Miller v. American Family Mutual Insurance

330 P.3d 631, 262 Or. App. 730, 2014 Ore. App. LEXIS 642
CourtCourt of Appeals of Oregon
DecidedMay 14, 2014
Docket101014862; A150186
StatusPublished
Cited by3 cases

This text of 330 P.3d 631 (Miller v. American Family Mutual Insurance) 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
Miller v. American Family Mutual Insurance, 330 P.3d 631, 262 Or. App. 730, 2014 Ore. App. LEXIS 642 (Or. Ct. App. 2014).

Opinion

NAKAMOTO, J.

In this breach of insurance contract case, defendant American Family Mutual Insurance Company appeals a general judgment and money award in plaintiffs favor on his claims for personal injury protection (PIP) benefits and uninsured motorist (UIM) benefits. Pursuant to ORCP 54 E, defendant served plaintiff with an offer of judgment on the PIP claim before trial, which plaintiff accepted. On appeal, defendant raises two assignments of error. It first contends that the trial court erred by ruling that defendant’s offer of judgment, once accepted, necessarily included an admission of, and precluded defendant from contesting, its obligation to pay for plaintiffs surgery — the key issue that then remained for trial on the UIM claim. Defendant also contests the trial court’s award of attorney fees to plaintiff. We reverse and remand.

Plaintiff was involved in an automobile accident with an uninsured driver and initiated this suit against defendant, his automobile insurer, to recover PIP and UIM benefits under his insurance policy. Plaintiffs policy provided for a $15,000 limit on PIP benefits and a $50,000 limit on UIM benefits. Plaintiff alleged over $90,000 in medical expenses, approximately $80,000 of which was attributable to a spinal surgery that plaintiff had undergone several months after the accident. Defendant had paid some of plaintiffs nonsurgical medical expenses related to the accident ($6,960.11) under plaintiffs PIP coverage, but defendant refused to pay any of plaintiffs surgery-related expenses because defendant contested the necessity of the surgery. In his complaint, plaintiff sought a judgment for the balance of the PIP policy limit and the $50,000 UIM policy limit, as well as his costs and reasonable attorney fees.

Approximately one month before the 2011 trial date, defendant served plaintiff with an offer of judgment pursuant to ORCP 54 E.1 Under ORCP 54 E(l), “any party against whom a claim is asserted may *** serve upon any other party asserting the claim an offer to allow judgment to be [733]*733entered against the party making the offer for the sum, or the property, or to the effect therein specified.” If the party asserting the claim accepts the offer, “judgment shall be given accordingly as a stipulated judgment.” ORCP 54 E(2).

Defendant offered to allow judgment on plaintiffs PIP claim for what amounted to the balance of plaintiffs PIP policy limits. That offer of judgment provided:

“Pursuant to ORCP 54 E, defendant offers to allow limited judgment on plaintiffs claim for PIP benefits in the amount of $8,039.89. This offer does not apply to plaintiffs claim for Uninsured Motorist benefits and should plaintiff accept this Offer to Allow Judgment, the Uninsured Motorist benefits claim will remain at issue. If this Offer to Allow [J]udgment is not accepted and filed within the time and manner allowed under ORCP [54 E], it shall be deemed automatically withdrawn.”

Plaintiff timely accepted defendant’s offer of judgment on the PIP benefits claim. No limited judgment was entered.

Then, on the day before trial, plaintiff filed a trial memorandom containing a motion in limine seeking an order to prevent defendant from offering evidence at trial that plaintiffs surgery was not necessary, the key disputed issue remaining for trial on the UIM claim.2 The trial court held a hearing on the motion that same day.

At the hearing, plaintiff argued that, by offering to allow judgment with regard to at least some of the surgery expenses, defendant had admitted that the surgery was necessary and could not contest that issue in the trial on plaintiffs UIM claim. Plaintiffs argument was based on the fact that only approximately $10,000 of his medical expenses were unrelated to the surgery, meaning that, when defendant offered to pay the balance of the $15,000 PIP policy, some portion of the surgery expenses was necessarily included within that payment. According to plaintiff, his acceptance of the offer of judgment effectively meant that a judgment had been entered against defendant on plaintiffs PIP claim, and, as a result, it had the same effect as any [734]*734other judgment, i.e., it resolved issues that were necessarily concluded by that judgment, including the issue of whether the surgery was necessary. Accordingly, plaintiff argued, defendant was precluded from contesting the necessity of the surgery. Plaintiff explained his position:

“Well, you can’t have it both ways. You can’t pay for surgical bills that are being reasonably and necessarily incurred and then say that surgery wasn’t reasonable or necessary, and that’s the conundrum that defendant’s offer of judgment places defendant in.
“One of the reasons we accepted the limited offer of judgment was just so that it would have that effect. We are entitled to that effect. The statute says so, and the rules on judgment [s] are that the findings that are necessarily— necessarily make up the judgment are conclusively determined. That’s one of them.”

The trial court reserved its ruling to allow defendant to file a brief concerning the preclusive effect of the accepted offer of judgment on the UIM claim. In its brief, defendant argued, among other things, that the terms of the offer were restricted to the PIP claim and that issue preclusion did not apply because the offer of judgment had not been made in a different action and the issue had not actually been litigated, which are both requirements for issue preclusion.

The next day, the trial court reconvened and summarized the issue before it as: “whether * * * the acceptance of [the] offer to allow judgment [] under the terms that are * * * set forth there in that offer have issue preclusion effect on the defendant and the defendant’s ability to contest the * * * necessity of the surgery.” After hearing further argument, the court granted plaintiffs motion, ruling that issue preclusion barred defendant from further contesting the necessity of surgery:

“[T]he ruling is that there is issue preclusion that operates here, and, you know, it’s a — obviously a fact specific inquiry here in this particular case * * * as there always is when we get to issues of issue preclusion, and that we * * * can have issue preclusion within a case here when we have a situation where we’ve got the offer to allow judgment, that given the amounts that we’ve got here, necessarily includes amounts [735]*735for the surgery that’s at issue here, and so that would mean that once that offer of judgment’s accepted, then the defense is precluded from then arguing the necessity.
«ífí * * * *
“So *** to be clear *** what the Court’s ruling is[,] *** it’s issue preclusion as to the necessity of the surgery because of the amounts that we’ve got here involved, * * * the idea being that once that offer of judgment is * * * accepted, it apparently involves a determination that the surgery was necessary, at least to the extent of the amount set forth in the * * * offer of judgment.”

Defendant then confirmed that it did not intend to contest the reasonableness of plaintiffs medical expenses, and, because those expenses exceeded plaintiffs UIM policy limit, the parties agreed that there were no issues left to try.

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Cite This Page — Counsel Stack

Bluebook (online)
330 P.3d 631, 262 Or. App. 730, 2014 Ore. App. LEXIS 642, Counsel Stack Legal Research, https://law.counselstack.com/opinion/miller-v-american-family-mutual-insurance-orctapp-2014.