Strawn v. Farmers Ins. Co. of Oregon

258 P.3d 1199, 350 Or. 336, 2011 Ore. LEXIS 444
CourtOregon Supreme Court
DecidedMay 19, 2011
DocketCC 9908-09080; CA A131605; SC S057520, S057629
StatusPublished
Cited by74 cases

This text of 258 P.3d 1199 (Strawn v. Farmers Ins. Co. of Oregon) is published on Counsel Stack Legal Research, covering Oregon Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Strawn v. Farmers Ins. Co. of Oregon, 258 P.3d 1199, 350 Or. 336, 2011 Ore. LEXIS 444 (Or. 2011).

Opinions

[339]*339LINDER, J.

Plaintiff Mark Strawn filed a class action against defendants Farmers Insurance Company of Oregon, Mid-Century Insurance Company, and Truck Insurance Exchange (collectively, Farmers).1 The complaint alleged that Farmers had breached its contractual obligations and committed fraud by instituting a claims handling process that arbitrarily reduced payments for reasonable medical benefits owed under its automobile insurance policies. A jury returned a verdict for plaintiffs. Based on that verdict and a post-verdict class claims administration process, the trial court entered a judgment against Farmers for approximately $900,000 in compensatory damages and $8 million in punitive damages. Farmers appealed. On appeal, the Court of Appeals concluded that the punitive damages award exceeded federal constitutional limits, but otherwise affirmed the judgment. Strawn v. Farmers Ins. Co., 228 Or App 454, 209 P3d 357 (2009).

Both parties petitioned for review. In its petition, Farmers presented three issues. The first two raise challenges to the liability verdict entered against Farmers. The third issue challenges the punitive damages award, arguing that the Court of Appeals should have reduced the punitive damages award farther. In plaintiffs’ petition, they first contend that the Court of Appeals should not have reached the constitutionality of the punitive damages award for procedural reasons. Alternatively, plaintiffs contend that the full amount of punitive damages awarded by the jury was within constitutional limits.

We allowed both petitions for review. As we will explain, we reject Farmers’s arguments that seek to set aside the jury’s liability determinations on plaintiffs’ claims. On the punitive damages issues, we conclude that the Court of [340]*340Appeals should not have reached Farmers’s constitutional challenge to the amount of the punitive damages award. Consequently, we affirm in part and reverse in part the decision of the Court of Appeals, and we affirm the judgment of the trial court.

I. FACTS AND PROCEDURAL BACKGROUND

This case involves personal injury protection (PIP) benefits offered by insurance policies written by Farmers. Both by statute and by contract, Farmers was obligated to pay “[a]ll reasonable and necessary expenses of medical, hospital, dental, surgical, ambulance and prosthetic services incurred within one year after the date of the person’s injury,” up to a certain limit. ORS 742.524(1)(a).2 Because the parties do not take issue with the summary of the facts provided by the Court of Appeals (which were set out in the light most favorable to plaintiffs, as the prevailing party), we quote that summary here:

“Before 1998, Farmers processed requests for PIP benefits by having its claims adjusters review each medical bill to determine whether the bill was reasonable — that is, whether it was both ‘usual and customary.’ In 1997, however, Farmers decided to change that process. In an effort to recover losses and regenerate its surplus after the 1994 Northridge, California earthquake, Farmers instituted its ‘Bring Back a Billion’ campaign. Farmers’ corporate headquarters in Los Angeles alerted its regional offices of the ‘increasing importance’ of generating money without raising premiums. In June 1997, Farmers instructed its [341]*341Portland office to reduce payment of PIP benefits to realize ‘PIP dollar savings * * *[,] an untouched area.’
“In an effort to reduce PIP payments, the Oregon PIP claims manager, Heatherington, contracted with Medical Management Online (MMO), a bill review vendor. MMO, in turn, licensed a ‘cost containment software program’ from Medata, a company that manages a database of roughly 100 million medical expenses. The software sorts those medical expenses by Current Procedural Terminology (CPT) codes, geographic region, and price. CPT codes, which are created by the American Medical Association, are used by medical providers to bill insurers. Geographic regions in the database are defined according to ‘PSRO’ areas, which are socio-demographic regions established by the federal government in 1980 for workers’ compensation purposes. For Oregon, the federal government identified two PSRO areas: (1) the Portland-metro area and (2) the rest of the state.
“The software allowed MMO’s clients (mostly insurance companies and state agencies) to determine whether a bill from a medical provider was more expensive than a given percentage of the range of charges in other bills for the same CPT code in the provider’s designated geographic area. Clients were able to select any percentile that they wished, and MMO then evaluated the bills that it received from the client to determine whether the bills exceeded that percentile. If a bill exceeded the preselected percentile, MMO generated an Explanation of Benefits (EOB) form that reduced payment with reference to ‘reason code’ ‘RC40.’ The EOB explained the code as follows:
“ ‘RC40: This procedure was reduced because the charges exceeded an amount that would appear reasonable when the charges are compared to the charges of other providers within the same geographic area.’[3]
“The software was promoted as reducing medical provider payments by 26 percent.
“Beginning in January 1998, Farmers implemented its new PIP handling process through MMO — a process that, in Heatherington’s words, represented ‘a significant change [342]*342in the way we handle our bills.’ Farmers selected the eightieth percentile as the cutoff point for ‘reasonable’ expenses. That is, Farmers determined that any bills that exceeded the eightieth percentile in the MMO database would be deemed to exceed the ‘reasonable’ charge and would be ‘reduced’ to that eightieth percentile. The program worked as follows: After Farmers’ insureds were treated for their injuries, their medical providers sent their bills directly to Farmers. Farmers then forwarded the bills to MMO, and MMO entered the bills into its database. If the bill was more than the charge that was at the eightieth percentile of the charges for that same CPT code in the designated region, MMO documented that fact on an EOB form with an RC40 code.
“Although Farmers contended at trial (and still contends) that the EOB form constituted only a ‘recommendation’ from MMO as to reasonableness, claims adjusters were expected to follow the recommendation. The adjusters were downgraded if they departed from MMO’s recommendations and were rewarded when they followed them. Thus, the ‘recommendation’ was, as a practical matter, the final determination of reasonableness.
“Between January 26, 1998 and July 21, 1999 (the class period), Farmers reduced more than 60,000 individual bills by a total of approximately $750,000. The majority of the individual reductions were small: 90 percent were for $25 or less; more than one quarter were for $3 or less. Although Farmers offered medical providers an opportunity to justify the charges that exceeded the established percentile, it was generally not cost-effective for medical providers to pursue those avenues. The medical providers who took advantage of the opportunity to justify their charges rarely secured any additional payment from Farmers.

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Bluebook (online)
258 P.3d 1199, 350 Or. 336, 2011 Ore. LEXIS 444, Counsel Stack Legal Research, https://law.counselstack.com/opinion/strawn-v-farmers-ins-co-of-oregon-or-2011.