The Minnesota No-Fault Act provides for basic economic-loss benefits for losses suffered through injury “arising out of maintenance or use of a motor vehicle.” Minn. Stat. § 65B.46, subd. 1.

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State Farm Mutual Automobile Insurance v. Frelix · 2009 1 citation

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Ordinarily, an injured party is compensated through his or her no-fault benefits coverage as the expenses and losses are incurred, and unless the tortfeasor is underinsured, the tortfeasor and his or her *? liability insurer cover the remainder of the damages. See Richards, 518 N.W.2d at 28; cf. Balderrama v. Milbank Mut. Ins. Co., 324 N.W.2d 355, 356 (Minn.1982) (holding that a prior settlement for common-law liability claims does not abrogate the statutory rule that every person suffering loss from injury as a result of a motor-vehicle accident has a right to basic-economic-loss benefits); Minn. Stat. § 65B.46, subd. 1 (2006).

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LeBeau v. John Deere Insurance Co. · 1998 2 citations

ANALYSIS An occupant of a motor vehicle that is insured pursuant to the no-fault act is entitled to collect basic economic loss benefits from an insurer, even if the accident occurs in another state. Minn. Stat. § 65B.46, subd. 2 (1990). Basic economic loss benefits include payments for medical expenses. Minn. Stat. § 65B.44, subds. 1, 2 (1990). Basic economic loss benefits are payable when an expense is incurred. Minn. Stat. § 65B.54 subd. 1 (1990). Because LeBeau's accident occurred in Wisconsin, John Deere ordinarily would be entitled to assert subrogation[1] rights against LeBeau after paying a claim for medical expenses, if that payment were to result in double recovery by LeBeau. Minn. Stat. § 65B.53, subd. 2 (1990). But LeBeau settled the tort action before he incurred additional medical expenses for his daughter's surgery. LeBeau claims that he is entitled to recover from John Deere any medical expenses incurred after the settlement, and that a no-fault insurer has no subrogation rights under Minn. Stat. § 65B.53 in the situation where basic economic loss accrues after a tort settlement. The parties cite Ferguson v. Illinois Farmers Ins. Group Co., 348 N.W.2d 730 (Minn.1984). There, the supreme court held that when an insured recovers a judgment against a tortfeasor, the insured's expected medical expenses may not be deducted from the judgment and assigned to the no-fault carrier. Rather, the insured should receive the entire judgment from the tortfeasor, less the costs of collection, including reasonable attorney fees. Then, after the insured has exhausted the damages allocated for medical expenses, the insured may recover any additional medical expenses from the no-fault insurer. Id. at 730. LeBeau argues that critical to Ferguson was the fact that the insured received a judgment that included a specific identifiable recovery allocated to future medical expenses. But here, although LeBeau did not receive a judgment against Larson, he did agree to a settlement which, like the judgment in Ferguson, allocated a specific amount for expected medical expenses.[2] Therefore, applying Ferguson, to avoid double recovery, LeBeau must first exhaust the amount of the settlement allocated for expected medical expenses, less costs of collection and reasonable attorney fees, before he is entitled to recover any medical expenses from John Deere. The total amount of LeBeau's settlement was $25,000, including $9,000 for expected medical expenses. From the $25,000, the district court deducted $2,755, or 11.02%, for costs of collection and reasonable attorney *86 fees. When the amount of $9,000 is similarly reduced by the 11.02% costs of collection and attorney fees, the resultant $8,008.20 represents the net amount of future medical expenses that LeBeau must exhaust pursuant to Ferguson before he may recover no-fault benefits from John Deere. The actual cost of the surgery was $8,508.25. Because this amount exceeds $8,008.20, LeBeau has in fact exhausted the amount of future medical expenses attributable to the settlement and has stated a proper claim against John Deere for the balance of $500.05. LeBeau did not include the above calculations in his briefs to this court, and he apparently made a tactical decision not to do so. However, undisputed evidence in the record supports our calculations, and in response to questioning by this court at oral argument, the parties fully addressed the issue to our satisfaction. Therefore, in the interest of judicial economy,[3] we hold that when either a judgment against or a settlement with a tortfeasor includes a designated amount for expected medical expenses, that amount must be reduced proportionally by the total costs of collection, including reasonable attorney fees, and that net amount must be exhausted before the insured seeks to recover any additional medical expenses from the no-fault carrier. We note that if the district court had required John Deere to pay LeBeau's claim for the surgery, such payment would result in a double recovery to the extent of $8,008.20, triggering John Deere's subrogation rights and bringing the case again before the court. The district court's decision to instead resolve the parties' entire dispute is supported by an overriding purpose of the no-fault act, which is to avoid "[t]he detrimental impact of automobile accidents * * * upon the orderly and efficient administration of justice in this state[.]" Minn. Stat. § 65B.42; accord Minn. Stat. § 65B.42(4) (reiterating this purpose by stating that the no-fault act is intended "[t]o speed the administration of justice, [and] to ease the burden of litigation on the courts of this state").

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Medicine Lake Bus Co. v. Smith · 1996 2 citations

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Smith v. Illinois Farmers Insurance Co. · 1990 6 citations

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Wolf v. State Farm Insurance Co. · 1990 1 citation

We do not agree with State Farm’s position that the initial burden of proof was on Wolf to establish her entitlement to benefits by presenting evidence on the issues of causation and necessity. An insured has a right to basic economic loss benefit under the No-Fault Act. Minn. Stat. § 65B.46, subd. 1. Once an insurer receives reasonable proof of the fact and amount of loss realized, it has a duty to respond to an insured’s claims in a timely manner. Minn. Stat. § 65B.54. Assuming State Farm received reasonable proof of Wolf’s losses, the burden was on it to establish Wolf was not entitled to benefits. See Ruppert v. Milwaukee Mutual Insurance Co., 392 N.W.2d 550, 556, 557 (Minn.Ct.App.1986), pet. for rev. denied (Minn. Oct. 22, 1986) (suggesting benefits may be terminated only if insured has been cured and thus requires no further treatment or if insured is receiving treatment for pre-ex-isting condition). Generally, an insured may meet that burden with evidence obtained during an adverse medical examination. See Minn. Stat. § 65B.56, subd. 1. Assuming State Farm meets its burden on retrial with Smookler’s deposition testimony, the burden may then shift to Wolf to establish her entitlement to benefits.

Patel v. Metropolitan Transit Commission · 1989 1 citation

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Green ex rel. Deuel v. American Family Mutual Insurance Co. · 1988 1 citation

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Edwards v. State Farm Mutual Automobile Insurance Co. · 1986 2 citations

III. Appellant also argues that Diane Edwards' murder was not an "accident" within the scope of the uninsured motorist provision. Because we have found the injuries in this case did not arise from the use of a vehicle, we need not decide this issue. We note, however, that a majority of jurisdictions addressing the issue have found that the term "accident" should be viewed from the perspective of the victim. Under this rationale, the courts have universally held that intentionally inflicted injuries were "accidents" within the scope of uninsured motorist coverage. See Country Companies v. Bourbon by Bourbon, 122 Ill. App.3d 1061, 78 Ill.Dec. 407, 462 N.E.2d 526 (1984); Redden v. Doe, 357 So.2d 632 (La.Ct.App.1978); Sciascia v. American Insurance Co., 183 N.J.Super. 352, 443 A.2d 1118 (N.J.Super.Ct.Law Div.1982), aff'd 189 N.J.Super. 236, 459 A.2d 1198 (N.J.Super.Ct.App.Div.1983). Also in Meric v. Mid-Century Insurance Co., 343 N.W.2d 688 (Minn.Ct.App.1984) this court allowed no-fault recovery under Minn. Stat. § 65B.46 (1982), for an assault related to a vehicle. Id. at 690. The issue of whether the assault qualified as an "accident" was not directly addressed in Meric. We note, however, that section 65B.46 provides: If the accident causing injury occurs outside this state in the United States, United States possessions, or Canada, the following persons and their surviving dependents suffering loss from injury arising out of maintenance or use of a motor vehicle have a right to basic economic loss benefits[.] Under this statute the Meric court would have had to find that the assault was an "accident causing injury" in order to conclude the statute provided coverage. Consistent with Meric, we agree with the dissent's implied recognition that the murder of Diane Edwards was an "accident" for purposes of uninsured motorist and personal injury coverage. Such a determination recognizes that while an intentional tortfeasor may be uninsured, or may be denied the protection of his third party liability coverage because of an exclusionary clause, the consequences befalling that intentional tortfeasor should not be transferred to the injured person who subsequently looks to his or her own insurer for first party coverage.

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