State Farm Mutual Automobile Insurance v. Ainsworth

402 S.E.2d 759, 198 Ga. App. 740, 102 Fulton County D. Rep. 25, 1991 Ga. App. LEXIS 253
CourtCourt of Appeals of Georgia
DecidedFebruary 12, 1991
DocketA90A2357
StatusPublished
Cited by9 cases

This text of 402 S.E.2d 759 (State Farm Mutual Automobile Insurance v. Ainsworth) is published on Counsel Stack Legal Research, covering Court of Appeals of Georgia primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State Farm Mutual Automobile Insurance v. Ainsworth, 402 S.E.2d 759, 198 Ga. App. 740, 102 Fulton County D. Rep. 25, 1991 Ga. App. LEXIS 253 (Ga. Ct. App. 1991).

Opinion

Birdsong, Presiding Judge.

Appellant State Farm Mutual Automobile Insurance Company (State Farm) appeals the order of the state court which granted appellee Ann L. Ainsworth’s (Ainsworth) motion for partial summary judgment, awarded appellee $25,000 lost wages, and denied State Farm’s motion for summary judgment on the basis that bad faith penalties and punitive damages are issues for jury resolution.

On July 8, 1988, appellee who was the permissive driver of a vehicle insured by State Farm was injured in a collision. The policy contained optional no-fault coverage; appellee was eligible for personal injury protection benefits of $25,000 and medical payment coverage of $5,000 thereunder.

On August 1, 1988, appellee’s brother submitted an application for benefits in appellee’s behalf upon a State Farm claims form. The application reflected, inter alia, appellant had suffered five broken ribs, three broken vertebrae, and three breaks of the pelvic bone, and on its face, it contained a claim for approximately $30,000 of continuing medical expenses, and a separate claim for $800 lost wages to date. Appellee had not returned to work as of the date of the application. Further, the application apparently did not have any type of medical bills or wage statements attached, and it contains no place thereon where an applicant could make any valid designation or election regarding the priority in which claims are to be paid.

On August 8, 1988, State Farm paid medical providers the amount of $7,620. The record does not clearly establish what medical bills if any were in State Farm’s possession on this date. As it was stipulated that only $5,000 of the existing policy coverage was allocated as medical payment coverage, at least $2,620 of the $7,620 amount apparently was paid from available personal injury protection benefits.

On August 12, 1988, State Farm sent its standard employer’s wage and salary verification form to appellee’s listed current employer. Apparently, on no occasion did State Farm advise either the alleged employer or the appellee that time was of the essence for any reason in responding to this inquiry.

On August 17,1988, State Farm received medical bills, pertaining to appellee, in an amount which exceeded the remaining policy benefits. (In addition to the injuries listed above, appellee apparently had suffered abdominal and intestinal injuries necessitating a colostomy.)

On September 7, 1988, more than 30 days after the receipt of the application for benefits but about 21 days from the stipulated date of receipt of medical bills, State Farm paid medical providers the re *741 maining no-fault benefits of $22,380, thereby exhausting all applicable coverage pertaining to the appellee.

Five days later, on September 12, 1988, State Farm received a relatively ambiguous response from appellee’s alleged current employer to their wage and salary verification inquiry.

On November 15, 1988 appellee’s attorney sent a letter to State Farm demanding $2,500 loss of earnings and that all optional no-fault coverage be paid in payment of loss of earnings, which were predicted to continue for at least 12 months or more. Held:

1. Appellant asserts that the state court erred in granting appellee’s motion for partial summary judgment. Resolution of this contention requires consideration of matters asserted in certain of appellant’s other enumerations of error.

(a) Appellant asserts, in its first enumeration of error, that the lower court erred in holding “an insured can await payment of medical expenses (to a hospital and physicians identified in the application for benefits) and then request payment of another category of covered losses after benefits have been exhausted.” Appellant does not cite a specific part of the record where such holding was affirmatively made, and it is not the function of this court to cull the record in search of error. Armech Svc. Co. v. Rose Elec. Co., 192 Ga. App. 829, 830 (386 SE2d 709). Moreover, the application for benefits, submitted in appellee’s behalf, on its face contained a request for payment of both medical expenses and lost wages, and this application was received by appellant before any benefits had been exhausted. Appellant’s assertion, as crafted in its first enumeration of error, is without merit.

(b) Appellant asserts in its second enumeration the state court erred in holding that the required “direction to pay” had not been provided by the appellee.

OCGA § 33-34-4 (a) (2) prescribes, inter alia, a minimum no-fault motor vehicle accident insurance coverage to provide “[c]ompensation to insured injured persons without regard to fault up to an aggregate minimum limit of $5,000.00 per insured injured person for . . . (A) [a]ll necessary medical expenses, not to exceed $2,500.00 ...(B) [e]ighty-five percent of the loss of income or earnings of the insured during disability with a maximum benefit of $200.00 per week” and, certain other compensable expenses not here applicable. OCGA § 33-34-5 (a) pertinently provides: “Each insurer shall also make available on an optional basis the following coverage . . . (1) [a]n aggregate limit of benefits payable without regard to fault up to $50,000.00 per person. Benefits purchased in excess of $5,000.00 shall be paid as determined by the insured without apportionment to cover any of the following expenses incurred by the insured but not compensated for under paragraph (2) of subsection (a) of Code Section 33-34-4 . . . (A) [a]ny expenses of the type described in subparagraph (a) (2) (A) *742 of Code Section 33-34-4 . . . (B) [e]ighty-five percent of the loss of income or earnings of the insured during disability” and, certain other expenses not here applicable. (Emphasis supplied.)

It is clear on the face of the statute that the insured is statutorily entitled to determine the order in which his legitimate no-fault expense claims will be paid, and the state court did not err in so concluding. As the pertinent language of OCGA § 33-34-5 is plain and susceptible of but one natural and reasonable construction, an appellate court has no authority to place a different construction upon it, but must construe it according to its terms. Ringewald v. Crawford W. Long Mem. Hosp., 258 Ga. 302, 303 (1) (368 SE2d 490). The question remains, however, as to how this right should be exercised,

Appellant, citing inter alia State Farm &c. Ins. Co. v. Penrow, 142 Ga. App. 463, 466 (236 SE2d 275), asserts that appellee by identifying the healthcare providers who were to be paid in the application for benefits is estopped from challenging appellant’s subsequent exhaustion of all optional benefits through the timely payment of these providers. The cases cited by appellant are factually distinguishable from this case.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

State Farm Fire and Casualty Company v. King Sports, Inc.
489 F. App'x 306 (Eleventh Circuit, 2012)
Hooters of Augusta, Inc. v. Nicholson
537 S.E.2d 468 (Court of Appeals of Georgia, 2000)
Quiktrip Corp. v. Childs
469 S.E.2d 763 (Court of Appeals of Georgia, 1996)
Clark v. State
432 S.E.2d 220 (Court of Appeals of Georgia, 1993)
Vlahos v. Sentry Insurance
426 S.E.2d 350 (Supreme Court of Georgia, 1993)
Peacock v. Rapid Group, Inc.
419 S.E.2d 61 (Court of Appeals of Georgia, 1992)
Morris v. State Farm Mutual Automobile Insurance
418 S.E.2d 119 (Court of Appeals of Georgia, 1992)
State Farm Mutual Automobile Insurance v. Jinks
416 S.E.2d 539 (Court of Appeals of Georgia, 1992)

Cite This Page — Counsel Stack

Bluebook (online)
402 S.E.2d 759, 198 Ga. App. 740, 102 Fulton County D. Rep. 25, 1991 Ga. App. LEXIS 253, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-farm-mutual-automobile-insurance-v-ainsworth-gactapp-1991.