Budnella v. USAA Gen. Idemnity Co.
| Decision Date | 27 January 2021 |
| Docket Number | Civil Action No. 20-cv-00944-KMT |
| Parties | NICHOLAS BUDNELLA, Plaintiff, v. USAA GENERAL IDEMNITY COMPANY, Defendant. |
| Court | U.S. District Court — District of Colorado |
ORDER
Before the court are two motions: (1) "Plaintiff's Verified Motion for Summary Judgment and/or for Determination of Law," together with a brief in support of Plaintiff's motion; and (2) "Defendant USAA General Indemnity Company's Cross Motion for Summary Judgment." [("Plaintiff's Motion"), Doc. No. 22; ("Plaintiff's Brief"), Doc. No. 23; ("Defendant's Motion"), Doc. No. 24.] Both sides have responded to one another's motions. [("Plaintiff's Response"), Doc. No. 25; ("Defendant's Response"), Doc. No. 26.)
On June 9, 2017, Plaintiff Nicholas Budnella, while acting in the course and scope of his employment with Cooling Cubed, LLC, and while operating a vehicle owned by Cooling Cubed, LLC, was involved in an automobile accident with a third party in Colorado Springs, Colorado. [Joint Statement of Undisputed Facts in Support of Cross-Motions for Summary Judgment ("UF"), Doc. No. 21 at ¶¶ 1-2.] The accident came about when the third-party driver "crashed into the vehicle being driven by Plaintiff."1 [("Complaint"), Doc. No. 5 at ¶ 6.]2 Subsequent to the collision, Plaintiff filed a claim for workers' compensation insurance with Cooling Cubed, LLC's insurer, Pinnacol Assurance, and received worker's compensation benefits. [UF ¶ 3.]
Defendant USAA General Indemnity Company ["USAA GIC"] provided personal automobile insurance coverage to Plaintiff under Policy No. 03907 82 79G 7101 5 ["the Policy"], which was in effect on the date of the accident. [UF ¶ 5.] Approximately one year after the accident, and after receiving benefits from worker's compensation,3 Plaintiff made a claim against USAA GIC for benefits pursuant to the Medical Payments portion of his personal automobile policy. [UF ¶ 7.] The insurer thereafter denied the claim, citing Exclusion No. 4 of the Policy, which reads: "We do not provide benefits under this Part for any covered person for [Bodily Injury] . . . [o]ccurring during the course of employment if workers' compensation benefits are required or available." [("Policy"), Doc. No. 24-1 at 24; UF ¶¶ 5, 8.]
Plaintiff challenges the denial of benefits, arguing that Exclusion No. 4 is impermissibly ambiguous. [Pl.'s Mot. 5; Pl.'s Brief 5.] Plaintiff is adamant that Exclusion No. 4 violates Colorado's Medical Payments statute, Colo. Rev. Stat. § 10-4-635(2)(a), as well as Colorado public policy, and he contends that the exclusion should be stricken from the Policy. [Pl.'s Brief 5-7.] Budnella also argues that the denial of coverage by USAA GIC constitutes bad faith.[Compl. ¶¶ 18-20.] USAA GIC counters that any interpretive ambiguity which could be attributed to the terms 'required' or 'available' in Exclusion No. 4 is immaterial here, because, in fact, the workers' compensation benefits were not only "available," they were actually fully paid. [Def.'s Mot. 6.] Defendant further contends that the Medical Payments statute works in conjunction with Colorado's other no-fault insurance scheme, Workers' Compensation, and that Exclusion No. 4 reflects that legislative intent. [Id. at 9-10.] USAA GIC argues that the Medical Payments statute does not prohibit policy exclusions generally, nor does Exclusion No. 4 itself violate public policy. [Id. at 11-14.]
Summary judgment is appropriate if "the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(a). The moving party bears the initial burden of showing an absence of evidence to support the nonmoving party's case. Celotex Corp. v. Catrett, 477 U.S. 317, 325 (1986). "Once the moving party meets this burden, the burden shifts to the nonmoving party to demonstrate a genuine issue for trial on a material matter." Concrete Works, Inc. v. City & County of Denver, 36 F.3d 1513, 1518 (10th Cir. 1994) (citing Celotex, 477 U.S. at 325). The nonmoving party may not rest solely on the allegations in the pleadings, but must instead designate "specific facts showing that there is a genuine issue for trial." Celotex, 477 U.S. at 324; see also Fed. R. Civ. P. 56(c). A disputed fact is "material" if "under the substantive law it is essential to the proper disposition of the claim." Adler v. Wal-Mart Stores, Inc., 144 F.3d 664, 670 (10th Cir.1998) (citing Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986)). A dispute is "genuine" if the evidence is such that it might lead a reasonable jury to return a verdict for the nonmoving party.Thomas v. Metropolitan Life Ins. Co., 631 F.3d 1153, 1160 (10th Cir. 2011) (citing Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986).
Through their cross motions for summary judgment, both parties agree the issues ripe for court resolution may be decided here as a matter of law. [Pl.'s Mot. 1; Defs.' Mot. 2.]
The Policy at issue includes a Medical Payments provision ["Part B"], which is separate from the Policy's provisions concerning Liability Coverage ["Part A"], Uninsured Motorists Coverage ["Part C"], and Physical Damage Coverage ["Part D"]. [Policy 21-38; see UF ¶ 5.] Parts A and C provide coverage on the basis of fault, to wit: a determination of who caused, and therefore is responsible for, damages incurred during the accident. [See Policy 21-24, 28-31.] Benefits pursuant to Parts A and C are dependent, in most cases, on third-party involvement, as either a tortfeasor4 who is responsible for causing the accident/damages and who may or may not have his own insurance (implicating Part C), or as a victim of the insured if the insured was at fault for causing the accident/damages (Part A). [Id.]
Part B, on the other hand, provides "no-fault" insurance coverage, which is designed to provide payment for treatment of bodily injury incurred by the policyholder as a result of an automobile accident, regardless of who was at fault or the ownership of the automobile(s) involved. [Id. at 24-28.] The provision includes, inter alia, payment for immediate trauma care rendered by emergency medical providers. [Id.] Part B is the only provision at issue in this case.
Under the terms of the Policy, USAA GIC agreed to pay "the medical payment fee for medically necessary and appropriate medical services," which were "sustained by a covered person in an auto accident and incurred for services rendered within one year from the date of the auto accident," subject to twelve specific exclusions where Medical Payments coverage would not be provided under the Policy. [Policy 26-28.] The Part B exclusions are:
[Policy 27-28 (emphasis added); UF ¶ 6.]
The Workers' Compensation Act, Colo. Rev. Stat. §§ 8-40-101 et seq., establishes benefits available to workers injured in the course and scope of employment, and sets forth the procedures for obtaining those benefits. Section 8-42-101(1)(a), provides that:
Every employer, regardless of said employer's method of insurance, shall furnish such medical, surgical, dental, nursing, and hospital treatment, medical, hospital, and surgical supplies, crutches, and apparatus as may reasonably be needed at the time of the injury or occupational disease and thereafter during the disability to cure and relieve the employee from the effects of the injury.
Colo. Rev. Stat. § 8-42-101(1)(a). The workers' compensation scheme also provides that:
The director shall establish a schedule fixing the fees for which all surgical, hospital, dental, nursing, vocational rehabilitation, and medical services, whether related to treatment or not, pertaining to injured employees under this section shall be compensated. It is unlawful, void, and unenforceable as a debt for any physician, chiropractor, hospital, person, expert witness, reviewer, evaluator, or institution to...
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