Pususta v. State Farm Ins. Companies

• Decision Date: 19 July 2001
• Docket Number: No. C8-99-1068.,C8-99-1068.
• Citation: 632 N.W.2d 549
• Parties: Mariah PUSUSTA, Respondent, v. STATE FARM INSURANCE COMPANIES, Petitioner, Appellant.
• Court: Minnesota Supreme Court

632 N.W.2d 549

Mariah PUSUSTA, Respondent, v. STATE FARM INSURANCE COMPANIES, Petitioner, Appellant.

No. C8-99-1068.

Supreme Court of Minnesota.

July 19, 2001.

Robert W. Roe, Thomas J. Lyons & Associates, P.A., St. Paul, for respondent.

William M. Hart, Katherine A. McBride, Jenneane L. Jansen, Meagher & Geer, P.L.L.P., Minneapolis, for appellant.

Heard, considered, and decided by the court en banc.

OPINION

ANDERSON, RUSSELL A., Justice.

In mandatory arbitration, respondent Mariah Pususta sought no-fault medical expense benefits from her insurance carrier, appellant State Farm Insurance Companies (State Farm), for injuries she sustained in an automobile accident on December 6, 1997. We are asked to review the no-fault arbitrator's legal conclusion, upheld by the district court and affirmed by the court of appeals, that the arbitrator is precluded from considering whether some of the claimed medical expenses were for injuries that resulted from a prior nonautomobile accident, and if so, whether reimbursement for such expenses should be denied. We reverse and remand.

Pususta was in an automobile accident on December 6, 1997. At that time, she was receiving chiropractic care for back and neck injuries she sustained five years earlier in a horse-riding accident. In 1994, her chiropractor requested that her health insurance carrier allow 24 chiropractic visits per year to treat the injuries sustained in the horse-riding accident. In 1997, Pususta visited the chiropractor once a month until the automobile accident in December. Following the accident, Pususta's pain worsened and her chiropractor concluded that the auto accident had exacerbated her prior injuries. After the accident, Pususta received more frequent chiropractic care: seven times in December 1997, nine times in January, eight times in February, nine times in March, seven times in April, twice in May, once in June, twice in July, and twice in August.

Pususta had a no-fault automobile insurance policy with State Farm. Following the accident, State Farm reimbursed Pususta for the medical care she received for her injuries through February 1998, but State Farm refused to provide further coverage until Pususta submitted to an independent medical exam (IME). Pususta attended an IME on July 16, 1998. The independent medical examiner concluded that some of Pususta's injuries were caused by the earlier horse-riding accident and that chiropractic care for injuries arising out of the auto accident was warranted only through the first week in April 1998. State Farm informed Pususta that on this basis it would provide coverage only for expenses incurred through the first week of April.

Pususta sought arbitration of the dispute and coverage for all chiropractic care through September 16, 1998, the date of the arbitration. State Farm argued it should not be required to pay for medical expenses incurred after the first week in April because the remaining medical expenses were due to the horse-riding injury and further treatment for any injuries related to the automobile accident was not reasonable or necessary. State Farm also argued that if it were required to pay for any medical care received after the first week in April, the expenses should be apportioned based on the degree to which the automobile accident caused the injuries. Specifically, State Farm asked that it not be required to pay for the 24 chiropractic visits per year that the chiropractor requested for the injuries that existed before the auto accident.

The arbitrator awarded Pususta all of her medical expenses through August 1998. In his written conclusions, the arbitrator stated that the facts of the case "would call for apportionment, based upon the prior accident," but that our decision in Great West Casualty Co. v. Northland Ins. Co., 548 N.W.2d 279 (Minn.1996), precluded him from doing so. State Farm appealed. The district court upheld the award, and the court of appeals affirmed, concluding that under Great West, it was not clear that that the arbitrator erred by refusing to apportion medical expenses. See Pususta v. State Farm Ins. Cos., No. C8-99-1068, 1999 WL 1101388 (Minn.App.1999). We granted review to consider the no-fault arbitrator's conclusion that he was precluded by our decision in Great West from considering whether a portion of the claimed medical expenses resulted from injuries caused by the horse-riding accident and whether reimbursement for such expenses should be denied.

No-fault arbitrators are limited to deciding questions of fact and their legal determinations are subject to de novo review by the courts. Weaver v. State Farm Ins. Cos., 609 N.W.2d 878, 882 (Minn.2000). The issue before us is a legal determination, which we review de novo. Nathe Bros., Inc. v. Am. Nat'l Fire Ins. Co., 615 N.W.2d 341, 344 (Minn.2000).

We begin our analysis of the issue by examining the provisions of the Minnesota No-Fault Automobile Insurance Act¹ (No-Fault Act) relating to reimbursement of medical expenses. Our primary objective in interpreting statutory language is to give effect to the legislature's intent as expressed in the language of the statute. Minn.Stat. § 645.16 (2000). The No-Fault Act provides that an injured person, such as Pususta, is entitled to medical expense reimbursement "for all loss suffered through injury arising out of the maintenance or use of a motor vehicle * * *." Minn.Stat. § 65B.44, subd. 1 (2000) (emphasis added). The term "loss" is defined as economic detriment, which includes medical expenses "resulting from the accident causing the injury." Minn.Stat. § 65B.43, subd. 7 (2000) (emphasis added). The statutory language thus incorporates the element of causation into the determination of what losses are reimbursable.

The question that the trier of fact, in this case the arbitrator, must determine under the No-Fault Act is whether the medical expenses Pususta claims result from injuries arising out of, or caused by, the use or maintenance of a motor vehicle; that is, whether the medical expenses claimed are for injuries caused by the automobile accident. We have set forth three general considerations for determining whether an injury arose out of the use of a motor vehicle. See Cont'l W. Ins. Co. v. Klug, 415 N.W.2d 876, 878 (Minn.1987)

. In the case of this car accident, we are concerned only with the first consideration, which is the extent of causation between the automobile and the injury. Id.² The causal connection is established if "the injury is a natural and reasonable incident or consequence of the use of the vehicle." N. River Ins. Co. v. Dairyland Ins. Co., 346 N.W.2d 109, 114 (Minn.1984) (quoting Tlougan v. Auto-Owners Ins. Co., 310 N.W.2d 116, 117 (Minn.1981)).

As applied to this case, the arbitrator appeared to question whether all of the medical expenses Pususta claimed resulted from injuries caused by the car accident, but he declined to answer the question, referring to such a determination as an "apportionment" of expenses caused by the horse-riding accident and expenses caused by the auto accident. The arbitrator determined that the facts of this case called for such an apportionment, but he interpreted our decision in Great West to prohibit the apportionment of damages where two separate accidents contributed to an injury. See 548 N.W.2d at 281.³

In Great West, the insured injured his shoulder in 1988 in an accident that arose out of the use of a motor vehicle while he was working. Id. at 279. At the time he was insured by and received no-fault benefits from Northland Insurance Company. Id. In June 1991, the insured re-injured his shoulder, again arising out of use of a motor vehicle. Id. At that time, Great West was his insurance carrier and it promptly provided coverage for his economic losses related to the injury. Id. at 279-80. By May 1992, Great West had paid more than $15,000 in no-fault benefits for the shoulder injury. Id. at 280.

Great West brought a subrogation and contribution action against Northland under Minn.Stat. § 65B.47 (2000), which establishes the priority for coverages available when the loss results from use of a vehicle for employment. For example, the statute provides that if a person is insured in a vehicle provided by his employer, basic economic loss benefits are to be provided by the insurance carrier covering the vehicle, or, if none, the carrier covering the injured person. Minn.Stat. § 65B.47, subd. 1 (2000). The statute provides that where two or more obligations to pay benefits are applicable, the reparation obligor against whom a claim is asserted must pay the claim as if wholly responsible, but that obligor may bring an action for contribution against other obligors. Id., subd. 5. The statute also allows for an action in subrogation. Id., subd. 6.

Great West claimed that the injury for which it paid benefits was partially caused by the June 1988 accident when the claimant was insured by Northland and sought reimbursement under Minn.Stat. § 65B.47 from Northland for a portion of the benefits Great West paid its insured. Great West, 548 N.W.2d at 280. We were asked whether under section 65B.47, a no-fault carrier may by subrogation or contribution obtain reimbursement from another no-fault carrier for paid benefits that it contends were for injuries resulting from an earlier car accident, when the claimant was insured by the other carrier. We noted that subrogation in the no-fault context is purely a creature of statute and that the definition of "loss" under Minn.Stat. § 65B.43, subd. 7, implies that, for purposes of subrogation and contribution under section 65B.47, only one accident can be deemed the cause of an injury. Great West, 548 N.W.2d at 280-81. We concluded that the authorization for actions for subrogation and contribution in Minn.Stat. § 65B.47 does not apply to a multiple accident situation. Great West, 548 N.W.2d at 281.

Great West is distinguishable from the case at bar be...