Kiefer v. General Casualty Co. of Wisconsin

381 N.W.2d 205, 1986 N.D. LEXIS 258
CourtNorth Dakota Supreme Court
DecidedJanuary 30, 1986
DocketCiv. 11038
StatusPublished
Cited by5 cases

This text of 381 N.W.2d 205 (Kiefer v. General Casualty Co. of Wisconsin) is published on Counsel Stack Legal Research, covering North Dakota Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Kiefer v. General Casualty Co. of Wisconsin, 381 N.W.2d 205, 1986 N.D. LEXIS 258 (N.D. 1986).

Opinion

MESCHKE, Justice.

We hold that no-fault auto insurance is not required to duplicate payment of medical expenses where they have been separately paid by health insurance “coordinated” with the no-fault policy. Accordingly, we reverse the trial court’s decision requiring duplication of payment.

On July 16, 1983, Robert Kiefer, while he was a passenger in an uninsured vehicle, was seriously injured in a single car accident. He was unable to work until May 21, 1984, and had substantial medical and hospital bills. Kiefer claimed benefits under his own automobile insurance policy issued by General Casualty Insurance Company of Wisconsin, which included North Dakota no-fault personal injury protection benefits, as well as uninsured motorist coverage.

Kiefer collected the $25,000 uninsured motorist benefit from General Casualty. General Casualty paid $6,600 to Kiefer for weekly wage loss benefits under its no-fault coverage and paid the first $5,000 of Kiefer’s medical expenses as required by Blue Cross-Blue Shield, Kiefer’s health insurer, pursuant to the coordination of benefits provision of the North Dakota Auto Accident Reparations Act, § 26-41-10(3), N.D.C.C. 1 It also paid $405.53 of medical expense items and deductibles which were not covered by Blue Cross-Blue Shield. Thus, General Casualty paid $12,005.53 of no-fault benefits to Kiefer. Kiefer’s remaining medical expenses (which totaled over $27,000) were paid by Blue Cross-Blue Shield.

Relying on the fact that his medical expenses exceeded his no-fault limits of $15,-000, Kiefer demanded payment of the $2,994.47 balance of his no-fault limits. General Casualty declined to pay because Kiefer had “not incurred appropriate economic loss” where Blue Cross-Blue Shield had paid. This lawsuit followed.

The trial court held that a no-fault insurer must pay its insured for economic losses even if they have been paid by separate insurance benefitting the insured. The trial court felt that the Blue Cross-Blue Shield requirement that the no-fault insurer pay the first $5,000 of medical expenses was the only coordination of benefits allowed between those separate policies of insurance under § 26-41-10(3) of the North Dakota Auto Accident Reparations Act:

“ ‘3. An insurer, health maintenance organization, or nonprofit service corporation, other than a basic no-fault insurer, authorized to do business in this state may coordinate any benefits it is obligated to pay for economic loss incurred as a result of accidental bodily injury, with the first five thousand dollars of basic no-fault benefits. An insurer, health maintenance organization, or nonprofit service corporation may not coordinate benefits unless it provides those persons who purchase benefits from it with an equitable reduction or savings in the direct or indirect cost of purchased benefits. A coordination of benefits plan shall be approved by the commissioner of insurance.’ ” (Emphasis by the trial court).

Emphasizing expressions of this Court in St. Alexius Hospital v. Eckert, 284 N.W.2d 441 (N.D.1979), General Casualty argues against allowing “double recovery or duplication of benefits.” It points out that no-fault insurance is designed to protect against “economic loss because of accidental bodily injury arising out of the operation of a motor vehicle,” (our emphasis) § 26-41-10(1), N.D.C.C., and argues that there is no “economic loss” to the extent that another insurer pays medical ex *207 penses. General Casualty stresses that its policy contains a provision on “non-duplication of benefits”:

“No eligible injured person shall recover duplicate benefits for the same elements of loss under this or any similar insurance, including approved plans of self-insurance.”

Kiefer argues that his medical expenses were far in excess of his no-fault coverage so that he is entitled to payment of the remaining no-fault coverage, without regard to payments by his health insurer. He urges that the “collateral source” rule applies, precluding General Casualty from benefitting from another insurance policy, separately obtained by the insured. Kiefer claims that the North Dakota Auto Accident Reparations Act permits reduction of no-fault benefits only for benefits received from workmen’s compensation, § 26-41-10(1), N.D.C.C., and excludes “a basic no-fault insurer” from the provision allowing limited coordination of benefits between insurers. § 26-41-10(8), N.D.C.C. Kiefer relies upon the holding of Wallace v. TriState Insurance Company, 302 N.W.2d 337 (Minn.1980).

In Wallace, the Minnesota Supreme Court considered a comparable situation where medical expenses, which exceeded no-fault benefits, were nearly all paid under a health policy for the insured. The Minnesota Supreme Court held that the no-fault insurer could not “defer its payment of benefits because of the existence of health insurance covering the same losses,” 302 N.W.2d at 339, because it was not allowed by Minnesota’s no-fault insurance act. Further, considering a section similar to subsection 3 of § 26-41-10 of our Act, the Minnesota Supreme Court reasoned that a no-fault insurer “has no right to coordinate its benefits” with a health insurer.

The Minnesota “coordination of benefits” subsection authorized coordination of benefits only by insurers “other than a reparation obligor” (no-fault insurer). Our North Dakota subsection similarly authorizes coordination of benefits only by insurers “other than a basic no-fault insurer.” The statutory similarity suggests similarity in statutory construction leading to a result like Wallace in our state.

However, in Wallace, the Minnesota Supreme Court recognized that the health insurer had not coordinated its benefits with the no-fault insurer, although statutorily permitted to do so. Here, Kiefer’s health insurer did require coordination of benefits as authorized by statute and General Casualty did pay the first $5,000 of Kiefer’s medical expenses as required by that coordination. The differences, in the actual coordination implemented in this case and in the extent of coordination of benefits authorized by our statute, certainly create a different setting for statutory construction than in Wallace. 2 Thus, Wallace is not persuasive precedent for determining how to “coordinate any benefits ... for economic loss incurred as a result of accidental bodily injuries” under our statute. Rather, it appears to us that the corollary of having paid what is required by the statutorily permitted coordination is that General Casualty should not have to also pay what the coordinating insurer cannot require it to pay.

Kiefer’s reliance on the “collateral source” doctrine is misplaced. The “collateral source” rule has been shaped to avoid advantage to wrongdoers from insurance policies and other resources of those they injure. 3 See Keller v. Gama, 378 N.W.2d *208 867 (N.D.1985).

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Bluebook (online)
381 N.W.2d 205, 1986 N.D. LEXIS 258, Counsel Stack Legal Research, https://law.counselstack.com/opinion/kiefer-v-general-casualty-co-of-wisconsin-nd-1986.