BILLY G. SIBLEY, PETITIONER,
v.
ADJUSTCO, INC., RESPONDENT

Fla. | 1992-04-09
No. 77357
SHAW, C.J., and McDONALD, BARKETT, GRIMES, KOGAN and HARDING, JJ., concur.
596 So. 2d 1048 Florida Supreme Court (1992) Negative Treatment
Cited by 14 cases

AI-generated. These summaries, headnotes, and key points are machine-generated and may contain errors or omissions. Always verify against the full opinion text below. Not legal advice.

Synopsis

The Florida Supreme Court held that a workers' compensation claimant may pursue an independent tort action against an insurance carrier for intentional fraudulent conduct by its adjuster, even without a prior criminal conviction. Section 440.37 provides an alternative remedy, not an exclusive one, for employees claiming they were defrauded by carriers or their agents.


Holding

The Court held that section 440.37 provides an alternative cause of action rather than the exclusive remedy for fraudulent conduct by carriers or their agents. A criminal conviction is not a condition precedent to bringing an independent common law tort action for intentional tortious conduct. The statutory provisions were not intended to bar recovery for intentional torts.


Headnotes

[1] A criminal adjudication of guilt is not a condition precedent to the maintenance of an independent tort action when an employee claims injury arising from the alleged fra…

[2] Section 440.37, Florida Statutes, provides an alternative cause of action for claimants alleging fraud by an employer or carrier, rather than an exclusive remedy.

Previewing 2 of 4 headnotes on this case. FLexlaw’s editorially structured points of law — every proposition, pinpointed — are reserved for members.

Join FLexlaw to unlock all legal intelligence

Key Quotes

“section 440.37 provides only an alternative cause of action rather than the exclusive cause of action under these circumstances. Furthermore, we find that those statutory provisions were not intended to bar recovery for intentional tortious conduct.”

The core holding that the statutory remedy does not preclude common law tort actions for intentional fraud.

Previewing 1 of 3 key quotes on this case — the court’s exact language, pinpointed for members.

Join FLexlaw to unlock all legal intelligence

Facts & Procedural History

Billy Sibley suffered a heart attack while unloading his truck and was awarded workers' compensation benefits by an industrial claims judge. While Sib…

The full statement of facts, procedural history, and disposition for this case are member content.

Join FLexlaw to unlock all legal intelligence

© FLexlaw, Inc. — AI-generated enrichments are proprietary. All rights reserved.


Opinion of the Court
OVERTON, Justice.

OVERTON, Justice.

We have for review Sibley v. Adjustco, Inc., 573 So. 2d 353 (Fla. 2d DCA 1990), where the district court held that a workers’ compensation claimant was prohibited by the provisions of section 440.37, Florida Statutes (1989), from bringing an independent action against an insurance carrier on grounds that its adjuster committed intentional, fraudulent, and bad faith acts in taking a statement concerning the claim. The district court then certified the following question as one of great public importance:

WHEN AN EMPLOYEE CLAIMS INJURY ARISING FROM THE ALLEGED FRAUDULENT ACT OF AN EMPLOYER/CARRIER COMMITTED IN THE COURSE OF A PROCEEDING INITIATED PURSUANT TO CHAPTER 440[, FLORIDA STATUTES (1989),] IS A CRIMINAL ADJUDICATION OF GUILT PRESCRIBED IN SECTION 440.37 A CONDITION TO THE MAINTENANCE OF AN INDEPENDENT TORT ACTION?

Sibley v. Adjustco, Inc., No. 89-03430 (Fla. 2d DCA Jan. 24, 1991) (Order on Motion for Certification).1 We answer the question in the negative and quash the decision of the district court.

The facts of this case are as follows. In Sibley’s workers’ compensation proceeding, prior to the circuit court action, the industrial claims judge found that Sibley was entitled to workers’ compensation benefits. The judge found that Sibley suffered an acute myocardial infarction caused by unloading his truck and that this was not the type of labor and exertion performed during the normal course of his job. The judge noted that Sibley was hospitalized for approximately three weeks, one week of which was in the intensive care cardiac unit. As a result of Sibley’s condition, the judge found a 50% permanent partial disability in accordance with the opinions of the treating physicians. The judge also made an express finding concerning the conduct of William Adams, the adjuster in this action, stating:

I have thoroughly reviewed and considered the statement which was taken by William Adams, an adjuster, employed by the employer and its carrier, which statement was taken on or about December 1, 1981. It is my finding that the statement was taken while Mr. Sibley was under less than optimum physical condition and that he was at that time not completely aware of his surroundings nor fully cognizant of the implications and ramifications of the questions being posed to him by the adjuster. I do not find that the statement as transcribed is of credible value and appears to a large degree to have been edited by the interviewer and does not contain all of the facts and circumstances surrounding the occurrence of the heart attack or of the matters discussed at the time of the taking of the statement as testified to by the claimant and by his wife who was present at the time of the taking of the statement. I, therefore, specifically reject the statement as having substantial weight and merit and of having any credible value in the findings of compensability herein. Sibley’s complaint alleged that, while he was hospitalized in a heavily sedated condition, his statement was taken by William Adams, an employee of the workers’ compensation carrier.

Furthermore, Sibley claimed that the statement taken by Adams was inaccurate and had been edited in material respects and that, because of Adams’ fraudulent acts, the carrier refused to pay Sibley workers’ compensation benefits. Sibley’s complaint charged that such acts were intentional misconduct and not negligent conduct protected by chapter 440, Florida Statutes (1989). The insurance carrier moved to dismiss the action and the trial court granted the insurance carrier’s motion, concluding that section 440.11, Florida Statutes (1989), provided the carrier with immunity from liability.

On appeal, the district court affirmed but did not rest its affirmance upon section 440.11. In its decision, the district court noted that “the workers’ compensation statute presents a comprehensive legislative effort to provide protective and compensatory mechanisms to working people who experience physical injury or loss in carrying out the employer’s objectives.” Sibley, 573 So. 2d at 355. The district court explained that, to accomplish these objectives and to implement chapter 440, the legislature enacted section 440.37, entitled “Misrepresentation; fraudulent activities; penalties.” That statute provides, in pertinent part:

(1) Any person who willfully makes any false or misleading statement or representation for the' purpose of obtaining or denying any benefit or payment under this chapter:
(b) Who prepares or makes any written or oral statement that is intended to be presented to any employer, insurance company, or self-insured program in connection with, or in support of, any claim for payment or other benefit pursuant to any provision of this chapter, knowing that such statement contains any false or misleading information concerning any fact or thing material to such claim, shall be guilty of a felony of the third degree, punishable as provided in s. 775.-082, s. 775.083, or s. 775.084.

(2)(e) The provisions of this subsection shall also apply with respect to any employer, insurer, self-insurer, adjusting firm, or agent or representative thereof who intentionally injures, defrauds, or deceives any claimant with regard to any claim. Such claimant shall have the right to recover the damages provided in this subsection.

The district court found the interlocking provisions of section 440.37 controlling and concluded that the legislature intended that section to be the sole means for a claimant to obtain relief for the behavior alleged to have been committed by the adjuster and the carrier in this case.

In answering the certified question, we must determine whether the provisions of sections 440.37(1)(b) and 440.37(2)(e), Florida Statutes (1989), which require a criminal conviction as a condition precedent to the maintenance of a tort action by an employee who claims to have been defrauded, are the exclusive remedy or an alternative cause of action.

We note that, under sections 440.37(1)(b) and 440.37(2)(e), Florida Statutes (1989), a criminal conviction resolves the question of liability and leaves for resolution only the question of damages.

However, where there is no criminal conviction, an independent common law cause of action requires the establishment of liability as well as damages.

We hold that section 440.37 provides only an alternative cause of action rather than the exclusive cause of action under these circumstances.

Furthermore, we find that those statutory provisions were not intended to bar recovery for intentional tortious conduct. Byrd v. Richardson-Greenshields Sec., Inc., 552 So. 2d 1099 (Fla.1989); Fisher v. Shenandoah Gen. Constr. Co., 498 So. 2d 882 (Fla.1986); Lawton v. Alpine Eng’red Prods., Inc., 498 So. 2d 879 (Fla.1986).2 Given the distinctive characteris tics of this statutory action and the common law action, we conclude that the legislature was providing an alternative cause of action and not eliminating a common law right of action for an intentional tort.

Accordingly, we answer the certified question in the negative, quash the decision of the district court, and remand this cause for further proceedings consistent with this opinion.

It is so ordered.

SHAW, C.J., and McDONALD, BARKETT, GRIMES, KOGAN and HARDING, JJ., concur. . We have jurisdiction. Art. V, § 3(b)(4), Fla. Const. . We note that the adjuster who allegedly committed the tortious acts is not a party defendant to this cause. We do not address whether the circumstances of this case constitute an inten tional tort by an employee for which an employer is responsible because that issue is not before us.


Cases With Similar Vibessemantic neighbors from the corpus


Citator

Cited By

  • Rodrigo Aguilera v. Inservices, Inc., 905 So. 2d 84 (Fla. 2005)
    …ot have jurisdiction to take this case. The decision of the Third District in Inservices, Inc. v. Aguilera, 837 So. 2d 464 (Fla. 8d DCA 2002), does not expressly and directly conflict with the question of law we answered in Sibley v. Adjustco, Inc., 596 So. 2d 1048 (Fla.1992). Second, on the merits, I agree with the Third District that the exclusivity provisions of the workers’ compensation statute bar Aguilera from filing an independent tort claim for intentional infliction of emotional distress arising direc…
    1 / 5
  • Liberty Mut. Ins. Co. & Norma J. Peele v. Steadman, 968 So. 2d 592 (Fla. 2d DCA 2007)
    …e carrier. The Third District should not have limited itself to considering whether Aguilera’s allegations involved wrongdoing totally separate and independent of the workers’ compensation claim process itself. Pursuant to Sibley [v. Adjustco, Inc., 596 So. 2d 1048 (Fla.1992) ], if an insurance carrier engages in outrageous actions and conduct that constitutes an intentional tortious act while processing the claim beyond mere short delays in payment and simple bad faith, the carrier is not cloaked with a shiel…
  • Inservices, Inc. v. Rodrigo Aguilera, 837 So. 2d 464 (Fla. 3d DCA 2002)
    …is is not to say that a compensation carrier is immune from all intentional torts. The workers’ compensation scheme does not immunize a compensation carrier from wrongdoing which occurs independently of its claims handling. Sibley v. Adjustco, Inc., 596 So. 2d 1048 (Fla.1992) (adjuster who fraudulently edited the statement of a claimant which results in the denial of benefits constitutes an intentional act independent of the handling of a workers’ compensation claim); cf. Associated Indus. of Fla. Prop. & Cas.…
    1 / 2

Previewing 3 of 5 citing cases — full citator treatment, depth of discussion, and citing context are member features.

Join FLexlaw to unlock all legal intelligence

Authorities Cited

Full citator, related cases, and AI research tools

Open in FLexlaw