Lizama v. Allstate Fire & Cas. Ins. Co.

425 P.3d 464, 292 Or. App. 611
CourtCourt of Appeals of Oregon
DecidedJuly 5, 2018
DocketA162760
StatusPublished

This text of 425 P.3d 464 (Lizama v. Allstate Fire & Cas. Ins. Co.) 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
Lizama v. Allstate Fire & Cas. Ins. Co., 425 P.3d 464, 292 Or. App. 611 (Or. Ct. App. 2018).

Opinion

DeVORE, J.

*612This appeal involves a dispute over attorney fees in an action on an automobile insurance policy. Plaintiff sued defendant for personal injury protection (PIP) and uninsured motorist (UM) benefits under his automobile insurance policy with defendant after he was involved in a motor vehicle accident with an uninsured driver. The only issues remaining in the case after court-annexed arbitration and a subsequent settlement between the parties as to damages concerned plaintiff's claims for attorney fees under ORS 742.061.1 The trial court granted summary judgment to defendant on those claims and dismissed the case.

On appeal, plaintiff challenges the trial court's rulings that (1) plaintiff was not entitled under ORS 742.061(2) to attorney fees on his PIP claim because of an agreement between defendant and plaintiff's treating medical provider, Accident Care Specialists (ACS), in which ACS reportedly agreed to waive plaintiff's medical bills with respect to any potential PIP claim; and (2) plaintiff was not entitled under ORS 742.061(3) to attorney fees on his UM claim because defendant's "safe harbor" letter was *613sufficient to exempt it from payment of fees. We agree with plaintiff that the court erred in both respects. Accordingly, we reverse and remand.

I. FACTS

The pertinent historical and procedural facts are undisputed. Plaintiff was injured in a motor vehicle accident with an uninsured driver on June 20, 2014. At the time of the accident, plaintiff was insured by defendant under an Oregon automobile policy that provided statutorily required PIP and UM coverage. On July 2, 2014, after receiving notice of the accident, defendant sent plaintiff's counsel a letter stating that it had "accepted coverage" for plaintiff's UM claim, that it would "now focus [its] efforts on liability issues and damages related to this claim," and instructing plaintiff of the steps he needed to take to submit a claim. The letter also included the following paragraph:

"Once we have sufficient information that supports your client's claim, we will make every attempt to reach a fair agreement on the amount of Uninsured or Underinsured Motorist benefits due under the policy. If *466for some reason we are not able to reach an agreement on the amount due, your client may request that [defendant] submit the claim to a third-party arbitrator who can determine the amount of benefits to which your client is entitled. Keep in mind that the arbitrator's decision is final and cannot be disputed or appealed."

(Emphasis added.)

Plaintiff sought medical treatment for his injuries at ACS and incurred medical expenses totaling $6,530.65. Defendant did not pay those expenses. On September 23, 2014, defendant sent a letter to plaintiff's counsel, acknowledging plaintiff's treatment at ACS and stating, in part:

"You are advised that [defendant] and [ACS] (including its owner, Alexis Lee) have reached an agreement that will resolve any potential PIP claim associated with bills issued to your client by [ACS] associated with your client's care related to this motor vehicle accident. [ACS] maintains that any and all treatment that has or will be performed will be reasonable, necessary, and proper. However, [ACS]
*614will not submit these bills for payment by [defendant] as part of any PIP claim. Moreover, [ACS] will take no collection action against your client for payment of bills associated with this claim."

Plaintiff subsequently filed an action against defendant in circuit court; in his amended complaint, he alleged a claim for PIP benefits in the amount of $6,530.65 for the medical expenses he incurred with ACS, and a claim for UM benefits, which included the same medical expenses, as well as noneconomic damages not to exceed $10,000, and lost wages in the amount of $3,284.40. He also sought attorney fees pursuant to ORS 742.061. The court ordered the case transferred to arbitration, where plaintiff recovered damages, as well as costs and attorney fees.2 Defendant appealed the arbitration award, seeking trial de novo on all issues of law and fact. The parties subsequently reached a settlement agreement as to damages, leaving the attorney fee issues to be resolved by the trial court.

Defendant then filed a motion for summary judgment on the question of plaintiff's entitlement to attorney fees as to both his PIP and UM claims.3 With respect to PIP, defendant argued that, because plaintiff's PIP claim only included medical bills from ACS and, pursuant to an agreement between ACS and defendant, those medical bills "were completely waived with respect to any PIP claim," plaintiff's PIP claim did not provide a basis for attorney fees under ORS 742.061(2). In support of that argument, defendant included as exhibits its September 23, 2014, letter described above and a declaration from Lee, ACS's owner. Lee's declaration stated, in part:

"For purposes of any potential PIP claim associated with this loss, the medical bills for the treatment rendered by ACS for [plaintiff] is being waived for reasons unrelated to the subject litigation. Although bills will be issued and provided to Plaintiff for services, ACS is electing as its sole *615and exclusive remedy to recover amounts from the tortfeasor and/or his/her insurance carrier."

As to attorney fees associated with plaintiff's UM claim, defendant argued that, although that claim remained viable (because ACS had waived its medical bills only for purposes of a PIP claim), plaintiff was not entitled to fees because defendant timely provided plaintiff with a "safe harbor" letter-referring to its July 2, 2014, letter to plaintiff's counsel-which, under ORS 742.061(3), precludes an award of fees.

Plaintiff responded that his PIP claim "exists as a matter of law" regardless of the agreement between defendant and ACS because his "right to PIP benefits is contractual and statutory, and cannot be undone by a third party agreement." Plaintiff submitted evidence that ACS had presented all of its *467bills for plaintiff's medical treatment to defendant's PIP adjuster for payment, and that, according to plaintiff, established his PIP claim. In addition, plaintiff argued that, in fact, his medical bills were not waived, and, as proof, he attached Lee's deposition testimony.

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Bluebook (online)
425 P.3d 464, 292 Or. App. 611, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lizama-v-allstate-fire-cas-ins-co-orctapp-2018.