Woodrich v. Farmers Ins. Co., Inc.

405 F. Supp. 2d 1276, 2004 U.S. Dist. LEXIS 28955, 2004 WL 3621911
CourtDistrict Court, N.D. Oklahoma
DecidedMay 7, 2004
Docket03 CV 396H(C)
StatusPublished

This text of 405 F. Supp. 2d 1276 (Woodrich v. Farmers Ins. Co., Inc.) is published on Counsel Stack Legal Research, covering District Court, N.D. Oklahoma primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Woodrich v. Farmers Ins. Co., Inc., 405 F. Supp. 2d 1276, 2004 U.S. Dist. LEXIS 28955, 2004 WL 3621911 (N.D. Okla. 2004).

Opinion

ORDER

HOLMES, Chief Judge.

NOW ON THIS 22nd day of April, 2004, the Motion for Partial Summary Judgment of Farmers Insurance Company, Inc. (“Farmers”) comes on for hearing before *1277 the Court. Farmers moves that the Court enter partial summary judgment in Farmers’ favor by finding that, as a matter of law:

1. Under the terms of Mark Wood-rich’s insurance policy, Farmers is only obligated to pay medical payments (“med pay”) coverage benefits to Mr. Woodrich for his reasonable medical expenses;
2. Mr. Woodrich’s reasonable medical expenses cannot exceed the amount of money that Mr. Woodrich’s medical providers accepted as full payment for their services;
3. Farmers has already paid med pay benefits to Mr. Woodrich in a total amount that exceeds what his medical providers accepted as full payment;
4. Farmers does not owe additional contract benefits to Mr. Woodrich at this time; and
5. Mr. Woodrich cannot recover an attorney fee as damages in connection with his bad faith claim.

After considering the briefs submitted by the parties and hearing the arguments of counsel, the Court finds and orders that Farmers’ Motion should be granted in its entirety.

FINDINGS OF FACT

The following material facts are not in dispute:

1. On August 13, 2002, Mr. Woodrich was involved in the auto accident that resulted in the insurance claims that are involved in this lawsuit.

2. On the accident date, Mr. Woodrich was the named insured for Farmers Policy No. 08-12130-65-76. The Policy provided med pay coverage with a $100,000.00 per person, per accident limit. The Policy’s terms concerning med pay coverage are contained in Endorsement E1142, which, in relevant part, stated as follows:

ENDORSEMENT AMENDING PART III — MEDICAL

Coverage E — Medical Expense Coverage Your EZ Reader Car Policy

It is agreed that your policy is amended as described below:

Part III MEDICAL is deleted and replaced with the following:

PARTID MEDICAL

Coverage E — Medical Expense Coverage

We will pay reasonable expenses for necessary medical services furnished within two years from the date of the accident because of bodily injury sustained by an insured person.

Additional Definitions Used In This Part Only

As used in this part, insured person means:

1. You or any family member while occupying, or through being struck by, a motor vehicle or trailer, designed for use on public roads....
Necessary Medical Services means medical services which are usual and customary for treatment of the injury, including the number or duration of treatments, in the county in which those services are provided.
Necessary Medical Services are limited to necessary medical, surgical, dental, x-ray, ambulance, hospital, professional nursing and funeral services, and include the cost of pharmaceuticals, orthopedic and prosthetic devices, eyeglasses, and hearing aids. We will reimburse you for any necessary medical services already paid by you.
❖ * * ❖ # *
Reasonable Expenses means expenses which are usual and customary for necessary medical services in the county in *1278 which those services are provided. We will reimburse you for any reasonable expenses already paid by you.

3. After the ■ accident, Mr.. Woodrich submitted medical bills to Farmers from the following medical providers: Family Medicine Associates, Tulsa Pain Consultants, Inc., Broken Arrow Physical Therapy, Radiology Consultants, St. Francis Hospital, Orthopedic Hospital of Oklahoma, Rick Huskey, D.C., Physical Rehabilitation of Tulsa and Neurological Specialists. He also submitted documents in support of a claim for prescription drug costs.

4. The face amount of Mr. Woodrich’s medical bills, not considering any discounts, total $15,429.28. In addition, Mr. Woodrich submitted receipts and documents for prescriptions totaling $216.97. The total face amount of the medical bills and prescription charges that Mr. Wood-rich submitted to Farmers is $15,429.28.

5. The “face amount” of the medical bills and prescription charges that Mr. Woodrich submitted to Farmers do not necessarily reflect what Mr. Woodrich’s medical providers.or pharmacists accepted as full payment.

6. At all relevant times, Mr. Woodrich had health insurance with United Healthcare, and many of his medical bills from the accident were submitted to and paid by United Healthcare. Some of Mr. Wood-rich’s medical bills were discounted by the medical providers after bills were submitted to United Healthcare.

7. The “face amount” of Mr. Wood-rich’s bill from Family Medicine Associates was $1,251.00. However, Family Medicine Associates’ bill was submitted to United Healthcare, which paid the bill, except for $285.91. Family Medicine Associates then wrote off $285.91, thereby reducing the outstanding balance to zero.

8. The face amount of Tulsa Pain Consultants bill was $1,695.00. However, Tulsa Pain Consultants’ bill was submitted to United Healthcare, which paid the bill except for $1,228.86. Tulsa Pain Consultants then wrote off $1,228.86, thereby reducing the outstanding balance to zero.

9. Mr. Woodrich is not personally liable for the write-offs that were applied to the bills as a result of the payments from United Healthcare.

10. The write-offs of Tulsa Medicine Associates and Tulsa Pain Consultants, standing alone, reduced Mr. Woodrich’s liability for his medical expense by $1,514.57, bringing the total amount that was accepted by the providers as full payment to no more than $14,131.68.

11. To date, Farmers Insurance Company, Inc., has paid med pay benefits to Mr. Woodrich and his attorney in the total amount of $14,430.86.

12. In other words, Farmers Insurance Company, Inc., has already paid Mark Woodrich and his attorney more than his medical providers and pharmacists have accepted as full payment for their services and products.

13. In this lawsuit, Mr. Woodrich has contended that the “collateral source rule” prevents Farmers from considering the physician write-offs in determining the amount of med pay benefits that Farmers owes to him.

14. Mr. Woodrich claims damages in this lawsuit that are based upon a $400.00 attorney fee payment he made to Roberts Potts as an alleged result of Farmers’ alleged delay in the handling of his med pay claim.

15. Mr. Woodrich first submitted medical bills to Farmers for payment in November 2002. Farmers paid part, but not all, of the medical bills before suit was filed on May 5, 2003. After this suit was filed, *1279

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

Related

State Farm Mutual Automobile Insurance v. Bowers
500 S.E.2d 212 (Supreme Court of Virginia, 1998)
DENCO BUS LINES, INC. v. Hargis
1951 OK 11 (Supreme Court of Oklahoma, 1951)
Weatherly v. Flournoy
1996 OK CIV APP 109 (Court of Civil Appeals of Oklahoma, 1996)
Blythe v. University of Oklahoma
2003 OK 115 (Supreme Court of Oklahoma, 2003)
Barnes v. Oklahoma Farm Bureau Mutual Insurance Co.
2000 OK 55 (Supreme Court of Oklahoma, 2001)

Cite This Page — Counsel Stack

Bluebook (online)
405 F. Supp. 2d 1276, 2004 U.S. Dist. LEXIS 28955, 2004 WL 3621911, Counsel Stack Legal Research, https://law.counselstack.com/opinion/woodrich-v-farmers-ins-co-inc-oknd-2004.