Shirley M. Tucker, Cross-Appellant v. Aetna Casualty & Surety Company, Cross-Appellee

801 F.2d 728, 1986 U.S. App. LEXIS 31464
CourtCourt of Appeals for the Fifth Circuit
DecidedOctober 1, 1986
Docket85-4453
StatusPublished
Cited by8 cases

This text of 801 F.2d 728 (Shirley M. Tucker, Cross-Appellant v. Aetna Casualty & Surety Company, Cross-Appellee) is published on Counsel Stack Legal Research, covering Court of Appeals for the Fifth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Shirley M. Tucker, Cross-Appellant v. Aetna Casualty & Surety Company, Cross-Appellee, 801 F.2d 728, 1986 U.S. App. LEXIS 31464 (5th Cir. 1986).

Opinion

W. EUGENE DAVIS, Circuit Judge:

This case turns on the interpretation of a clause in an automobile insurance policy. The district court held that the clause in dispute reduced the uninsured motorist limit below that which Mississippi law requires, 609 F.Supp. 1574. We disagree with this interpretation of the policy and modify the compensatory damage award and reverse the award of punitive damages.

I.

Shirley M. Tucker suffered injuries on January 8, 1983, in an automobile accident caused solely by an uninsured motorist. On that date, Mrs. Tucker was insured by Aetna Casualty & Surety Company (Aetna) through a policy that provided uninsured motorists (UM) coverage with a limit of $10,000 1 and medical payments (med-pay) coverage with a limit of $2,000. She submitted medical bills to Aetna, but Aetna refused to pay the bills until she signed its Auto-Rite Policy Medical Expense Agreement. Mrs. Tucker, on advice of her attorney, refused to sign the form agreement because it included a clause that counsel interpreted as reducing the limits of the uninsured motorists coverage below that established by Mississippi law. Aetna also refused payment of Mrs. Tucker’s medical bills because of her refusal to provide copies of medical reports and other necessary *730 medical information. Aetna considered this information necessary because of Mrs. Tucker’s complex medical picture: she not only suffered from a pre-existing illness, but was also injured in a later accident in February 1983.

Mrs. Tucker filed suit against Aetna seeking recovery under her uninsured motorist and medical payment coverages. She also sought punitive damages for Aetna’s alleged bad faith refusal to pay damages and for its attempt to reduce her uninsured motorists limit below the statutory minimum. The district court held that: 1) Aet-na was justified in refusing to pay Mrs. Tucker’s medical bills because Tucker failed to furnish the requisite medical information. This breach was not so egregious, however, to warrant denial of all recovery to Tucker under the policy. 2) Aetna was liable for punitive damages for retaining a clause in its policy that attempted to reduce UM coverage below the legal minimum. The district court awarded Mrs. Tucker $1,708.92 under the med-pay provision of the policy, $20,000 in UM benefits, and $43,417.84 in punitive damages.

Aetna contends in this appeal that: the policy language does not reduce the UM limite below the statutory minimum; Tucker should be denied coverage because of her failure to provide necessary medical information; and the district court erred in computing damages. Tucker cross-appeals contending that the amount of punitive damages are inadequate.

II.

A.

Mississippi law requires insurers to include UM coverage in their automobile liability policies with minimum limits of $10,-000 per person and $20,000 per occurrence. Miss.Code.Ann. §§ 83-11-101, 65-15-43 (Supp.1985). Any provision attempting to reduce coverage below those statutory limits is illegal. Talbot v. State Farm Mutual Automobile Insurance Co., 291 So.2d 699 (Miss.1974); Harthcock v. State Farm Mutual Automobile Insurance Co., 248 So.2d 456 (Miss.1971). Relying on Talbot and Harthcock, the district court agreed with Mrs. Tucker that the following provision in the uninsured motorists section of Aetna’s policy had the effect of reducing the UM limit below the statutory minimum in violation of Mississippi law:

III. Limits of Liability ...
(e) The company shall not be obligated to pay under this insurance that part of the damages which an insured may be entitled to recover from the owner or operator of an uninsured highway vehicle which represents expenses for medical services payable under the Medical Payment Coverage.

The district court interpreted the policy as requiring a reduction of the UM coverage by that amount recoverable under the med-pay provision. The court concluded that once the med-pay recovery was deducted from the UM limit, the available UM coverage was illegally reduced below the statutory minimum.

Aetna argues that paragraph (e) does not require the reduction of UM coverage below the statutory limits; rather it is designed to prevent the insurer from paying medical expenses under both the med-pay provision and the UM coverage. Talbot and Harthcock are readily distinguishable. In both cases, the insurer attempted to reduce the limits of its UM coverage. In Harthcock, the insured plaintiff suffered damages of $14,000. She attempted to recover the $5,000 limit of her UM coverage from her insurer, State Farm. Her policy with State Farm contained an “other insurance” clause which purported to reduce her UM coverage by that amount recovered from other insurance. Because the insured had collected $5,000 in insurance proceeds from another insurer, State Farm argued that it owed the insured nothing, even though only $5,000 of her total damages of $14,000 had been paid. The Mississippi Supreme Court held that the “other” insurance clause was unenforceable because it reduced the UM limit below the statutory minimum. 248 So.2d at 461-62. Similarly, the court in Talbot disallowed the insurer’s *731 attempt to reduce the $5,000 limit of its UM coverage by payments of $652.72 made under the med-pay coverage when the insured’s damages exceeded the $5,000 limit after the medical expenses were paid.

In this case Mrs. Tucker’s damages were assessed at $40,000 plus her medical expenses. Aetna concedes that its policy requires it to pay Mrs. Tucker’s medical bills plus the $20,000 limit on her UM coverage. Aetna’s interpretation of the disputed clause (e) therefore does not have the effect of reducing the $20,000 UM limit in Mrs. Tucker’s policies.

How this clause operates under Aetna’s interpretation can best be demonstrated by example. Assume Mrs. Tucker’s total medical expenses were $1,000. InaHdition, assume she suffered $15,000 in damages for her injury. Under this scenario, she could recover a total of $16,000: $1,000 under the med-pay provision and $15,000 under the UM coverage. Clause (e) would prevent a double recovery of medical expenses under both med-pay and UM.

We agree with Aetna’s interpretation of clause (e). The only effect of this clause is to allow Aetna to avoid paying the insured’s medical expenses twice: once under med-pay coverage and again under UM. The clause does not reduce the UM limit. As in Mrs. Tucker’s case the total UM limit is owed if the insured’s total damages, exclusive of the medical expenses paid under med-pay, exceeds the UM limit.

Tucker further argues that the Auto-Rite Medical Expense Agreement that Aetna tendered to her for signature attempted to reduce the policy’s UM coverage below the limits established by Mississippi law. The pertinent section of that agreement required that any payment of medical expenses

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Cite This Page — Counsel Stack

Bluebook (online)
801 F.2d 728, 1986 U.S. App. LEXIS 31464, Counsel Stack Legal Research, https://law.counselstack.com/opinion/shirley-m-tucker-cross-appellant-v-aetna-casualty-surety-company-ca5-1986.