David BERGMANN, Personal Representative of the Estate of Terrel Ann Bergmann, Petitioner on Review, v. Jennifer HUTTON, Defendant, and FARMERS INSURANCE COMPANY OF OREGON, Respondent on Review.
(CC 00-3304-L-2; CA A115380; SC S50395)
In the Supreme Court of the State of Oregon
December 2, 2004
101 P3d 353 | 337 Or 596
David BERGMANN,
Personal Representative of the Estate of
Terrel Ann Bergmann,
Petitioner on Review,
v.
Jennifer HUTTON,
Defendant,
and
FARMERS INSURANCE COMPANY OF OREGON,
Respondent on Review.
(CC 00-3304-L-2; CA A115380; SC S50395)
101 P3d 353
Kenneth M. Tharp, of Frohnmayer, Deatherage, Pratt, Jamieson, Clarke & Moore, P.C., Medford, argued the cause and filed the brief for respondent on review.
Thomas M. Christ, of Cosgrave Vergeer Kester LLP, Portland, argued the cause and filed the brief for amici curiae Liberty Northwest Insurance Company, Mutual of Enumclaw Insurance Company, State Farm Mutual Automobile Insurance Company, Oregon Mutual Insurance Company, Safeco Insurance Company, and the American Insurance Association. With him on the brief was Thomas W. Brown, Portland.
Meagan A. Flynn, of Preston Bunnell & Stone, LLP, Portland, filed the brief for amicus curiae Oregon Trial Lawyers Association.
GILLETTE, J.
Kistler, J., dissented and filed an opinion in which Carson, C. J., and Balmer, J., joined.
In this automobile insurance case, the issue is whether an insurer is entitled to offset the amount that an injured insured received in workers’ compensation benefits against the amount that the insurer otherwise would have been obligated to pay to the insured under the insured‘s underinsured motorist (UIM) coverage in a policy issued by the defendant insurer. The issue arose when plaintiff1 submitted a claim under the UIM coverage. Defendant responded that the policy entitled it to offset the workers’ compensation payments that plaintiff had received and that, in the offset, defendant owed plaintiff nothing. Plaintiff then brought this contract action against defendant. Defendant moved for summary judgment respecting the offset for workers’ compensation benefits. The trial court granted defendant‘s motion, and, on appeal, the Court of Appeals affirmed that ruling without opinion. Bergmann v. Hutton, 186 Or App 566, 65 P3d 1132 (2003). We allowed review and, for the reasons that follow, now reverse the decision of the Court of Appeals and the judgment of the trial court.
Because we are reviewing a grant of summary judgment, we view the facts from the summary judgment record, and all reasonable inferences that may be drawn from them, in the light most favorable to the nonmoving party, in this case plaintiff insured. Oregon Steel Mills, Inc. v. Coopers & Lybrand, LLP, 336 Or 329, 332, 83 P3d 322 (2004).
In October 1998, plaintiff was seriously injured in an automobile collision caused by the failure of another driver, defendant Hutton, to stop at a red light. At the time of the accident, plaintiff was 51 years old. She worked at a bank and earned a salary of more than $3,000 per month. After the accident, plaintiff‘s condition was such that she was unable to return to work and had difficulty participating in normal life activities.
At the time of the accident, defendant Farmers Insurance Company (Farmers) insured plaintiff under an
Plaintiff‘s damages resulting from the accident totaled more than $650,000.2 Farmers tendered the policy limit of $25,000 under Hutton‘s policy, and plaintiff received a total of $107,652 in workers’ compensation benefits. Because those amounts did not fully compensate plaintiff for her losses, plaintiff made a claim for damages under the UIM provisions of her automobile insurance policy.3
Farmers denied that claim. Farmers contended that the policy and applicable law entitled it to deduct from the amount that it otherwise would owe to plaintiff under the UIM provision of its policy both the amount tendered on behalf of the negligent driver and the amount that plaintiff received in workers’ compensation benefits. Because those amounts collectively exceeded the policy limit of $100,000, Farmers asserted that plaintiff‘s UIM benefits were exhausted and Farmers owed her nothing.
Plaintiff filed the present action against Farmers for breach of contract.4 Farmers answered, denying any liability, and moved for summary judgment. Farmers argued, among other things, that the Court of Appeals had held, in California Casualty Indemnity Exchange v. Maritzen, 123 Or App 166, 860 P2d 259 (1993), and in Pitchford v. State Farm Mutual Auto. Ins. Co., 147 Or App 9, 934 P2d 616 (1997), that UIM policy provisions similar to the one at issue here permitted the insurer to offset the amount that the insured received in workers’ compensation benefits against the insured‘s UIM policy limits. According to Farmers, those Court of Appeals holdings were dispositive and mandated a ruling in its favor
In this court, plaintiff contends that, under the governing statute,
We begin by examining the statutes pertinent to UIM coverage.5
“(a) The limit of liability stated in the declarations as applicable to ‘each person’ is the limit of the insurer‘s liability for all damages because of bodily injury sustained by one person as the result of any one accident and, subject to the above provision respecting each person, the limit of liability stated in the declarations as applicable to ‘each accident’ is the total limit of the company‘s liability for all damages because of bodily injury sustained by two or more persons as the result of any one accident.
“*****
“(c) Any amount payable under the terms of this coverage because of bodily injury sustained in an accident by a person who is an insured under this coverage shall be reduced by:
“(A) All sums paid on account of such bodily injury by or on behalf of the owner or operator of the uninsured vehicle and by or on behalf of any other person or organization jointly or severally liable together with such owner or operator for such bodily injury including all sums paid under the bodily injury liability coverage of the policy; and
“(B) The amount paid and the present value of all amounts payable on account of such bodily injury under any workers’ compensation law, disability benefits law or any similar law.”
(Emphasis added.)
The parties assign different meanings to that statutory subsection and, in particular, to the highlighted phrase, “any amount payable under the terms of this coverage,” in
Plaintiff, by contrast, asserts that the phrase “any amount payable under the terms of this coverage” in
To resolve the question of which of those competing interpretations is correct, we turn to the now-familiar methodology for construing statutes that this court summarized in PGE v. Bureau of Labor and Industries, 317 Or 606, 859 P2d 1143 (1993). Under that methodology, we first examine the text of the statute, in context, in an effort to discern the intent of the legislature. Id. at 610. If the meaning of the statute is clear at that level of analysis, then further inquiry is unnecessary. Id. at 611.
We begin with the text of
For example, the phrase “this coverage” quite clearly is a general reference to UM coverage, which is the express subject of
The wording of those statutes also makes clear that the term “coverage” is not synonymous with the term “policy.” As is evident from the quoted material above,
By contrast, the “policy” is the specific contract between the insurer and the insured, which, by statute, is required to include certain terms. Under
In addition, we observe that the phrase “any amount payable under the terms of this coverage because of bodily injury sustained in an accident by a person who is insured under this coverage” tracks the wording of
“The insurer will pay all sums which the insured * * * shall be legally entitled to recover as general and special damages from the owner or operator of an uninsured vehicle because of bodily injury sustained by the insured caused by accident and arising out of the ownership, maintenance or use of such uninsured vehicle.”
(Emphasis added.) Thus, the amount that is “payable” by the insurer under the “coverage” is “all sums” that the insured is “legally entitled to recover” as a result of an accident with an uninsured motorist. In the usual case, that amount would be equal to the insured‘s total damages, although there may be cases in which the insured would not be “legally entitled to recover” all of his or her damages, such as when the tortfeasor is immune from liability or when there has been a determination of comparative fault.9 Notably, in defining the insurer‘s liability for coverage,
Farmers asserts that
We observe at the outset that Farmers unintentionally (but pivotally) muddies the waters by referring to the “terms of her coverage” and equating that concept to the terms of plaintiff‘s policy. That is, by referring to “her” (plaintiff‘s) coverage, Farmers conflates the contract that it and plaintiff entered into, i.e., the policy, with the statutory reference to the “terms of this coverage.” (Emphasis added.) “This coverage” in
The distinction that we draw here is borne out by the text of
“The limit of liability stated in the declarations as applicable to ‘each person’ is the limit of the insurer‘s liability for all damages because of bodily injury sustained by one person as the result of any one accident * * *.”
The term “declarations,” while not defined in the statute, is an unambiguous reference to a page of the policy itself. In common parlance, it is the first page of an insurance policy and summarizes the terms of that policy, including, among other things, setting out the insurer‘s limit on liability.
Farmers argues that, because paragraphs (a) and (c) are found in the same part of the statute,
Finally, we think that it is noteworthy that
Farmers maintains that interpreting
That concern is misplaced. First, no matter what types of offsets
Finally, Farmers contends that this court, in its earlier opinion in Grijalva v. Safeco Ins. Co., 329 Or 36, 985 P2d 784 (1999), held that the meaning of
In Grijalva, the plaintiff and her coworker were driving together in the coworker‘s car when it was struck by a car driven by an underinsured motorist, Dawson. The facts recite that the plaintiff “suffered damages in excess of $100,000.” 329 Or at 39. The plaintiff received some compensation from Dawson‘s insurer, as did the coworker. In addition, both the plaintiff and the coworker received workers’ compensation benefits. Neither the plaintiff nor the coworker was made whole by those recoveries, and, therefore, the plaintiff and the coworker filed claims under the coworker‘s UIM policy. The insurer paid the coworker part of the amount that she sought but denied the plaintiff‘s claim entirely, on the ground that it was entitled to offset the amounts that both the plaintiff and the coworker received from Dawson‘s insurer and in workers’ compensation benefits from the amount of the coworker‘s liability limit. After those reductions were taken, there was nothing left for the plaintiff.
The precise issue before this court in Grijalva was whether
In the present case, plaintiff had an underinsured motorist coverage policy with a liability limit $100,000. She received workers’ compensation benefits totaling approximately $107,000. Applying a policy provision that it contended was consistent with
As is evident from the discussion above, Farmers should not have applied the amount that plaintiff received in workers’ compensation benefits to reduce the amount of Farmers’ liability to plaintiff under the policy. Instead, Farmers should have applied those benefits in reduction of the total amount of damages that plaintiff legally would have been entitled to receive from Hutton because of bodily injury sustained in the accident that Hutton caused. Accepting for purposes of review on summary judgment that plaintiff‘s damages well exceeded both the amount that plaintiff received in workers’ compensation benefits and the amount of Farmers’ liability limit under the UIM policy, Farmers was liable to plaintiff for some amount under that policy. It follows that the trial court‘s ruling granting summary judgment to Farmers was in error. Likewise, the Court of Appeals erred in affirming that ruling. The case must be remanded to the circuit court to determine what amount is owing to plaintiff.
KISTLER, J., dissenting.
The majority holds that, in computing uninsured motorist benefits, a statutory offset for workers’ compensation payments should be deducted from the amount of the damages that the insured sustained. In my view, the text and the context of the governing statute require a different result. They require that any workers’ compensation payments be deducted from the amount of the insured‘s damages up to the limits of liability. I respectfully dissent.
Two propositions follow from this statutory context. First, the phrase “this coverage” in
Two of those terms are relevant here. First,
The text and context of
In this case, the insured‘s damages exceed $650,000, and the insurer‘s limit of liability is $100,000. Under the terms of the coverage stated in
The majority reaches a different conclusion. Relying on
The majority‘s second point is at odds with its own interpretation. As the majority notes, and I agree, the phrase “the terms of this coverage” gains meaning only from its context. The majority looks to one contextual source—
The majority‘s more substantial point is that, under
To be sure, as the majority notes,
Because the text and context of
Carson, C. J., and Balmer, J., join in this dissent.
