Winters v. State Farm Mutual Automobile Insurance

994 P.2d 881, 99 Wash. App. 602, 2000 Wash. App. LEXIS 348
CourtCourt of Appeals of Washington
DecidedFebruary 29, 2000
Docket23396-7-II
StatusPublished
Cited by17 cases

This text of 994 P.2d 881 (Winters v. State Farm Mutual Automobile Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals of Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Winters v. State Farm Mutual Automobile Insurance, 994 P.2d 881, 99 Wash. App. 602, 2000 Wash. App. LEXIS 348 (Wash. Ct. App. 2000).

Opinion

Morgan, J.

Three questions are presented. (1) After a personal injury protection coverage (PIP) insured has fully recovered his or her damages, does a PIP insurer have a right to reimburse itself for its earlier PIP payments by deducting the amount of such payments from an underinsured motorist coverage (UIM) award, assuming its policy so provides? (2) Does a PIP insurer maintain this right even if it elects to subrogate against the at-fault tortfeasor? (3) Is a PIP insurer’s right conditioned on its paying a pro rata share of costs and fees that the PIP insured reasonably incurred to recover full compensation? The answer to each question is yes.

On January 30, 1994, Winters was hit head-on by Anna Cunningham, then rear-ended by James Edalgo. Winters was injured.

Cunningham had liability insurance with Leader National Insurance Company. Her limits were $25,000. Edalgo was uninsured.

Winters had PIP coverage and UIM coverage through State Farm. Her PIP and UIM limits exceeded the amounts in issue here.

The Winters-State Farm policy provided that State Farm *605 could recover its PIP payments from money recovered by the insured, provided the insured was fully compensated first. Using “we” to mean State Farm, the policy stated that “[w]e are to be repaid our payments . . . out of any recoveryt,]” 1 but that “[o]ur right to recover our payments applies only after the insured has been fully compensated for the bodily injury, property damage or loss.” 2 The policy also stated that “[a]ny amount paid or payable for damages under the first party benefits coverage will not be paid again as damages under this [UIM] coverage.” 3

The Winters-State Farm policy also provided that State Farm would share in the expenses of obtaining a recovery under certain circumstances. The policy stated:

If the insured recovers from the party at fault and we share in the recovéry, we will pay our share of the legal expenses. Our share is that per cent of the legal expenses that the amount we recover bears to the total recovery.[ 4 ]

Four proceedings took place after the accident. (1) State Farm paid Winters or her health care providers $8,271 under its PIP coverage. (2) Winters sued Cunningham. She settled for $25,000 5 and was paid that amount by Leader National. She did not share this recovery with State Farm. 6 (3) State Farm or its assignee sued Edalgo, recovering a *606 default judgment for $8,271, plus interest. The record does not show whether the judgment has been paid. 7 (4) Winters presented a UIM claim to State Farm. She and State Farm agreed that Cunningham and Edalgo were at fault, and that she was fault-free. The arbitrator awarded total damages of $40,271, including special damages of $8,271 and general damages of $32,000. The parties agreed that State Farm could deduct $25,000, representing Cunningham’s liability limits. They disagreed on whether State Farm could deduct $8,271, representing recoupment of its earlier PIP payments. State Farm unilaterally recouped its PIP payments by paying only $7,000 on the UIM award ($40,271 award, less $25,000 liability limits and $8,271 previous PIP payments).

In June 1997, Winters sued State Farm for an additional $8,271. She claimed, in effect, that State Farm had no right to reimburse itself for its PIP payments by deducting those payments from her arbitration award. She also claimed, in the alternative, that State Farm had no right to reimburse itself unless it paid a pro rata share of the fees and costs she had reasonably incurred to litigate against Cunningham and arbitrate against State Farm (in other words, unless State Farm paid a pro rata share of the fees and costs she had reasonably incurred to recover her total damages). The trial court granted State Farm’s motion for summary judgment and ordered Winters to pay $2,500 of State Farm’s attorney fees.

I

Winters contends that State Farm had no right to unilaterally recoup its PIP payments from the UIM award. We disagree.

A PIP insurer has a right to be reimbursed for PIP payments made to a fault-free PIP insured, at least where its *607 policy so provides. 8 A PIP insurer may not enforce this right before the PIP insured has been fully compensated, but it may enforce the right after the PIP insured has been fully compensated. 9 When the right is otherwise enforceable, a PIP insurer may implement it by claiming against settlement proceeds in the hands of the insured; 10 by suing the tortfeasor in a separate action; 11 or, in a UIM case, by offsetting its previous PIP payments against a UIM award. 12 The underlying ideas are (1) that the fault-free PIP insured should be restored to his or her pre-accident position; (2) that the fault-free PIP insurer should be restored to its pre-accident position; and (3) that restoring the PIP insured to its pre-accident position is more important than restoring the PIP insurer to its pre-accident position. 13

Here, State Farm’s policy provided for reimbursement of PIP payments out of a UIM award, so long as Winters was fully compensated first. The policy provided that State Farm would be repaid its PIP payments “out of any recovery[,]” *608 14 but “only after the insured has been fully compensated for the bodily injury, property damage or loss.” 15 The policy also provided that “[a]ny amount paid or payable for damages under [PIP] coverage will not be paid again as damages under this [UIM] coverage.” 16 In addition, State Farm reimbursed itself only after Winters had been fully compensated. By the time it took the $8,271 out of the UIM award, Winters had received her total damages of $40,271 ($8,271 in PIP payments, $25,000 in liability proceeds, and $7,000 in UIM proceeds). We conclude that State Farm was entitled to reimburse itself in the manner that it did—subject to Section III of our discussion.

II

Winters contends that State Farm lost its right to reimbursement by attempting to subrogate against Edalgo. We disagree.

As already noted, Washington’s public policy is to return the PIP insurer to its pre-accident position, provided that the PIP insured is fully compensated first.

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Cite This Page — Counsel Stack

Bluebook (online)
994 P.2d 881, 99 Wash. App. 602, 2000 Wash. App. LEXIS 348, Counsel Stack Legal Research, https://law.counselstack.com/opinion/winters-v-state-farm-mutual-automobile-insurance-washctapp-2000.