Anderson v. Farmers Insurance

71 P.3d 144, 188 Or. App. 179, 2003 Ore. App. LEXIS 718
CourtCourt of Appeals of Oregon
DecidedJune 12, 2003
DocketCV98-08-38946; A112325
StatusPublished
Cited by1 cases

This text of 71 P.3d 144 (Anderson v. Farmers Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals of Oregon primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Anderson v. Farmers Insurance, 71 P.3d 144, 188 Or. App. 179, 2003 Ore. App. LEXIS 718 (Or. Ct. App. 2003).

Opinion

ARMSTRONG, J.

Defendant Farmers Insurance Company of Oregon (Farmers) appeals from a judgment for plaintiff, its insured, on plaintiffs claim for breach of contract arising out of Farmers’ failure to preauthorize payment of personal injury protection (PIP) benefits for the full cost of plaintiffs knee replacement surgery after an automobile accident. We affirm.

Most of the facts are not in dispute. Plaintiff was injured while driving his own automobile, which Farmers insured. At that time, plaintiff and his wife had three separate but identical policies insuring three different vehicles, each providing $25,000 in PIP coverage. The parties agree that the PIP policy insuring the car that plaintiff was driving at the time of the accident was the “primary” policy and that the policies covering the two other family vehicles were “excess” policies. ORS 742.526. Each PIP policy contained an “other insurance” clause prohibiting the “stacking”1 of coverage:

“If any applicable insurance other than this policy is issued to you or a family member by us or any other member company of the Farmers Insurance Group of Companies, the total amount payable among all such policies shall not exceed the limits provided by the single policy with the highest limits of liability.”

(Emphasis in original.) The parties agree that, by its terms, the clause restricts plaintiffs PIP benefits to the limits of the highest policy, in this case $25,000. As Farmers acknowledges, however, the clause is not enforceable “in full.” Because the policies are for equal amounts, the clause would have the effect of completely denying PIP coverage on the two excess policies, when Oregon law requires some coverage. ORS 742.520 and 742.524 require every motor vehicle insurance policy to provide $10,000 in PIP coverage for each [182]*182insured for “all reasonable and necessary expenses of medical, hospital, dental, surgical, ambulance and prosthetic services incurred within one year after the date of the person’s injury.” Thus, Farmers concedes that, despite the anti-stacking clause in its policies, it was required to provide the minimum statutory PIP coverage in each policy; it calculates the amount due plaintiff as $25,000 under the primary policy and $10,000 under each excess policy, for a total PIP benefit of $45,000. In plaintiffs view, he is entitled to the full limits of his PIP policies on each policy for a total of $75,000 in PIP benefits.

Plaintiffs damages, including the proposed surgery, were in excess of $65,000. Farmers paid $32,000 toward plaintiffs medical expenses and agreed to pay an additional $13,000, which would have covered half the cost of the surgery, for a total PIP benefit of $45,000. Because plaintiff could not afford to pay the remaining $13,000 for the surgery, he chose not to have it and canceled the surgery and a preoperative medical examination. He brought this action against Farmers seeking damages for Farmers’ failure to agree to pay the full cost of the surgery. The trial court concluded as a matter of law that plaintiff was entitled to the full PIP limits on each policy, to the extent of his damages. A jury found that Farmers had breached its contract with plaintiff by refusing to pay the full cost of the knee replacement surgery and awarded plaintiff $26,000 in economic damages and $200,000 in noneconomic damages. Farmers appeals from the judgment that the court entered on the jury verdict.

Farmers concedes that the challenged policy provision, if applied according to its terms, likely violates ORS 742.520. It asserts, nonetheless, that the anti-stacking provision can be applied with respect to policy limits in excess of the statutory minimum limits and, accordingly, that the trial court erred in denying its motion for summary judgment because, as a matter of law, plaintiffs PIP coverage under the three policies was only $45,000. In support of its position, Farmers looks to case law dealing with a similar issue in the context of motor vehicle liability insurance.

In Collins v. Farmers Ins., 312 Or 337, 822 P2d 1146 (1991), the plaintiff was an insured person under a motor [183]*183vehicle liability insurance policy with limits of $100,000 per person and $300,000 per occurrence. The policy contained an exclusion for bodily injury to insured persons. The insurer offered to settle the plaintiffs claim for $25,000, the minimum coverage required by the Financial Responsibility Law (FRL), and sought to enforce the exclusion for bodily injury to the insured as to coverage beyond the statutory minimum limits. The court agreed with the insurer that ORS 742.464 permits such a result. The statute provides:

“Any policy which grants the coverage required for a motor vehicle liability insurance policy under ORS 742.450, 806.080 and 806.270 may also grant any lawful coverage in excess of or in addition to the required coverage, and such excess or additional coverage shall not be subject to the provisions of ORS 742.031, 742.400 and 742.450 to 742.464. With respect to a policy which grants such excess or additional coverage only that part of the coverage which is required by ORS 806.080 and 806.270 is subject to the requirements of those sections.”

(Emphasis added.) The court explained the statute:

“The manifest purpose of ORS 742.464 is to permit an insurer to write any other lawful coverage that the insurer wishes to write, in addition to the required coverage. Such coverage may include higher limits than those required by ORS 742.450 and 806.080. But as to such higher limits, the mandatory requirements of ORS 742.450 and 806.080 do not apply. The insurer may limit such additional coverage by any exclusion not otherwise prohibited by law.
“To summarize, the law implies a provision in every motor vehicle liability insurance policy along these lines:
“THIS POLICY PROVIDES ALL THE COVERAGE REQUIRED BY OREGON LAW, INCLUDING ORS 742.450, 806.080, AND 806.270.
“Coverage other than that required by law may be limited by any lawful exclusion.”

312 Or at 342. The court held that the insurer could enforce the policy exclusion for bodily injury to its insureds with respect to limits in excess of $25,000. The court’s holding permits a motor vehicle liability insurer to enforce an exclusion [184]

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Padilla v. State Farm Mutual Automobile Ins. Co.
499 P.3d 100 (Court of Appeals of Oregon, 2021)

Cite This Page — Counsel Stack

Bluebook (online)
71 P.3d 144, 188 Or. App. 179, 2003 Ore. App. LEXIS 718, Counsel Stack Legal Research, https://law.counselstack.com/opinion/anderson-v-farmers-insurance-orctapp-2003.