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Tradewinds Construction v. Newsbaum
Citations: 606 So. 2d 708; 1992 WL 280769Docket: 91-03411
Court: District Court of Appeal of Florida; October 14, 1992; Florida; State Appellate Court
The District Court of Appeal of Florida, First District, reviewed an appeal regarding a workers' compensation benefits award. The judge of compensation claims (JCC) held that the insurance carrier, Aetna Life and Casualty Company, was estopped from denying coverage because it had made payments for over two years without raising a coverage defense. The claimant, Michael Newsbaum, a sole proprietor of Tradewinds Construction, argued he relied on the carrier's payments, leading him to forgo seeking alternative medical and disability benefits. The court clarified that equitable estoppel cannot extend insurance coverage beyond the terms of the policy or cover risks that are explicitly excluded. The record indicated that the claimant had not filed the necessary election for coverage as a sole proprietor and was informed by the insurance agent that he was not covered at the time of reporting his injury. Although he had paid premiums for employee coverage, he had not paid for his own coverage, thus precluding the application of equitable estoppel in this context. The court also noted a narrow exception to estoppel, where promissory estoppel might create coverage to prevent fraud or injustice. However, the court found that the essential elements for promissory estoppel were not met in this case. Consequently, the court reversed the JCC's order and remanded the case with instructions to dismiss the claim. Judges Booth, Smith, and Barfield concurred with the decision.