Berrios v. State Farm Insurance

781 N.E.2d 149, 98 Ohio St. 3d 109
CourtOhio Supreme Court
DecidedDecember 20, 2002
DocketNo. 2001-1618
StatusPublished
Cited by13 cases

This text of 781 N.E.2d 149 (Berrios v. State Farm Insurance) is published on Counsel Stack Legal Research, covering Ohio Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Berrios v. State Farm Insurance, 781 N.E.2d 149, 98 Ohio St. 3d 109 (Ohio 2002).

Opinions

Pfeifer, J.

Factual Background

{¶ 1} Appellant, Master G. Berrios, was involved in an automobile accident on December 16, 1997. The driver of the other vehicle was at fault in the collision and was insured by Progressive Insurance Company (“Progressive”). Berrios suffered damages that included $6,354.37 in medical bills.

2} At the time of the accident, Berrios was insured under an automobile insurance policy with appellee, State Farm Insurance Company (“State Farm”), which provided $100,000 per person in underinsured motorist (“UIM”) coverage and $25,000 in medical payments coverage.

{¶ 3} Under the policy that covered Berrios, State Farm charged separate premiums for UIM coverage and medical payments coverage. The policy’s biannual premium included $26.80 for uninsured/underinsured motorist coverage and $41.65 for medical payments coverage.

{¶ 4} As to medical payments coverage, the policy reads:

{¶ 5} “We will pay reasonable medical expenses incurred, for bodily injury caused by accident, for services furnished within three years of the date of the accident. * * *

(¶ 6} “* * * We will pay medical expenses for bodily injury sustained by:

{¶ 7} “* * *

{¶ 8} “2. any other person while occupying:

{¶ 9} “a. a vehicle covered under the liability coverage * *

{¶ 10} In the policy, State Farm claims a right of subrogation over medical payments paid. The language reads:

{¶ 11} “3. Our Right to Recover Our Payments

{¶ 12} “* * *

{¶ 13} “b. Under medical payments coverage:

{¶ 14} “(1) we are subrogated to the extent of our payments to the right of recovery the injured person has against any party liable for the bodily injury.

{¶ 15} “* * *

{¶ 16} “(3) if the person to or for whom we make payment recovers from any party liable for the bodily injury, that person shall hold in trust for us the proceeds of the recovery, and reimburse us to the extent of our payment.”

{¶ 17} Before Berrios settled with Progressive, State Farm paid $6,354.37 for Berrios’s medical bills under the medical payments coverage.

{¶ 18} Progressive offered the entirety of the tortfeasor’s $12,500 coverage to settle the case. State Farm gave its consent for Berrios to accept Progressive’s $12,500 offer, thereby waiving its subrogation rights under the UIM coverage. [111]*111State Farm did not, however, waive its subrogation rights for its medical payments. State Farm asserted a right to be repaid its $6,354.37 payment from the $12,500 paid by Progressive.

{¶ 19} Berrios accepted Progressive’s limits of $12,500 with the understanding that he would challenge State Farm’s claim to reimbursement for the medical payments. Berrios and State Farm settled Berrios’s UIM claim for an additional $6,000, and they agreed that State Farm’s right to reimbursement of the amount of the medical payments, $6,354.37, would be determined in litigation.

{¶ 20} On April 9, 1999, Berrios filed a declaratory judgment action in the Franklin County Court of Common Pleas. On February 3, 2000, the parties stipulated facts, narrowing the controversy to the question of whether State Farm could enforce a right of subrogation for the medical payments from the proceeds of Berrios’s settlement with the tortfeasor, in light of the fact that State Farm had also paid Berrios UIM coverage benefits.

{¶ 21} Both parties submitted motions for summary judgment. On April 10, 2000, the trial court granted State Farm’s motion for summary judgment and denied that of Berrios. Berrios appealed, and the Tenth District Court of Appeals affirmed the trial court. The cause is before this court upon the allowance of a discretionary appeal.

Law and Analysis

{¶ 22} In Shearer v. Motorists Mut. Ins. Co. (1978), 53 Ohio St.2d 1, 7 O.O.3d 1, 371 N.E.2d 210, this court struck down an insurance policy provision that permitted an insurer to reduce the amount recoverable under uninsured motorist (“UM”) coverage by the amount the insurer paid under the medical payments portion of the policy. “A contract condition providing for a deduction for medical payments paid under another portion of the insurance contract is in derogation of the public policy and purpose underlying R.C. 3937.18.” Id. at syllabus.

{¶ 23} This court considered the contractual setoff as a whittling away of the uninsured motorist protection insurers were required to provide by statute:

{¶ 24} “ ‘Permitting offsets of any type would allow insurers, by contract, to alter the provisions of the statute and to escape all or part of the liability which the Legislature intended they should provide. The medical payment coverage part of the policy is independent of the uninsured motorist coverage and should be treated the same as if it were carried with a different company. * * *

{¶ 25} “ ‘* * * The fact that the motorist sees fit to clothe himself with other insurance protection and pays a premium therefor — such as medical payments— cannot alter the mandatory safeguards that the Legislature considers necessary for the well-being of the citizen drivers of our state.’ ” Shearer, 53 Ohio St.2d at [112]*1127-8, 7 O.O.3d 1, 371 N.E.2d 210, quoting Bacchus v. Farmers Ins. Group Exchange (1970), 106 Ariz. 280, 282-283, 475 P.2d 264.

{¶ 26} In addition to the public-policy reasoning behind Shearer was a more practical issue — that people who pay separate premiums for separate coverages should get what they pay for: “ ‘[A] policy provision which the insured considers to be additional protection and for which he pays a premium with such extra protection in mind cannot be transposed by the insurer into a reduction of the mandatory minimum coverage.’ ” Id.

{¶ 27} In Grange Mut. Cas. Co. v. Lindsey (1986), 22 Ohio St.3d 153, 22 OBR 228, 489 N.E.2d 281, this court considered whether a subrogation clause, rather than a setoff clause as in Shearer, could allow insurers to reduce UM coverage payments by the amount paid under medical payments coverage.

{¶ 28} In Lindsey, the insured was injured in an automobile collision caused by an uninsured motorist. The insurer paid the insured’s medical bills pursuant to his medical payment coverage. The insured’s UM claim went to arbitration. The arbitrator arrived at an award well within the policy limits. The insurer sought to reduce the amount of the arbitration award by the amount it had previously paid under the medical payments coverage. The insurer argued that its case was different from the insurer in Shearer because of the subrogation clause, which had been lacking in Shearer. This court, concerned less with terminology than with the practical effect of the subrogation clause, rejected that distinction:

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Cite This Page — Counsel Stack

Bluebook (online)
781 N.E.2d 149, 98 Ohio St. 3d 109, Counsel Stack Legal Research, https://law.counselstack.com/opinion/berrios-v-state-farm-insurance-ohio-2002.