between employees and independent contractors when he wrote on the Application NMG did not use independent contractors or subcontractors. Such a misunderstanding would constitute an “honest mistake,” not a “lie” or a “willful” falsification.
Seventh Issue: Failure to Maintain Signed Liability Waivers
This next issue is a two-factor issue. If the employee/contractor signed a release, he was probably not an employee and was either a contractor or guest. A release was a factor required by the insurance company. If a release was signed it would stop the lawsuit by the injured employee/contractor. A release or liability waiver signed by all participants was a condition of coverage under the policy.
If there was no release signed, then the injured employee/contractor was probably an employee and covered by Worker’s Compensation. Either way, a signed release or no release provided an out for the insurance company.
New Jersey law permits an insurer to escape liability for its obligations under an insurance policy if the insured breaches a condition of coverage, but only if the insurance carrier suffers appreciable prejudice from the breach.
There is a two-factor test under New Jersey law the insurance company must meet to win on a coverage condition argument.
“[F]irst, ‘whether substantial rights have been irretrievably lost’ as a result of the insured’s breach, and second, ‘the likelihood of success of the insurer in defending against the accident victim’s claim’ had there been no breach.”
Since the insurance company wrote the policy, the insurance company has the burden of proving both factors of the test.
The motion for summary judgment was denied because the outfitter said that he misplaced the waiver. An even bigger reason for not granting the motion was:
Second, even if Atain cannot obtain Manchester’s waiver in time to rely on the waiver against Manchester in the underlying state court litigation, the absence of Manchester’s waiver will not necessarily reduce “the likelihood of success of the insurer in defending against the accident victim’s claim.”
The court is probably correct in this statement because the injured guide had signed several releases previously. There was just not one for the day of the accident.
NMG has provided Atain with Manchester’s signed acknowledgment of receipt of NMG’s employee handbook, which contains a waiver form. Moreover, while Vulpis acknowledged he could not locate the forms, Vulpis testified Manchester had previously signed a waiver (1) when Manchester initially became was a customer of NMG prior to serving as a guide, and (2) for the year 2015, when Manchester served as a guide. The only contrary evidence is Manchester did not sign a waiver on the day of the Injury. Atain points to no evidence contradicting Vulpis’s testimony concerning Manchester previously signing a waiver before the day of the Injury. Viewing the facts in the light most favorable to NMG, a genuine issue of material fact exists concerning whether NMG’s loss of Manchester’s waiver will appreciably prejudice Atain’s defense of Manchester’s underlying state court litigation.
At this point, the case is scheduled to proceed to trial.
So Now What?
1. I’ve said dozens of times, every person on a trip has to be identified as either an employee or a participant. If the person is an employee, they have to be listed on the worker’s compensation insurance. Everyone else, paying customer, friend, independent contractor or your mother-in-law must sign a release.
2. Independent contractors are a liability mess. Many companies attempt to use independent contractors because they believe it saves them state and federal taxes. It might. And it can be a good way to get a company started for the first several months. However, the issue of independent contractors has more traps than value.
There are no liability savings. As the outfitter or company, you are liable for any incident no matter if the person who caused the issues is an employee or independent contractor. If nothing else, you are liable for hiring an independent contractor who failed to do their job properly.
First contractors, especially in the outdoor industry, don’t have health insurance. So many, if injured, have no way to pay for their medical bills. Consequently, using independent contracts increases your chances of having a lawsuit, just like this one, because an independent contractor needs money to pay his or her medical bills and other bills when they can’t work.
On top of the other issues, proving someone is an independent contractor is very difficult. Many states have adopted the rule that says unless certain requirements are met, such a written contract, an independent contractor is an employee. An independent contractor has the right to show up at the job site at any time they want unless written differently in the contract. They should bring their own tools to work and have the freedom to make decisions. The only control the person hiring the contractor has over the independent contractor is to specify the job, the time frame, and how much they are going to pay for the job.
An even bigger issue for an employer is what is everyone else in the industry doing. If all of your competitors are using employees and not independent contractors, you face an insurmountable hurdle.
As the court stated:
Distinguishing independent contractors from employees is among the most contentiously litigated issues in courts today, arising in a host of different contexts, each with a different standard.
3. UNDERSTAND your insurance application, do not lie on it. If there are issues or questions, then attach a supplemental letter to the broker or to the policy explaining the decisions or answers on the application.
4. When you get your policy read it. You must know and understand all conditions of coverage. What must you do to make sure the policy covers you.
You also must know what you bought. Does the policy cover the activities that your company is doing? If in the summer you teach fishing at a pond and once in a while in the winter people ice skate on the same pond, you are more than a fishing guide and you better have coverage for ice skating.
What do you think? Leave a comment.
Who am I
Jim Moss
I’m an attorney specializing in the legal issues of the Outdoor Recreation Industry
I represent Manufactures, Outfitters, Guides, Reps, College & University’s, Camps, Youth Programs, Adventure Programs and Businesses
Copyright 2022 Recreation Law (720) 334 8529
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By Recreation Law Rec-law@recreation-law.com
James H. Moss
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