Tilbury Constructors, Inc. v. State Comp. Ins. Fund

In Tilbury Constructors, Inc. v. State Comp. Ins. Fund (2006) 137 Cal.App.4th 466, the Court held a breach of contract claim cannot be based on a dispute over how a workers' compensation carrier exercises its subrogation right. (Tilbury Constructors, supra, 137 Cal.App.4th at pp. 476-477.) The court explained not only is this a right that belongs to the insurer (and is not a duty or obligation owed to the insured), but also is a right as to which the insurer, by statute, has multiple options, including taking no action. (Id. at p. 476.) Further, a carrier's " 'decision regarding pursuing its subrogation rights after it has properly paid claims under the insurance policy does not affect the insured's receiving the benefits of the insurance agreement.' " (Id. at pp. 476-477.) Accordingly, a complaint about an insurer's exercise of its subrogation rights stands in contrast to a complaint based on allegations of "defalcations in the manner in which the insurer handled the claim, paid out the benefits, or dealt with the claims handling portion of the case." (Tilbury Constructors, supra, at p. 477.) The issue in Tilbury Constructors was whether the insured employer could sue SCIF for its handling of a subrogation claim. State Compensation Insurance Fund (SCIF) had paid nearly $220,000 in workers' compensation benefits to the injured employee and estimated future benefits would exceed $280,000. (Id. at p. 472.) Just prior to trial in the injured employee's lawsuit against an allegedly negligent third party, SCIF "sold" its subrogation rights to the employee for $10,000. (Ibid.) As a result, there was virtually no recoupment of the workers' compensation amounts paid to the injured employee, which adversely affected the employer's premiums. (Id. at pp. 472-473.) The employer sued for breach of the insurance contract and tortious breach of the implied covenant of good faith and fair dealing. (Id. at p. 470.)