Tucker v. Aetna Casualty & Surety Co.

609 F. Supp. 1574, 1985 U.S. Dist. LEXIS 19141
CourtDistrict Court, S.D. Mississippi
DecidedJune 6, 1985
DocketCiv. A. J83-0624(B)
StatusPublished
Cited by9 cases

This text of 609 F. Supp. 1574 (Tucker v. Aetna Casualty & Surety Co.) is published on Counsel Stack Legal Research, covering District Court, S.D. Mississippi primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Tucker v. Aetna Casualty & Surety Co., 609 F. Supp. 1574, 1985 U.S. Dist. LEXIS 19141 (S.D. Miss. 1985).

Opinion

*1575 FINDINGS OF FACT AND CONCLUSIONS OF LAW

BARBOUR, District Judge.

This cause came on for trial on the Amended Complaint of the Plaintiffs, Shirley M. Tucker and Jim Tucker, against Aetna Casualty & Surety Company on April 4, 1985, and continued thereafter to conclusion on April 9, 1985.

Plaintiff Shirley M. Tucker brought this action in the Circuit Court of the First Judicial District of Hinds County, Mississippi, against her automobile insurance carrier, Defendant, Aetna Casualty & Surety Company, seeking actual damages under her uninsured motorist coverage for personal injuries and medical expenses incurred, seeking to recover medical expenses under her medical payments coverage, and seeking punitive damages for Aetna’s bad faith refusal to honor Plaintiff's claim for injuries and damages, and intentional tort in using an undisputed claim to settle or reduce a disputed claim and in attempting to reduce statutory uninsured motorist coverages. Defendant removed the action to this Court. The complaint was subsequently amended to join as a Plaintiff Jim Tucker, the husband of Shirley M. Tucker, to assert an additional claim for damage to credit reputation occasioned by lawsuits filed against Jim Tucker due to Aetna’s failure to pay medical expenses under its policy.

FINDINGS OF FACT

Plaintiffs Shirley M. Tucker and Jim Tucker were insured under a policy of automobile insurance issued on July 21, 1982, by Aetna Casualty & Surety Company, Policy Number 87-SR-15237931 PCA, which provided, among other coverages, uninsured motorist coverage and medical payments coverage on two vehicles owned by Plaintiffs. This insurance policy was identical in every respect to the automobile insurance policies Aetna is selling here in Mississippi at the present time.

Plaintiffs purchased separate coverage with the Defendant, Aetna, on the two vehicles, and the policy provided uninsured motorist coverage on each vehicle in the amount of $10,000. Aetna’s writing agent, Horace M. McMurphy testified that a separate dollar amount was included in the total premium to provide uninsured motorist coverage. Although no separate dollar amount is set forth, the policy itself states that the premium for uninsured motorist coverage for each automobile is “included” in the total premium.

The policy provided medical payments coverage in the amount of $2,000. This coverage was excess to any other medical insurance covering the injured insured.

On January 8, 1983, Plaintiff Shirley M. Tucker was involved in an automobile accident with an uninsured motorist in which she received injuries for which she is entitled to compensation under medical payments and uninsured motorists coverages of the subject automobile insurance policy. The accident was entirely the fault of the driver of the other vehicle who was uninsured. Complicating the issue of damages in this case are the facts that the Plaintiff was involved in a second automobile accident on February 3 and that she had a prior medical history of psychological problems and a bad back. It appears from the conflicting evidence that the second accident on February 3 was somewhat less severe than the first accident. Shirley Tucker made a claim concerning this second accident to another insurance company and received a settlement for her injuries resulting from the second accident.

Plaintiff Shirley M. Tucker, by and through her counsel, initially submitted to Aetna for payment medical bills for treatment of injuries incurred as a result of the accident in question totalling $693.60. Included in the original bills submitted to Aetna were ambulance bills and other bills incurred as a result of the second accident. When presented with the claim for payment of medical expenses under the aforesaid policy, Aetna refused to pay Plaintiff unless and until its form agreement entitled “Auto-Rite Policy Medical Expense Agreement” was signed by Plaintiff Shir *1576 ley M. Tucker. The Auto-Rite Policy Medical Expense Agreement provided that Shirley M. Tucker would agree that payments made under the medical payments coverage of the policy would be applied toward the settlement of “any claim” or the satisfaction of any judgment for damages entered in her favor which she had made or would thereafter make on account of the accident against any person or organization to whom the liability coverage provided by the automobile insurance policy applied. 1

It is undisputed that the policy Aetna issued to the Tuckers (and to all of the other Mississippians who purchased an Auto-Rite policy from Aetna) contains provisions which limit uninsured motorist coverage in a manner violative of settled Mississippi law. Under the endorsement styled “Protection Against Uninsured Motorists Insurance (Mississippi)” is found the following illegal provision in “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 paid or payable under the Medical Payments Coverage.

The Protection Against Uninsured Motorists Insurance (Mississippi) endorsement was revised in January, 1980. It is noted that this is the Mississippi endorsement drafted, edited and intended to be included in the Aetna Auto-Rite policies issued in the State of Mississippi. Aetna acknowledged in its testimony that it knew that the provision was illegal under Mississippi law. Despite its knowledge of the illegality of the provision, Aetna has intentionally incorporated the illegal provision into its policies as late as July 21, 1982.

It is clear to this Court that Aetna intended for its adjusters to abide by and enforce the aforesaid illegal provision of its policy, since it so instructs its adjusters in its Methods .and Procedures Claim Manual, Section 4275. Under the uninsured motorists (AU, AUP) section, the Methods and Procedures Claim Manual states “also, clearly show that the uninsured motorist payments was reduced by the amount of the medical payment.”

As a condition precedent to its payment of med-pay benefits, Aetna required that the Tuckers execute an agreement which would have had the necessary legal effect of binding the Tuckers to the illegal limitation embodied in the Aetna policy. When the Tuckers refused to execute the Aetna agreement, on the grounds that it was illegal under Mississippi law, Aetna flatly refused to pay the med-pay benefits and cited the Tuckers’ refusal as ground for denial of Mrs. Tucker’s legitimate claim under the policy. When Mrs. Tucker’s lawyer pointed out the illegality of the agreement, Aetna stood on the terms of its policy, and insisted upon execution of the agreement as a condition precedent to making payments under the policy.

*1577 Plaintiffs have alleged that the Defendant, Aetna Casualty & Surety Company, has attempted by its use of the Auto-Rite Agreement to reduce uninsured motorist coverage by any payment it makes under medical payments coverage. Plaintiffs’ position is supported by the language found in a supervisor’s memo to the adjuster in this case found in Aetna’s claim file:

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Cite This Page — Counsel Stack

Bluebook (online)
609 F. Supp. 1574, 1985 U.S. Dist. LEXIS 19141, Counsel Stack Legal Research, https://law.counselstack.com/opinion/tucker-v-aetna-casualty-surety-co-mssd-1985.