Spearman v. Progressive Classic Insurance

366 P.3d 839, 276 Or. App. 114, 2016 Ore. App. LEXIS 86
CourtCourt of Appeals of Oregon
DecidedJanuary 27, 2016
Docket130201718; A155674
StatusPublished
Cited by7 cases

This text of 366 P.3d 839 (Spearman v. Progressive Classic 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
Spearman v. Progressive Classic Insurance, 366 P.3d 839, 276 Or. App. 114, 2016 Ore. App. LEXIS 86 (Or. Ct. App. 2016).

Opinions

FLYNN, J.

This appeal arises from plaintiffs action alleging that his motor vehicle insurance carrier breached its contract to pay uninsured motorist benefits. After prevailing in that action, plaintiff petitioned for an award of attorney fees under ORS 742.061(1), a statute that, in general, requires insurance companies to pay an attorney fee to an insured who prevails in an action to recover insurance benefits. The trial court denied plaintiffs fee petition after concluding that defendant’s response to the insurance claim brought defendant within the scope of ORS 742.061(3), a so-called “safe harbor” from the obligation to pay fees. The “safe harbor” applies in actions to recover uninsured/underinsured motorist (UM/UIM) benefits if “the only issues are the liability of the insured or underinsured motorist and the damages due the insured.” ORS 742.061(3).

On appeal, plaintiff argues that defendant raised issues beyond the scope of ORS 742.061(3) by suggesting that plaintiff had no “unreimbursed accident-related medical expenses,” i.e., that plaintiff could recover zero dollars in his UM action. We conclude from the statutory text and context that the issues that are within the scope of ORS 742.061(3) are the issues of liability and damages that an insured would have to establish in an action against the uninsured or underinsured motorist. To the extent that our decision in Cardenas v. Farmers Ins. Co., 230 Or App 403, 215 P3d 919 (2009), suggests “damages due” is a reference to the benefit due the insured from the insurer, we disavow that suggestion. Defendant’s pleadings — which admitted that plaintiff sustained some injury in the collision— disputed only the amount of damages plaintiff sustained, as permitted by ORS 742.061(3). Accordingly, we affirm.

I. BACKGROUND

The facts pertinent to this appeal are few and undisputed. Plaintiff was injured in a collision with an uninsured motorist and submitted a claim for UM benefits to defendant, which had sold him a policy of motor vehicle insurance. When the parties were unable to resolve the UM claim, plaintiff filed the present action on the policy. Plaintiffs complaint sought recovery for only “unreimbursed accident-related [117]*117medical expenses” — those expenses for which plaintiff had not already been reimbursed under other coverage. In its answer, defendant admitted that plaintiff sustained “some” injury in the collision with the uninsured motorist but disputed “the nature and extent of plaintiffs alleged injuries” and disputed “the reasonableness and necessity of some of plaintiffs accident-related medical expenses.”

Because the amount in dispute in plaintiffs action was less than $50,000.00, the trial court transferred the action to its arbitration program, ORS 36.400(3), and the arbitrator found plaintiff entitled to $6,022.80 under the UM policy. The arbitrator denied plaintiffs petition for attorney fees, however, and the trial court upheld that determination. That is the ruling to which plaintiff assigns error on appeal.

II. ANALYSIS

Plaintiff argues that, because his complaint sought only his “unreimbursed accident-related medical expenses,” defendant’s dispute regarding “the reasonableness and necessity of some of [p]laintiffs accident-related medical expenses” permitted defendant to assert that plaintiff had been fully compensated for his injuries. According to plaintiff, that position “would permit the finder of fact to determine that [p]laintiff was not entitled to any award” in the UM action and, thus, raises an issue beyond those permitted by ORS 742.061(3).

A. Pertinent Statutory Text, in General

Before examining the parties’ dispute in detail, we review the pertinent statutes. ORS 742.061(1) provides that, in an action upon an insurance policy, the insured is entitled to recover an award of reasonable attorney fees

“if a settlement [of an insurance claim] is not made within six months from the date proof of loss is filed with an insurer * * * and the plaintiff's recovery exceeds the amount of any tender made by the defendant in such action * * * 1

[118]*118As the Supreme Court has explained, that provision “applies to actions brought on insurance policies of any kind” and serves the “purpose of encouraging settlement of insurance claims without litigation.” Strawn v. Farmers Ins. Co., 353 Or 210, 221 n 8, 297 P3d 439 (2013). That general right to recover fees from recalcitrant insurers has been available to Oregon insureds — in essentially the same form as ORS 742.061(1) — since 1919. See Morgan v. Amex Assurance Company, 352 Or 363, 368, 287 P3d 1038 (2012) (discussing statutory history (citing Or Laws 1919, ch 110, § 1)).

The 1999 legislature, however, created the exception set out in ORS 742.061(3), as well as a parallel exception for actions to recover personal injury protection (PIP) benefits, which is set out in ORS 742.061(2). Or Laws 1999, ch 790, § 1. Those exceptions provide:

“(2) Subsection (1) of this section does not apply to actions to recover personal injury protection benefits if, in writing, not later than six months from the date proof of loss is filed with the insurer:
“(a) The insurer has accepted coverage and the only issue is the amount of benefits due the insured; and
“(b) The insurer has consented to submit the case to binding arbitration.
“(3) Subsection (1) of this section does not apply to actions to recover uninsured or underinsured motorist benefits if, in writing, not later than six months from the date proof of loss is filed with the insurer:
“(a) The insurer has accepted coverage and the only issues are the liability of the uninsured or underinsured motorist and the damages due the insured; and
“(b) The insurer has consented to submit the case to binding arbitration.”

ORS 742.061.

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Cite This Page — Counsel Stack

Bluebook (online)
366 P.3d 839, 276 Or. App. 114, 2016 Ore. App. LEXIS 86, Counsel Stack Legal Research, https://law.counselstack.com/opinion/spearman-v-progressive-classic-insurance-orctapp-2016.