Trayco Insurance v. Williams

61 A.3d 50, 430 Md. 396
CourtCourt of Appeals of Maryland
DecidedFebruary 25, 2013
DocketMisc. Docket No. 7
StatusPublished
Cited by8 cases

This text of 61 A.3d 50 (Trayco Insurance v. Williams) is published on Counsel Stack Legal Research, covering Court of Appeals of Maryland primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Trayco Insurance v. Williams, 61 A.3d 50, 430 Md. 396 (Md. 2013).

Opinion

GREENE, J.

We have before us questions of law certified by the United States District Court for the District of Maryland pursuant to the Maryland Uniform Certification of Questions of Law Act, [399]*399Md.Code (1973, 2006 Repl.Vol.), §§ 12-601 to 12-613 of the Courts and Judicial Proceedings Article and Maryland Rule 8-305. The District Court has asked us to determine whether Md.Code (1996, 2011 Repl.Vol.), § 19-513(e) of the Insurance Article (or “ § 19-513(e)”) requires an insurance company to deduct recovered workers’ compensation (“WC”) benefits from the benefits payable to an insured for uninsured motorist coverage (“UM”) and personal injury protection (“PIP”) when the insured has not reimbursed its WC provider, the WC provider claims the insured will need to reimburse it from any UM or PIP recovery, and the insured intends to reimburse the WC provider in the future. As an extension of this question, we are asked to determine the appropriate means for resolving a dispute between a PIP or UM insurer and insured regarding a WC provider’s subrogation right.1 Finally, we are asked whether § 19 — 513(e) permits an insurer to reduce its benefits payable for medical bill “write-downs,”2 assuming that the “wi’ite-downs” are considered a WC benefit under the applicable WC law.

We shall hold that, under the plain meaning of § 19-513(e), an insured’s benefits payable under UM and PIP coverage “shall be reduced” to the extent that the insured recovered benefits under WC and the WC provider has not been reimbursed. Further, we hold that if the applicable WC law treats “write-downs” of medical bills as WC benefits, and the WC [400]*400benefits have not been reimbursed, then the insurer shall deduct those benefits, calculated as discounts, from its benefits payable to the insured under § 19-513(e).

We adopt the facts of the case as set forth by the District Court in its Certification Order dated June 8, 2012:

[] TravCo Insurance Company (“TravCo”) issued to [] Crystal Williams a Maryland personal auto policy, number 978435964 101 1, effective July 28, 2007 to January 28, 2008. The Policy’s coverage included UM bodily injury coverage, with limits of $100,000.00 each person, and PIP coverage, with limits of $2,500.00 each person each accident. The policy’s UM coverage provided that “any amounts otherwise payable for damages under this coverage shall be reduced by all sums ... [p]aid because of the ‘bodily injury’ under ... [the] worker’s compensation law or similar law provided the insurer or self-insurer of worker’s compensation benefits has not been reimbursed for amounts paid under the worker’s compensation law or similar law.” The [P]olicy’s PIP coverage similarly provided: “Benefits payable by the Company under the terms of this insurance to or on behalf of an ‘injured person’ shall be reduced to the extent that benefits therefore are paid, to or on behalf of the ‘injured person’ under any worker’s compensation law of any state or the Federal Government.”
At all relevant times, Ms. Williams was employed by the District of Columbia government. On August 2, 2007, Ms. Williams was a passenger in a District of Columbia government’s vehicle driven by her supervisor. They were traveling on a work assignment. Their vehicle was rear-ended by an unknown driver. Ms. Williams was stunned by the impact. While she was sitting in the vehicle trying to recover, her supervisor told the other driver to leave the scene. The driver responsible for the accident left and no information about him is known. Ms. Williams was injured in the accident. She missed nine weeks of work and her loss of [] earning capacity was $10,476.00. She incurred $13,096.50 in medical expenses and received a 22% disability rating.1
[401]*401The medical invoices provided by Ms. Williams to TravCo indicate that her medical providers applied WC “write-downs,” totaling at least $3,591.53.
The District of Columbia government’s WC third-party administrator asserts a subrogation right in the amount of $11,043.60 against any PIP or UM recovery by Ms. Williams. Ms. Williams intends to reimburse the District of Columbia government, although TravCo disputes her obligation to do so. The amount that Ms. Williams would reimburse the District of Columbia government cannot be determined before the settlement or judgment with TravCo, and Ms. Williams has no funds to reimburse the District of Columbia government out of pocket.
TravCo does not dispute that Ms. Williams’ claims fall within the PIP or UM insuring agreements. Nevertheless, disputes regarding the effect of Section 19-513(e) have prevented settlement of her claims.

In light of the necessary interpretation of § 19-513(e) to resolve this issue, the District Court certified the following questions of law to this Court:

1. Does Section 19-513(e) of the Insurance Article, providing that uninsured motorist (“UM”) and personal injury protection (“PIP”) benefits “shall be reduced to the extent that the recipient has recovered benefits under the workers’ compensation [WC’] laws of a state or the federal government for which the provider of the [WC] benefits has not been reimbursed,” apply where the insured has not to date reimbursed the WC provider but the WC provider claims that the insured will need to reimburse it from any UM or PIP recovery?
2. If the answer to the first question is “yes,” what is the appropriate means to resolve a dispute between the insurer and insured as to the validity and extent of a WC provider’s subrogation right?2
[402]*4023. If the law applicable to the underlying automobile accident and to the WC claim treats “write-downs” of medical bills as WC benefits, do such “write downs” reduce the benefits payable under Section 19-513(e) of the Insurance Article? [3]

We note that under the Maryland Code, this Court “may reformulate a question of law certified to it.” Md.Code (1973, 2006 Repl.Vol.), § 12-604 of the Courts and Judicial Proceedings Article. Accordingly, we shall redact the first part of Question Two to reflect the appropriate question of law presented by the parties: What is the appropriate means to resolve a dispute between the insurer and insured as to the validity and extent of a WC provider’s subrogation right?

I.

The issue in the present case is the correct interpretation of Md.Code (1996, 2011 Repl.Vol.), § 19-513(e) of the Insurance Article, which provides:

§ 19-513. Limitations on recovery of benefits.
(e) Reduction due to workers’ compensation benefits. — Benefits payable under the coverages described in §§ 19-505 and 19-509 of this subtitle shall be reduced to the extent that the recipient has recovered benefits under the workers’ compensation laws of a state or the federal government for [403]*403which the provider of the workers’ compensation benefits has not been reimbursed.

The noted provisions within the statute refer to Maryland laws involving PIP, Md.Code (1996, 2011 Repl.Vol., Supp.2012), § 19-505 of the Insurance Article, and UM, Md. Code (1996, 2011 Repl.Vol.), § 19-509 of the Insurance Article.

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

Related

Bowens v. State Farm Mut. Auto. Ins.
Court of Appeals of Maryland, 2025
Westfield Insurance v. Gilliam
269 A.3d 1047 (Court of Appeals of Maryland, 2022)
Nationwide Mut. Insurance v. Shilling
227 A.3d 171 (Court of Appeals of Maryland, 2020)
Price v. Murdy
198 A.3d 798 (Court of Appeals of Maryland, 2018)
Ross v. Agurs
75 A.3d 1022 (Court of Special Appeals of Maryland, 2013)
Brethren Mutual Insurance v. Suchoza
66 A.3d 1073 (Court of Special Appeals of Maryland, 2013)

Cite This Page — Counsel Stack

Bluebook (online)
61 A.3d 50, 430 Md. 396, Counsel Stack Legal Research, https://law.counselstack.com/opinion/trayco-insurance-v-williams-md-2013.