Harwood v. Group Health Northwest

970 P.2d 760, 93 Wash. App. 569
CourtCourt of Appeals of Washington
DecidedJanuary 12, 1999
DocketNo. 16945-6-III
StatusPublished

This text of 970 P.2d 760 (Harwood v. Group Health Northwest) is published on Counsel Stack Legal Research, covering Court of Appeals of Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Harwood v. Group Health Northwest, 970 P.2d 760, 93 Wash. App. 569 (Wash. Ct. App. 1999).

Opinions

Kurtz, A.C.J.

After Avis Harwood was injured in an automobile accident, her insurer, Group Health Northwest, paid for her medical treatment. Ms. Harwood was represented by an attorney who obtained a recovery from the at-fault driver’s insurer. Group Health claimed a subrogation interest in the recovery pursuant to its insurance contract with Ms. Harwood, but refused to pay a pro rata share of her attorney fees. The court granted summary judgment to Group Health. Ms. Harwood appeals contending the court erred in holding that the terms of the insurance contract required her to present evidence that her counsel provided legal services that benefited Group Health before Group Health was obligated to pay a share of the legal expenses.

The Group Health insurance policy obligates the insurer to pay “an equitable apportionment” of legal expenses when “reasonable legal fees” have been incurred to recover [571]*571the insured’s medical expenses. The trial court interpreted this language to mean that the work of the attorneys must benefit Group Health before the insurer was obligated to share the cost of the legal work. We disagree with this interpretation of the contract, reverse the summary judgment and remand the matter to the trial court.

FACTS

On November 26, 1994, Avis Harwood was injured in an automobile accident. Group Health paid medical expenses in the amount of $8,788.90 on behalf of Ms. Harwood for the injuries she sustained in this collision. Ms. Harwood’s attorneys represented her in a claim against the third party driver who was insured by North Pacific Insurance Company. Group Health claimed a subrogation interest for the medical expenses it paid pursuant to the terms of its medical coverage agreement with Ms. Harwood which states as follows:

SECTION VI. SUBROGATION

“Injured person” under this section means an Enrollee covered by this Agreement who sustains compensable injury. “GHNWs medical expense” means the expense incurred by GHNW for the care or treatment of the injury sustained, computed in accordance with prevailing rates.
If the injured person was injured by an act or omission of a third party giving rise to a claim of legal liability against the third party, GHNW shall have the right, and is required under Medicare regulations, to recover its cost of providing Benefits to the injured person (right of subrogation) from the third party. GHNW shall be subrogated to and may enforce all rights of the injured person to the extent of its medical expense. Full compensation shall be measured on an objective, case-by-case basis, but is subject to a presumption that a settlement which does not exhaust the third party’s reachable assets is full compensation to the injured person.
The injured person, or the injured person’s representative, must cooperate fully with GHNW in effecting collection from [572]*572persons causing the injury. All sums collected from the third party for such injury, whether by legal action or settlement, shall be deemed to include GHNW’s medical expense, whether or not paid specifically for medical expense or with or without admission of liability for the injury. If settlement is made or judgment satisfied without provision for payment to GHNW of such amount, the Enrollee shall be liable to GHNW therefore only up to the amount of the settlement including legal fees and beneficiary coinsurance cost. The Enrollee agrees to furnish any further assignment which, in the judgment of GHNW, may be necessary to enforce such subrogation or to protect the rights of GHNW hereunder. These provisions are applicable for periods of coverage even if the Enrollee subsequently terminates enrollment.
When reasonable legal fees have been incurred to recover GH-NW’s medical expense, whether incurred in an action for damages or otherwise, and where there is recovery in GHNW’s behalf, there shall be an equitable apportionment of such legal expenses. This provision does not apply to occupationally incurred diseases, sickness and/or injury.

(Emphasis added.)

Group Health notified Ms. Harwood’s attorneys that Group Health did not retain their services and that it would pursue recovery on its own for the accident-related medical expenses paid by Group Health. At that time, Group Health created its own claim file and pursued recovery of its subrogated interest with North Pacific by notifying North Pacific of its subrogation claim.

Ms. Harwood’s attorneys negotiated directly with North Pacific Insurance to settle her personal injury claim. Ms. Harwood’s attorneys ordered her medical records from her health care providers, including Group Health. All of these health care providers, including Group Health, charged Ms. Harwood for copies of her medical records. Group Health did not share in any of these expenses. North Pacific Insurance requested, among other information, that Ms. Harwood’s attorneys provide her medical records from a previous automobile accident which occurred in May 1994, in order to distinguish the injuries sustained in the November 1994 automobile collision.

[573]*573Ms. Harwood settled her claim against North Pacific Insurance Company for $30,000. This settlement included the $8,788.90 paid by Group Health for medical expenses. Group Health refused to waive any portion of its subrogation claim despite having done so under the same policy after Ms. Harwood’s May 1994 automobile accident. As a result, Ms. Harwood’s attorneys held the disputed funds in their trust account pending the resolution of the dispute.

Group Health filed a lawsuit against Ms. Harwood’s attorneys in Spokane County District Court for conversion. Ms. Harwood was not named as a party in the lawsuit filed in district court. Ms. Harwood placed the entire $8,788.90 in the superior court registry. Ms. Harwood then filed a complaint for damages against Group Health for bad faith, breach of contract, and violation of the Consumer Protection Act.

Group Health subsequently moved for summary judgment. Group Health argued that its agreement paralleled the common law “benefit” test, such that in order for the agreement to apply, and for it to reduce its subrogation interest, Ms. Harwood must first show that: (1) The actions of her attorneys were necessary in recovering the subrogation; (2) The actions of Ms. Harwood’s attorneys in recovering the subrogation benefited Group Health; and (3) Liability, causation, and damages were disputed by the third-party carrier before the agreement applied to apportion any disputed funds. The trial court granted Group Health’s motion for summary judgment. The trial court held that Group Health’s interpretation of the agreement was correct, that Ms. Harwood had not shown that her attorneys’ actions benefited Group Health, and that Group Health was entitled to all of the claimed subrogation as a matter of law. Thereafter, the trial court denied Ms. Harwood’s motion for reconsideration.

Ms. Harwood appeals.

ANALYSIS

When reviewing an order of summary judgment, an [574]*574appellate court engages in the same inquiry as the trial court. In re Estates of Hibbard, 118 Wn.2d 737, 744, 826 P.2d 690 (1992).

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Bluebook (online)
970 P.2d 760, 93 Wash. App. 569, Counsel Stack Legal Research, https://law.counselstack.com/opinion/harwood-v-group-health-northwest-washctapp-1999.