STATE OF WISCONSIN
LABOR AND INDUSTRY REVIEW COMMISSION
P O BOX 8126, MADISON, WI 53708-8126 (608/266-9850)

JULIE RICHART, Applicant

THE GENERAL STORE, Employer

AMERICAN MANUFACTURERS MUTUAL INSURANCE COMPANY, Insurer

WORKER'S COMPENSATION DECISION
Claim No. 1999-064516


An administrative law judge (ALJ) for the Worker's Compensation Division of the Department of Workforce Development issued a decision in this matter. A timely petition for review was filed.

The commission has considered the petition and the positions of the parties, and it has reviewed the evidence submitted to the ALJ. Based on its review, the commission agrees with the decision of the ALJ, and it adopts the findings and order in that decision as its own.

ORDER

The findings and order of the administrative law judge are affirmed.

Dated and mailed November 28, 2001
richaju . wsd : 175 : 8  ND § 7.24  § 8.9

/s/ David B. Falstad, Chairman

/s/ James A. Rutkowski, Commissioner


MEMORANDUM OPINION

The insurer contends in its petition for commission review that the administrative law judge erred in entering a default order which found that the insurer was liable for any inexcusable delay in payment and assessed a penalty of $127.80. The insurer states that it could not find a record of the department's first request for information, and that the reason that there was a late payment involved was that the insured employer did not report the incident to the appropriate party. The insurer states that the claim was received from the employer on December 20, 1999, and that the insurer issued a first payment on December 23, 1999. However, the applicant timely reported her injury to the employer, and the employer gave the accident report to the insurer's broker. The broker was acting as the insurer's agent in this matter, and the broker's negligence in failing to forward the accident report to the insurer is imputed to the insurer. This is not a case in which the applicant or the employer did anything incorrectly. Simply, the insurance company's agent, the broker, failed to act in a timely manner to ensure that the claim could be paid promptly. Under such circumstances it was established that the insurance company through its agent was guilty of inexcusable delay in payment and a ten-percent penalty was appropriately awarded.

In addition, a default order was appropriately entered in this matter. The department gave the insurance company notice in its letter dated December 30, 1999, that it should explain the reason for the delay in payment or be subject to a default order. The letter dated December 30, 1999, was mailed to the appropriate address which was the same address that the default order was mailed to which the insurer received. There is no explanation why the insurer did not have notice or receive a copy of the department's letter dated December 30, 1999, and did not respond for almost two years prior to the default order being entered on August 22, 2001. Under the circumstances the commission finds that the department appropriately entered a default order and found the insurer liable for inexcusable delay in payment in the amount of $127.80.


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uploaded 2001/12/03