v.
Liberty Mutual Insurance Corp.
2022 IL 127140
IN THE SUPREME COURT OF THE STATE OF ILLINOIS (Docket No. 127140) PRATE ROOFING AND INSTALLATIONS, LLC, Appellee, v. LIBERTY MUTUAL INSURANCE CORPORATION, Appellant. Opinion filed May 19, 2022. JUSTICE MICHAEL J. BURKE delivered the judgment of the court, with opinion. Chief Justice Anne M. Burke and Justices Garman, Theis, Neville, Overstreet, and Carter concurred in the judgment and opinion. OPINION ¶1 At issue is whether the Department of Insurance (DOI) had the authority to resolve this dispute between Prate Roofing and Installations, LLC (Prate), and Liberty Mutual Insurance Corporation (Liberty) over whether Prate owed additional premiums on its workers’ compensation policy. The appellate court held that under its recent decision in CAT Express, Inc. v. Muriel, 2019 IL App (1st) 181851, the Department of Insurance (DOI) did not have the authority to resolve the dispute and thus vacated the DOI’s final order and the order of the circuit court affirming it. 2021 IL App (1st) 191842-U. We allowed Liberty’s petition for leave to appeal. Ill. S. Ct. R. 315 (eff. Oct. [1], 2020). For the reasons that follow, we disagree with the appellate court’s conclusion and hold that the DOI had the authority to resolve the dispute under section 462 of the Illinois Insurance Code (215 ILCS 5/462 (West 2018)). ¶2 BACKGROUND ¶3 A complete statement of facts may be found in the appellate court’s order. 2021 IL App (1st) 191842-U, ¶¶ 5-29. We summarize here only those facts necessary for an understanding of the sole issue that we address. ¶4 Plaintiff, Prate Roofing and Installations, LLC, is a roofing and construction installations contractor. In 2013, Prate sought workers’ compensation coverage through the Illinois Assigned Risk Plan, which provides workers’ compensation insurance coverage through a risk pool administered by the National Council on Compensation Insurance (NCCI). Liberty was assigned as Prate’s carrier. Prate renewed the policy from October 2014 to June 2015. During that period Liberty audited Prate’s records and determined that one of Prate’s subcontractors, ARW Roofing, LLC (ARW), did not have workers’ compensation insurance. Liberty determined that the omission had exposed it to more liability than it had bargained for and assessed Prate an additional premium of $127,305. ¶5 Prate filed an appeal with the Illinois Workers’ Compensation Appeals Board (Board), which provides dispute resolution services for the NCCI. The Board later informed the parties by letter that it did not have sufficient information to resolve the dispute. Specifically, the Board explained that it had not been given copies of the relevant policy forms and could not confirm or deny whether coverage existed for ARW during the policy period. The Board could also not determine whether ARW was “an LLC or an Inc.” when work was performed and whether that had a bearing on the dispute. The Board suggested that Prate refile its dispute with the DOI along with a copy of the letter explaining why the Board declined to rule.
127141
¶6 Prate then appealed to the DOI under section 462 of the Insurance Code. The parties waived their right to an in-person hearing and requested that the issues be determined by written submissions and exhibits. Liberty argued that it was entitled to the additional premium because Prate had been making payments to an uninsured subcontractor, ARW. Liberty explained that Prate had a certificate of insurance for another subcontractor, Reliable Trade Services, Inc. (RTS), but that certificate did not cover ARW. Because ARW was an uninsured subcontractor, it created a potential exposure for Liberty, entitling Liberty to an additional premium. Liberty cited Section C.2. of its policy with Prate, which provided:
“All other persons engaged in work that could make us liable under Part One Workers Compensation Insurance of this policy. If you do not have payroll records for these persons, the contract price for their services and materials may be used as the premium basis. This paragraph 2 will not apply if you give us proof that the employers of these persons lawfully secured their workers compensation obligations.”
Liberty also relied on (1) section 1(a)(3) of the Workers’ Compensation Act (820 ILCS 305/1(a)(3) (West 2018)), which provides that employers who engage a subcontractor are
“liable to pay compensation to the employees of any such contractor or sub- contractor unless such contractor or sub-contractor has insured, in any company or association authorized under the laws of this State to insure the liability to pay compensation under this Act, or guaranteed his liability to pay such compensation”
and (2) rule 2-H of the basic manual of the Illinois Assigned Risk Plan, which states that, “For each subcontractor not providing such evidence of workers compensation insurance, additional premium must be charged on the contractor’s policy for the uninsured subcontractor’s employees according to Subcontractor Table 1 and 2 below.” Prate had argued that all the payments it made to ARW were passed through to RTS, but Liberty contended that it was impossible to verify this. Liberty also pointed out that payments were being made to both entities throughout the policy period.
127142
¶7 Liberty explained in an exhibit that it had calculated the additional premium using the default method provided in manual rule 2-H, tables 1 and 2, as Prate had failed to provide “any invoices to allow [Liberty] to determine the jobs involved, cost breakdowns, or the timeframe for the jobs in which payment is in question.” Accordingly, Liberty assessed the additional premium as 90% of the total paid to ARW. This is the amount specified for situations where a subcontractor fails to furnish adequate documentation and the job involves “labor only.”
¶8 Prate’s position was that Liberty had failed to establish that Prate was bound by the NCCI basic manual or subject to an additional premium for uninsured subcontractors. Assuming arguendo that Prate was subject to the terms of the manual, Prate argued that no additional premium was warranted because ARW did not have any employees. Prate noted that NCCI manual rule 2-H refers to “employees of uninsured subcontractors” and the “uninsured subcontractor’s employees.” Prate explained that all work on Prate projects was performed by employees of RTS and that RTS had workers’ compensation insurance during the relevant time period. Thus, Liberty was not entitled to an additional premium because it had not assumed any risk for workers’ compensation claims involving ARW. Alternatively, Prate claimed that the amount of the additional premium should be only $20,304.52, as Prate had provided evidence that the actual cost of labor for ARW jobs was $44,140.25. Prate contended that this amount should have been multiplied by the workers’ compensation premium rate of $46/100, for a maximum audit premium of $20,304.52.
¶9 The DOI’s hearing officer issued his findings of fact and conclusions of law, agreeing with Liberty on all of the issues. First, the hearing officer concluded that ARW did not have a workers’ compensation insurance policy of its own during the relevant period. Moreover, he concluded that the RTS policy did not provide coverage to ARW. Second, the hearing officer concluded that ARW had employees during the relevant policy period. Key to this determination was an admission by Prate’s president that RTS and ARW would complete contracts for one another. The hearing officer did not see how ARW could complete projects for RTS without employees of its own. Moreover, documents that listed RTS at the top appeared to be proofs of payment by RTS to ARW for workers’ compensation payroll during the relevant period. Third, the hearing officer determined that the arrangement between Prate and ARW exposed Liberty to workers’ compensation liability. The
127143
hearing officer noted that under Illinois law Prate was liable to pay compensation to the employees of subcontractors, unless the subcontractors had their own workers’ compensation insurance. See 820 ILCS 305/1(a)(3) (West 2018). Thus, the hearing officer’s determination that ARW had employees but did not have its own workers’ compensation policy meant that Liberty was exposed under Prate’s policy to workers’ compensation liability from ARW’s employees. Finally, the hearing officer determined that Liberty applied the proper standards in computing the increase in premiums. The hearing officer noted that Prate disputed that it was bound by NCCI manual rule 2-H. However, the binder of coverage issued to Prate stated that coverage would be “afforded under the applicable Workers Compensation Insurance Plan developed or administered by NCCI.” Accordingly, the hearing officer concluded that Prate had contractually consented to specific rules of the NCCI. The hearing officer found that both under the terms of the policy and basic manual rule 2-H, Liberty was permitted to use the contract price as the basis for determining the premium. Accordingly, “Liberty Mutual properly applied the NCCI Basic Manual’s rule to use at least 90% of the $300,673.56 in total contract payments from Prate Roofing to ARW LLC as the basis for calculating the additional premium owed by Prate Roofing for workers compensation liability from ARW LLC employees.” The hearing officer thus upheld “Liberty Mutual’s application of its rating system to the policy at issue.”
¶ 10 The Director of Insurance entered an order adopting the hearing officer’s findings of fact and conclusions of law as her own. Prate moved for rehearing, asserting that the hearing officer had overlooked evidence that (1) Prate’s use of ARW did not expose Liberty to workers’ compensation liability and (2) the total amount of labor provided on Prate projects was only $44,140.25, which meant that any additional premium would only have been $20,304.52. The Director concluded that Liberty had failed to show a good cause basis for rehearing and thus denied the motion.
¶ 11 On administrative review, the Cook County circuit court affirmed the DOI’s decision. The court explained in open court that it found that the factual finding that ARW did not have employees was not against the manifest weight of the evidence. The court believed that there were two mixed questions of law and fact: whether Liberty had been exposed to additional liability and whether the calculation of the
127144
additional premium was erroneous. The court found that the DOI’s resolution of these issues was not clearly erroneous. Prate then appealed.
¶ 12 While the case was pending in the Appellate Court, First District, that same district of the appellate court issued its ruling in CAT Express, 2019 IL App (1st) 181851. That case involved a dispute between Liberty and a different trucking company, CAT Express, Inc. (CAT). CAT applied for workers’ compensation coverage with the Illinois Assigned Risk Plan. Id. ¶ 1. Liberty was assigned as CAT’s carrier. Id. CAT disclosed six clerical workers subject to workers’ compensation coverage. Id. Following a premium audit, Liberty determined that CAT had failed to include as employees a large number of owner-operators. Id. Accordingly, Liberty determined that CAT owed an additional premium of $356,592. Id. CAT’s position was that the owner-operators were independent contractors and thus did not need to be disclosed. Id. CAT then requested that the NCCI resolve whether the owner-operators were employees or independent contractors. Id. The NCCI determined that it had no authority to resolve the dispute, explaining in a letter:
“ ‘The types of grievances that are under the jurisdiction of the NCCI/the [Illinois Workers’ Compensation Appeals Board] are limited to those relating to the interpretation or application of the following NCCI rules:
1) Experience Rating Plan, 2) Classification system, and 3) Manual Rules.
Coverage or employment status disputes require an interpretation of the state or federal law and cannot be resolved by interpretation or application of NCCI rules.’ ” Id. ¶ 5.
127145
The NCCI informed CAT that it could appeal to the DOI under section 462 of the Insurance Code (215 ILCS 5/462 (West 2016)). CAT Express, 2019 IL App (1st) 181851, ¶ 5. 1
¶ 13 CAT appealed to the DOI. Following a hearing, the hearing officer determined that the owner-operators were CAT employees and therefore CAT owed the additional premium. Id. ¶ 6. The Director adopted the hearing officer’s decision. Id. ¶ 7. CAT appealed to the circuit court, and the circuit court affirmed. Id.
¶ 14 CAT then appealed to the appellate court, and the court ordered supplemental briefing on the question of whether the DOI had the authority to resolve an employment status dispute. Id. ¶ 9. The DOI and the Director argued that the DOI had implied authority under sections 401, 402, 403, and 462 of the Insurance Code (see 215 ILCS 5/401, 402, 403, 462 (West 2016)). CAT Express, 2019 IL App (1st) 181851, ¶ 10. The DOI contended that the implied authority derived from section 401(c), which allows the Director to conduct hearings “ ‘as may be necessary and proper for the efficient administration of the insurance laws of this State’ ” (id. (quoting 215 ILCS 5/401(c) (West 2016))), and section 462, which provides for an appeal to the DOI from a rating organization decision rejecting a request for relief from “ ‘any person aggrieved by the application of its rating system’ ” (id. (quoting 215 ILCS 5/462 (West 2016))). Liberty contended that the DOI’s authority to resolve employment status disputes was derived from section 401(c). Id. ¶ 11. Liberty argued that section 462 was not implicated in that case because the DOI had treated CAT’s letter requesting assistance as a “ ‘fresh complaint.’ ” Id. By contrast, CAT argued that the DOI’s authority to resolve the dispute was provided by section 462 and that its jurisdiction was concurrent with the Illinois Workers’ Compensation Commission. Id. ¶ 12. CAT noted that under section 462, the NCCI was required to provide persons aggrieved by the application of its rating system an opportunity to be heard on the person’s written request to review the manner in which the rating system had been applied. Id. When the NCCI refused to resolve the dispute, it informed CAT that its recourse was to appeal to the DOI under section 462. Id.
127146
¶ 15 The appellate court rejected all of these positions. The court reiterated that what was at issue was an employment status dispute: whether owner-operators used by CAT were independent contractors or employees of CAT for purposes of coverage under Liberty’s workers’ compensation policy. Id. ¶ 16. The court noted that nothing in the Insurance Code provided express authority for the DOI to resolve employment status disputes between insurers and insureds. Id. The court thus took up the question of whether the legislature had provided the DOI such authority by “fair implication and intendment.” Id.
¶ 16 The court first held that implied authority did not exist under section 401(c). The court explained that, taken together, sections 401, 402, and 403
“generally give the Department and the Director broad authority to make rules and regulations to effectuate insurance laws, to conduct hearings and investigations to identify violations to properly effectuate the administration of Illinois insurance laws, and to institute enforcement actions of the Insurance Code or orders issued under the Insurance Code.” Id. ¶ 19.
The court acknowledged that the DOI’s authority under section 401(c) was broad but explained that a premium dispute between an insurer and insured did not involve the “ ‘efficient administration of the insurance laws of this State.’ ” Id. ¶ 20 (quoting 215 ILCS 5/401(c) (West 2016)). The parties had not explained to the court’s satisfaction how the dispute involved “any public interest, the administration of any insurance law or regulation, or the efficient regulation of the insurance industry’s market behavior or financial solvency.” Id. ¶ 22. Rather, the case was a premium dispute between an insurance company and insured that implicated only private interests. Id. The court did not believe that the DOI had express or implied authority to determine the scope of coverage under a contract of insurance because the DOI administers the insurance laws of the state, not individual insurance contracts. Id. ¶ 23.
¶ 17 The court then took up the question of whether section 462 provided the DOI with authority to resolve an employment status dispute. The court acknowledged that this section allows a party aggrieved by the application of a rating organization’s rating system to request a review with the rating organization and then appeal to the DOI if the decision is adverse to the party. Id. ¶ 27. The court concluded, nevertheless, that “CAT was not aggrieved by application of the NCCI
127147
rating system; CAT was aggrieved by Liberty’s determination as to the number of workers to which the rating system applied when calculating the adjusted premium.” Id. The court then explained what types of questions the DOI may consider under section 462 and why that case did not fall within any of those categories:
“Section 462 of the Insurance Code vests the Department with specific and limited authority that is not implicated here because CAT never disputed the application of an experience rating plan, a classification system, or any NCCI manual rules. The NCCI itself recognized that it did not have ‘jurisdiction over this dispute’ because ‘the types of grievances that are under the jurisdiction of the NCCI’ are limited to the interpretation or application of its experience rating plans, its classification system, or its manual rules. Section 462 limits the Department’s review to the final decision of the NCCI involving only these three areas,[2] and the NCCI expressly stated that it lacked jurisdiction because it does not decide employment status disputes, which do not implicate an ‘interpretation or application’ of its rules.
CAT did not raise any issue with Liberty’s application of the NCCI’s rating system to CAT’s payroll; CAT did not argue that Liberty applied the wrong classification code to CAT’s six disclosed clerical workers, that the owner- operators were misclassified, or that the applicable premium was incorrect. The only issue that CAT raised before the NCCI and the Department related to the substantive question of whether the owner-operators were CAT’s employees for purposes of workers’ compensation insurance coverage. In other words, CAT complained that Liberty erroneously determined that CAT had more employees than CAT claimed. The NCCI refused to get involved because it does not make determinations of who is or is not an employee, and referred CAT to the [DOI] under section 462 of the Insurance Code. There is nothing in the record before us or in the parties’ appellate briefs on the merits that suggests that the parties’ dispute turns on the application of the NCCI’s—or any other rating organizations’—rating system related to CAT’s risk and resulting premium. Instead, the parties’ dispute turns on whether Liberty correctly
2 This description is not entirely accurate. Section 462 does not limit the DOI to reviewing final decisions of the NCCI. A party is also entitled to seek review with the DOI if the NCCI fails to grant or reject the party’s request for review within 30 days. See 215 ILCS 5/462 (West 2018).
127148
determined that the owner-operators were not independent contractors but, rather, that they were CAT’s employees. Therefore, section 462 of the Insurance Code is inapplicable to the fundamental question in this case and cannot form the basis of the Department’s implied authority to resolve the dispute.” Id. ¶¶ 31-32.
The court thus vacated the DOI’s order as void and also vacated the circuit court’s order affirming it. The court explained, however, that the parties were not without a remedy, as employer-employee relationships are frequently decided in declaratory judgment actions filed in the circuit court. Id. ¶¶ 34-35.
¶ 18 In the present case, the appellate court determined that CAT Express was “dispositive of the merits of this appeal.” 2021 IL App (1st) 191842-U, ¶ 47. The court explained as follows:
“Here, the underlying dispute between Prate and Liberty Mutual was an employment status dispute: namely, whether Prate’s subcontractor ARW LLC, who had no workers’ compensation coverage, had employees that would trigger additional premiums under Prate’s policy. We specifically reject Liberty Mutual’s characterization of the issue in this case as simply an analysis of the NCCI’s Basic Manual Rule 2-H, i.e., whether Prate furnished satisfactory evidence that the subcontractor had workers’ compensation insurance in force. While it may be true that the final determination of how much additional premium is due would be calculated according to that rule, in order to reach that determination, there must be findings of fact and conclusions of law made to establish ARW LLC’s status as an employer and if so, whether any of its employees completed work on Prate’s projects. As we concluded in CAT Express, such determinations require the DOI and the Director to make factual findings regarding the parties’ private interests in the scope of their insurance contract. No public interest or administration of any insurance law or regulation is implicated by the dispute at bar.” 3 Id. ¶ 58.