Trayco Insurance v. Williams

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 Md.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 benefits 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 The 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 3. 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 which 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. PIP is a form of no fault insurance, that allows the insured to recover for medical expenses and lost income resulting from a motor vehicle accident.

See Swartzbaugh v. Encompass Ins. Co., 425 Md. 614, 617 , 42 A.3d 587, 589 (2012); § 19-505. Its main purpose “is to assure financial compensation to victims of motor vehicle accidents without regard to the fault of a named insured or other persons entitled to PIP benefits.” Clay v. GEICO, 356 Md. 257, 265-66 , 739 A.2d 5, 10 (1999) (citations and quotation omitted). UM is a form of first-party coverage that allows an insured to collect even when the at-fault tortfeasor has no liability insurance or insufficient insurance funds.

See Reese v. State Farm Mut. Auto. Ins. Co., 285 Md. 548, 552 , 403 A.2d 1229, 1231-32 (1979); § 19-509. “[T]he purpose of mandating UM coverage is to provide some measure of compensation to the innocent victims of financially irresponsible uninsured motorists.” Hines v. Potomac Elec.

Power Co., 305 Md. 369, 374 , 504 A.2d 632, 634 (1986) (citations omitted). TravCo argues that § 19-513(e) unambiguously requires an insurer to reduce PIP and UM benefits wherever the insured “has recovered” WC benefits, and the benefit provider has not yet been repaid for those benefits. Under this theory, TravCo contends, it is required to reduce Ms. Williams’s insurance benefits because she received WC benefits from the District of Columbia and has not yet reimbursed the District for those benefits. According to TravCo, this interpretation of § 19-513(e) makes sense because UM and PIP benefits are intended to provide some means of protective compensation to the insured if other means are unavailable or not immediately available, and that purpose has already been somewhat achieved when WC benefits have been recovered.

Finally, TravCo argues that, if the plain meaning of § 19-513(e) leads to unjust outcomes to the insured, the General Assembly has ⁴⁰⁴ the option of amending the statute to more appropriately reflect the legislature’s intentions. In fact, TravCo notes, that “[s]ince 1999, the General Assembly has passed six amendments to the UM and PIP statutes, including the 2001 amendment [to § 19-513(e) ].” Ms. Williams contends that she will reimburse the District of Columbia for her WC benefits, either because she is required to do so under District law, or, in the alternative, because she intends do so voluntarily. Therefore, she argues, she should not incur a reduction in her settlement or judgment proceeds from TravCo under § 19-513(e). Her claim is based on both the statute’s purpose and “the conclusion that the legislature could not have intended bizarre practical results” that would follow from TravCo’s interpretation of the statute.

According to Ms. Williams, the statute is intended to prevent windfall to the insured, not to create obstacles to fair recovery just because the injured party was involved in a work-related accident. 4 Ms. Williams further asserts that the General Assembly made this clear when it amended the statute in 2001 to allow insurance companies to reduce their UM and PIP payout only to the extent that the WC benefits have not yet beén reimbursed. 5 The 2001 amendment, Ms. Williams contends, is “remedial legislation, which should be interpreted broadly in favor of the injured worker[].” Finally, Ms. Williams argues that TravCo’s interpretation of the statute leads to impractical results because if an insured cannot afford to reimburse his or her WC provider before the insured receives his or her UM or PIP benefits, the insured is ⁴⁰⁵ penalized by receiving a lower sum from the insurance company, which is further reduced by any required future reimbursement to the WC provider. As such, the General Assembly, Ms. Williams contends, could not have “intended the ‘reimburs[ement]’ clause of [§] 19~513(e) to apply only if an injured worker repays the workers compensation carrier prior to the settlement or judgment.” As this case requires us to interpret the meaning of a Maryland statute, we apply our longstanding principles of statutory construction. In State Farm Mut. Auto.

Ins. Co. v. Ins. Comm’r, 283 Md. 663, 670 , 392 A.2d 1114, 1117-18 (1978) [hereinafter State Farm ], we discussed statutory interpretation principles with reference to the predecessor of the statute at issue in the present case. We explained: The cardinal rule of statutory construction is to ascertain and carry out the real legislative intention.

A statute should be construed according to the ordinary and natural import of the language used without resorting to subtle or forced interpretations for the purpose of limiting or extending its operation. That is, we must confine ourselves to the statute as written, and may not attempt, under the guise of construction, to supply omissions or remedy possible defects in the statute. Thus, if there is no ambiguity or obscurity in the language of a statute, there is usually no need to look elsewhere to ascertain the intent of the Legislature .... [Wjhere statutory language is plain and free from ambiguity and expresses a definite and sensible meaning, courts are not at liberty to disregard the natural import of words with a view toward making the statute express an intention which is different from its plain meaning. Id.

(citations and quotations omitted). The predecessor to § 19-513(e), Md.Code, Art. 48A, § 543(d), provided that PIP and UM benefits “shall be reduced to the extent that the recipient has recovered benefits under [WC] laws of any state or the federal government.” Md.Code, Art. 48A, § 543(d) (1957, 1972 Repl.Vol., 1978 Cum. Supp.). We explained that § 543(d) was “plain and unambigu ⁴⁰⁶ ous.” See State Farm, 283 Md. at 671 , 392 A.2d at 1118 (holding that the statute’s plain meaning required the insurer to reduce PIP benefits payable to its insured by the amount that the insured received under WC).

This Court reaffirmed that statement as to § 19-513(e)’s predecessor statute in later cases. See Hines, 305 Md. at 377-78 , 504 A.2d at 636-37 (noting that the language of the statute “is clear and unambiguous in requiring the reduction of PIP and UM benefits to the extent that the recipient has recovered [WC] benefits”); Smelser v. Criterion Ins. Co., 293 Md. 384, 385 , 444 A.2d 1024, 1025 (1982) (explaining that the statute “means precisely what it says when it specifies that ... [PIP benefits] are to be reduced to the extent that a recipient has recovered sums pursuant to [WC laws of any state]”). In State Farm, we were asked to determine whether an insurance company could deduct the monetary payments a claimant received under WC, even though the claimant already reimbursed the WC provider.

We focused our inquiry on what the term “has recovered” meant as it was used in the statute. State Farm, 283 Md. at 671-72 , 392 A.2d at 1118 . In other words, we were asked to interpret whether, under the statute, the claimant “recovered” the WC benefits, even though he repaid that money to the WC provider. Noting that the dictionary defined “to recover” as “to get,” “to obtain,” “to come into possession of,” “to receive,” “to succeed in a [legal] proceeding,” and “to obtain in any legal manner in contrast to voluntary payment,” we held that under those meanings, the insured had “recovered” WC benefits when he received the money from his WC provider as a result of his claim.

Id. (citations omitted). Therefore, under the statute, the insurer was required to reduce the benefits payable to the insured by the amount of WC benefits the insured had received. We were asked to interpret the statute again in Gable v. Colonial Ins.

Co., 313 Md. 701 , 548 A.2d 135 (1988). In that case, an insurance company claimed that its policy provision which stated that it could deduct PIP benefits by the amount the insured may be entitled to recover in the future under WC ⁴⁰⁷ law, allowed it to deduct the WC benefits the insured would have gotten, even though the insured party never received such WC benefits. Gable, 313 Md. at 702 , 548 A.2d at 135-36 . We explained that the term “has recovered” in the statute, referred, in the past tense, to WC benefits “actually received.”