Employers Health Insurance v. General Casualty Co. of Wisconsin

469 N.W.2d 172, 161 Wis. 2d 937, 1991 Wisc. LEXIS 305
CourtWisconsin Supreme Court
DecidedMay 13, 1991
Docket89-1021
StatusPublished
Cited by41 cases

This text of 469 N.W.2d 172 (Employers Health Insurance v. General Casualty Co. of Wisconsin) is published on Counsel Stack Legal Research, covering Wisconsin Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Employers Health Insurance v. General Casualty Co. of Wisconsin, 469 N.W.2d 172, 161 Wis. 2d 937, 1991 Wisc. LEXIS 305 (Wis. 1991).

Opinion

SHIRLEY S. ABRAHAMSON, J.

This is a review of a published decision of the court of appeals, Employers Health Ins. v. Gen. Cas. Co. of Wisconsin, 154 Wis. 2d 696, 454 N.W.2d 10 (Ct. App. 1990), reversing an order of the Milwaukee county circuit court, Judge Patricia D. McMahon. Employers Health Insurance brought an action to determine its right to subrogation under its medical insurance contract with Hugh J. Oldenberg, the insured. Employers Health sought reimbursement from General Casualty Company, which paid benefits to Hugh J. Oldenberg, its insured, under the uninsured motorist coverage provisions of its automobile liability policy.

The circuit court granted summary judgment to General Casualty Company of Wisconsin and dismissed the summary judgment motion of Employers Health. The court of appeals reversed the circuit court, holding that summary judgment should be granted in favor of Employers Health under the terms of the insurance policies and the Wisconsin uninsured motorist statute, sec. 632.32(4)(a), Stats. 1987-88. 1 We reverse the decision of *942 the court of appeals.

The issue presented in this case is whether Employers Health, a health insurer that paid medical benefits to its insured, may maintain an action for subrogation to recover these medical payments from General Casualty, the insured's automobile liability carrier that made payments to the insured for bodily injury (without specifying a particular sum for medical payments) under its uninsured motorist coverage. We conclude that Employers Health may not maintain the subrogation action under either the terms of its policy or the doctrine of equitable subrogation.

The facts are not in dispute. On October 23, 1985, the insured was seriously injured in an automobile accident involving an uninsured motorist, William J. Klein. There is no dispute that Klein negligently caused the injury. Both Employers Health and General Casualty paid benefits to the insured under the terms of their respective insurance policies.

Employers Health paid medical benefits to the insured under a group policy in the amount of $54,853.23 *943 for medical expenses incurred from injuries in the automobile accident. Under its contract with the insured, Employers Health was subrogated to the insured's "right to recover damages from a responsible third party." In September of 1987, Employers Health wrote General Casualty seeking subrogation of the insured's medical expenses.

During the fall of 1987, approximately two years after the accident, General Casualty settled its insured's claim under its uninsured motorist coverage by purchasing an annuity for him with a monthly payment of $2,700 for life. 2 General Casualty did not itemize its settlement, but General Casualty asserts in this action that its settlement covered all of the insured's claimed losses for bodily injury, including medical expenses.

Employers Health maintains that General Casualty has both a contractual and statutory obligation to pay the insured's medical expenses and that Employers Health's policy with the insured entitles it to subrogation against General Casualty.

The court of appeals held for Employers Health, basing its decision largely on its interpretation of the language of the two insurance policies. 3 It concluded that *944 Employers Health's policy expressly provides that it is subrogated to the insured's right to recover damages from a "responsible third party" and that it may recover benefits paid under the policy for which any other insurance provides medical pay coverage or medical expense coverage is available to the insured.

The court of appeals further concluded that the "plain meaning" of the General Casualty policy is that General Casualty would pay all losses, including medical expenses, the insured is legally entitled to recover from the owner or operator of an uninsured vehicle, unless there is "other similar insurance.'' 4 Because the health insurance provided by Employers Health was not, according to the court of appeals, "other similar insurance, '' General Casualty is responsible for the insured’s medical expenses.

After analyzing both Employers Health and General Casualty's insurance policies the court of appeals concluded that General Casualty is contractually bound to pay medical expenses and that Employers Health is entitled to reimbursement for medical payments it made on behalf of the insured. The court of appeals did not address Employers Health's claim for subrogation under equitable principles.

*945 Employers Health maintains that its insured's policy gives it the right to subrogation against General Casualty. The language in the policy on which Employers Health relies reads as follows:

"If, after payments have been made under the Policy, You or Your covered Dependent has a right to recover damages from a responsible third party, We shall be subrogated to Your rights to recover." (Emphasis added.) 5

The policy does not define the phrase "recover damages from a responsible third party." When no extrinsic evidence is introduced to interpret the wording of the insurance contract, this court determines the interpreta *946 tion as an issue of law, without deference to the circuit court or court of appeals. Swart v. Rural Mut Ins. Co., 117 Wis. 2d 478, 482, 344 N.W.2d 719 (Ct. App. 1984). The language of the policy should be given the common and ordinary meaning it would have in the mind of a lay person. Reserve Life Ins. Co. v. La Follette, 108 Wis. 2d 637, 645, 323 N.W.2d 173 (Ct. App. 1982). In interpreting the policy the court may consider the apparent object or purpose of the insurance, the subject matter of the insurance, the situation of the parties and the circumstances surrounding the making of the contract. Swart, 117 Wis. 2d at 482, citing Chemtec Midwest Services, Inc. v. Ins. Co. of No. Amer., 290 F. Supp. 106, 109 (W.D. Wis. 1968).

Employers Health argues that the phrase "responsible third party" means a financially, contractually or legally responsible third party and that General Casualty is an entity financially, contractually and legally responsible under its policy and the uninsured motorist law to pay damages to an injured insured.

General Casualty argues that the phrase "recover damages from a responsible third party" refers to recovery of damages from the wrongdoer causing the insured's injury or illness.

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469 N.W.2d 172, 161 Wis. 2d 937, 1991 Wisc. LEXIS 305, Counsel Stack Legal Research, https://law.counselstack.com/opinion/employers-health-insurance-v-general-casualty-co-of-wisconsin-wis-1991.