Vogelin v. American Family Mutual InsuranceVogelin v. American Family Mutual Insurance
In this insurаnce breach-of-contract case, we decide how a liability payment that plaintiff recovered from a tort-feasor affects her recovery of underinsured motorist (UIM) benefits under her own insurance policy. We conclude that the relevant Oregon statutes permitted defendant — plaintiffs insurer — to calculate plaintiffs UIM benefit by subtracting the tortfeasor’s liability payment from the uninsured motorist (UM) liability limit of plaintiffs policy, instead of by subtracting that payment from the amount of plaintiffs total damages.
The facts are undisputed. Plaintiff, who had purchased an automobile insurance policy from defendant, was injured in an automobile collision in 2003 and sustained damages exceeding $300,000. The driver who collided with plaintiff and injured her had liability insurance with a liability limit of $25,000; the driver’s insurance carrier paid that amount to plaintiff. Because the driver’s liability payment was not sufficient to pay the full amount of plaintiffs damages, plaintiff made a claim against defendant for UIM benefits; the UM liability limit under her own policy was $100,000. The parties discussed various settlement amounts but did not come to an agreеment.
Plaintiff filed this action against defendant in 2005 for breach of contract, arguing that
The trial court agreed with defendant and, after a jury returned a damages finding of $304,035.70, entered judgment for plaintiff in the amount of $75,000, plus attorney fees and costs. The Court of Appeals affirmed.
Vogelin v. American Family Mutual Ins. Co.,
We begin our analysis with
“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 the bodily injury by or on behalf of the owner or operator of the uninsured vehicle * * *, 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 the bodily injury undеr any workers’ compensation law, disability benefits law or any similar law.”
(Emphasis added.)
In
Bergmann,
“the amount that the insured legally would be entitled to recover from the owner or operator of an uninsured or underinsured vehicle on account of bodily injury sustained by the insured in an accident caused by the ownership or operation of the uninsured or underinsured vehicle.”
Id. at 610. Because, in the usual case, “that amount would be equal to the insured’s total damages,” id. at 605, the court held that the plaintiff in Bergmann was entitled to recover the amount of his total damages less the workers’ compensation benefits that he had received. Id. at 610.
Responding to the insurer’s concern in
Bergmann
that the foregoing interpretation of
“First, no matter what types of offsetsORS 742.504 permits, the maximum amount for which the insurer is liable under its UM coverage is the limit of liability set out on the declarations page of the policy.ORS 742.504(7)(a) . Second,ORS 742.502(2)(a) essentially defines the limit of the insurer’s liability in the UIM context. That section provides that UIM benefits are ‘equal to uninsured motorist coverage benefits less the amount recovered from other automobile liаbility insurance policies.’ Nothing inORS 742.504(7)(c) , and certainly nothing in the interpretation of that provision that we announce here, renders those provisions of the statute inoperable. Thus, even if the insured’s damages continue to exceed the policy limits after appropriate deductions from the total damages are taken, the maximum amount for which the insurer will be liable is the limit of liability set out in the declarations. And if, after reducing the amount that the insured legally would be entitled to recover in the various ways permitted inORS 742.504(7) , the resulting amount is lessthan the insurer’s liability limit, then that rеsulting amount is the maximum that the insurer will have to pay. The insurer may have to pay, but the payment will never exceed the liability limits that are stated on the declarations page. No unreasonable result obtains.”
Id. at 608.
This case involves a payment on behalf of a tortfeasor, which is addressed under
However, although our analysis begins with
Before examining the parties’ arguments further, we set out the applicable 2001 version of
(1) “A motor vehicle bodily injury liability policy shall have the same limits for uninsured motorist coverage as for bodily injury liability coverage unless a named insured in writing elects lower limits.”
(2) “The insured may not elect limits lower than the amounts prescribed to meet the requirements ofORS 806.070 for bodily injury or death.”
(3) “Uninsured motorist coverage larger than the amounts required byORS 806.070 shall include under-insurance coverage for damages or death caused by accident and arising out of the ownership, maintenance or use of a motor vehicle that is insured for an amount that is less than the insured’s uninsured motorist coverage.”
(4) “Underinsurance benefits shall be equal to uninsured motorist coverage benefits less the amount recovered from other automobile liability insurance policies.” 3
The first two sentences of
The third sentence of
This court recently discussed the meaning of the third sentence of
Resolution of that dispute turned on the meaning of the word “coverage,” as used in the third sentence of
This case concerns the meaning of the fourth sentence of
“Underinsurance benefits shall be equal to uninsured motorist coverage benefits less the amount recovered from other automobile liability insurance policies.”
The fourth sentence addresses, as does
In defendant’s view, that phrase from the fourth sentence of
Plaintiff counters that we must interpret the phrase “uninsured motorist coverage benefits” in the fourth sentence of
To support her position, plaintiff emphasizes that, if we were to construe
For its part, defendant acknowledges that its proposed interpretation of the fourth sentence of
The wording of the two statutes is difficult to decipher and reconcile, and both parties have strong arguments. Had the legislature used the terms “damages,” “policy limits,” or “liability limits” in the fourth sentence of
In 1967, the legislature first required that every automobile insurance policy in Oregon provide UM coverage, defined as insurance against the risk of injury or death in an accident arising out of the ownership, maintenance, or use of an “uninsured motor vehicle.” Or Laws 1967, ch 482, §§ 1, 2 (originally
former
Because UM insurance paid benefits to an insured only when the vehicle that had caused the injury had no insurance whatsoever, circumstances existed in which an insured could recover more insurance benefits when injured by an uninsured driver than when injured by a driver who was insured, but at a level insufficient to pay the injured driver’s damages in full. So, for example, if an insured with a $100,000 UM liability limit were injured by an uninsured driver, suffering damages of $75,000, the insured would not be able to recover any insurance benefits from the tortfeasor, but could recover the amount of $75,000 under his or her own UM policy. However, if the insured were injured by an insured tortfeasor with a liability limit of $25,000, the insured could recover only that amount from the tortfeasor and could not recover any additional benefit from its own insurer. In that example, the insured would recover $50,000 less in insurance benefits when injured by an insured driver than the insured would recover when injured by an uninsured driver.
The legislature confronted that incongruity in 1981 by enacting legislation that required insurers to provide their insureds with coverage for injuries inflicted by underinsured, as well as by uninsured, vehicles. Or Laws 1981, ch 586.
8
That legislation was drafted and considered by the 1980 Interim Joint Committee on the Judiciary before the commencement of the 1981 legislative session; the legislation lаter moved through the 1981 session as Senate Bill (SB) 31 (1981). As we
Much of the discussion before the Interim Joint Committee on the Judiciary that preceded the 1981 legislative session bears on our analysis here. For example, Frank Howatt, an assistant insurance commissioner, explained to the committee how a tortfeasor’s liability payments would be applied under the new UIM legislation:
“[T]he amount of insurance you would recover [from the tortfeasor] would be an offset, of course, against the [UM] limit that you carry.”
Tape Recording, Joint Committee on the Judiciary, Subcommittee on Insurance, Sept 12, 1980, Tape 9, Side A. Howatt stated that he wanted the wording to make it “obvious that the intent was to cover this gap that arises when the other party is not uninsured but [he] is insured and your own policy [limit] is a higher limit and the offset should he applied against that higher limit rather than simply eliminating the coverage” Id. (emphasis added). Howatt later explained, “You don’t collect the full benefit under the uninsured [motorist policy]; you collect the difference between that and * * * the other party’s insurance.” Tape Recording, Joint Committee on the Judiciary, Oct 5, 1980, Tape 1, Side A.
Others who spoke before the Interim Joint Committee on the Judiciary about the draft legislation echoed that understanding. Noam Stampfer, counsel to the committee and the drafter of the proposed legislation, stated,
“What this legislation would do is to track underinsurance and uninsurance [benefits]. Rather than stack [UIM and UM benefits] one on top of the other, it would just track them[,] so that the underinsurance would fill the gap between the amounts received from the other party’s policies and the amount that the person is insured to under that person’s uninsured motorist coverage.”
Id. Senator Vern Cook provided an example of how the UIM coverage would work:
“[I]f he [i.e., the tortfeasor] has the minimum policy [limit] and you [i.e., the insured] have a 50/100 liability policy which gives you 50/100 [in] uninsured [motorist] coverage if he is uninsured, this would mean that, if he has only $15[,000], you’ll also get an extra $35[,000] on your own policy for uninsured [motorist] coverage. So you would collect up to $15[,000] from the third party and then up to $35[,000] from your own [policy].”
Id.
Plaintiff does not dispute that, in general, the statutory UIM requirements were designed to fill a “gap” in coverage. In plaintiffs view, however, statements by other proponents of the legislation demonstrate that the legislature intended that UIM benefits fill the gap between the tortfea-sor’s liability limits and the insured’s damages, rather than a gap between the tortfeasor’s liability limits and the insured’s UM liability limits. Plaintiff points to statements by Senator Ed Fadeley and Tom Bessonette of Oregon Mutual Insurance. Speaking during a hearing before the Joint Committee on the Judiciary, Senator Fadeley remarked:
“Suppose that I sued the other guy, and I only got $10,000 as a judgment, but I’ve got a $50,000 uninsured motorist policy under this statute, with underinsured mandated as part of it. So I’m supposed to get $50,000.1 wonder, if that last sentence and the word ‘recovered’ would allow me to get $40,000 in that instance, when what I recovered was $10[,000] and what I had in my policy was $50[,000].”
Tape Recording, Joint Committee on the Judiciary, Oct 5, 1980, Tape 1, Side A. Howatt then asked Senator Fadeley if his question was whether,
“ ‘if the man only got a judgment for $10,000, that he would recover some larger amount by virtue of this underinsurance?’ No, it says here, as I understand it, * * * [the legislation] say[s] underinsurance benefits shall be equal to uninsured motorist coverage benefit. Not [that] the uninsured motorist coverage benefit would be $10,000 wouldn’t it — you don’t recover more under your uninsurance motorist coverage than the amount of the judgment against the other driver. If you start with a $10,000 judgment, that would be payable under uninsurance, but then the existence of the other party’s insurance would normally cancel that benefit under your policy.”
Id.
Contrary to plaintiffs position, that exchange indicatеs that Senator Fadeley was concerned that the injured party not recover more than the amount of the damages that he or she was entitled to recover, not that the injured party be able to recover more than his or her UM liability limits. In fact, later in the proceedings, Senator Fadeley stated:
“If I was looking at it from an insurance salesman’s point of view, the intention is to allow me to buy an increase in my uninsured motor[ist] vehicle coverage and to have the increase in my motor vehicle insurance coverage сover the gap between low insurance and the benefits I bought.”
Id., Tape 2, Side A.
The testimony of Bessonette also is contrary to plaintiffs position. Testifying before the Senate Committee on Insurance, Banking, and Retirement, which considered SB 31 during the 1981 legislative session, Bessonette stated:
“Many people have been involved in automobile crashes and they were unable to collect a sufficient amount of damages for their injuries because there just wasn’t enough insurance on the other party. * * * This bill provides what we now call underinsurance. If you hit аnd collide with someone who has a $15,000 policy [limit] and you have a $100,000 injury, [then] you would collect $15,000 from the wrongdoer and $85,000 from your own insurance company and you would be made well.”
Tape Recording, Senate Committee on Insurance, Banking, and Retirement, SB 31, Jan 23,1981, Tape 5, Side A.
Plaintiff correctly points out that no one who spoke about the 1981 UIM legislation specifically addressed the gap between a tortfeasor’s liability limits and an injured party’s damages, but plaintiff does not gain by that argument. It is evident to us that the legislature did not do so becаuse it focused on the gap between a tortfeasor’s liability limits and the injured party’s UM liability limits.
Our review of the legislative history surrounding the enactment of the UIM legislation convinces us that defendant’s interpretation of the fourth sentence of
In sum, we conclude that the applicable statutes that governed the terms of the insurance policy that plaintiff purchased from defendant permitted defendant to calculate
The decision of the Court of Appeals and the judgment of the circuit court are affirmed.
Notes
As discussed in
Bergmann v. Hutton,
In
Bergmann,
the plaintiff apparently did not contend that the insurer was prohibited by law from deducting the amount paid on behalf of the tortfeasor from the limits of her UIM policy,
Bergmann,
“Underinsurance coverage [benefits] shall be equal to uninsured motorist coverage [benefits] less the amount recovered from other motor vehicle [automobile] liability insurance policies.”
See
Or Laws 2007, ch 287, § 2 (adding “coverage” and twice removing “benefits”); Or Laws 2005, ch 235, § 1 (adding “motor vehicle” and removing “automobile”). As noted in
Mid-Century Ins. Co. v. Perkins,
Provisions of
Citing
PGE v. Bureau of Labor and Industries,
Former
The legislature later required that an insurer provide as much UM coverage as liability covеrage, unless the insured elected otherwise, as now set out in the first two sentences of
As originally enacted, the underinsurance provisions currently set out in the third and fourth sentences of
“* * * Offers of uninsured motorist coverage larger than the amounts required by ORS chapter 486 shall include underinsurance coverage for damages or death caused by accident and arising out of the ownership, maintenance or use of a motor vehicle that is insured for an amount that is less than the insured’s uninsured motorist coverage. Underinsurance benefits shall be equal to uninsured motorist coverage benefits less the amount recovered from other automobile liability insurance policies.
“* * * Underinsurance coverage shall be subject to [former]ORS 743.792 [(1981) (nowORS 742.504 )].”
Or Laws 1981, ch 586, § 1.