United Services Auto. Ass'n v. Perry, No. 95-50512

CourtUnited States Courts of Appeals. United States Court of Appeals (5th Circuit)
Writing for the CourtBefore SMITH, DUHE and DeMOSS; PER CURIAM; DeMOSS
Citation92 F.3d 295
PartiesUNITED SERVICES AUTOMOBILE ASSOCIATION, Plaintiff-Appellee, v. William J. PERRY, Secretary of United States Department of Defense, and United States of America, Defendants-Appellants.
Docket NumberNo. 95-50512
Decision Date09 August 1996

Page 295

92 F.3d 295
65 USLW 2125
UNITED SERVICES AUTOMOBILE ASSOCIATION, Plaintiff-Appellee,
v.
William J. PERRY, Secretary of United States Department of
Defense, and United States of America,
Defendants-Appellants.
No. 95-50512.
United States Court of Appeals,
Fifth Circuit.
Aug. 9, 1996.

Page 296

Barry A. Chasnoff, Stephan B. Rogers, Polly Jessica Estes, Akin, Gump, Strauss, Hauer & Feld, San Antonio, TX, for plaintiff-appellee.

Stephanie Robin Marcus, Barbara C. Biddle, United States Department of Justice, Civil Division, Appellate Staff, Washington, DC, for defendants-appellants.

Appeal from the United States District Court for the Western District of Texas.

Before SMITH, DUHE and DeMOSS, Circuit Judges.

PER CURIAM:

In this case of first impression, we are called upon to interpret the meaning of Congress' 1990 amendment to 10 U.S.C. § 1095 (Supp.1995). Section 1095 allows the military to be reimbursed by insurance carriers for medical expenses it incurs in treating soldiers whom the carriers insure. We determine that the term "no-fault insurance carrier," as it appears in the statute, is ambiguous. We therefore defer to the interpretation of that term by the agency entitled to administer the statute, the Department of Defense ("DOD"), reverse the summary judgment in favor of the United Services

Page 297

Automobile Association ("USAA"), and render summary judgment for the government. 1

I.

This case arises from twelve separate automobile accidents 2 involving members of the military who were entitled to receive and did receive medical care in a military hospital and who were also insured by USAA. The service members were treated for their injuries at military hospitals at no cost to the soldiers. 10 U.S.C. §§ 1074, 1076 (Supp.1995). Each soldier had an individually-owned automobile insurance policy issued by USAA that contained liability coverage, uninsured motorist coverage, coverage for damage to the insured's vehicle and medical payments coverage ("Medpay"), which covered the insureds for medical costs arising from automobile accidents.

The government filed claims with USAA, seeking reimbursement for costs incurred in treating USAA's insureds. The government based its claim on 10 U.S.C. § 1095, which provides that "the United States shall have the right to collect from a third-party payer the reasonable costs of health care services incurred by the United States on behalf of such person through a [military hospital]...." Id. at § 1095(a)(1). The statute defines a "third-party payer" as "an entity that provides an insurance, medical service, or health plan by contract or agreement, including an automobile liability insurance or no-fault insurance carrier." Id. at § 1095(h)(1).

USAA refused to pay, and instead filed a declaratory judgment action against the government, seeking a determination that it did not owe reimbursement. Specifically, USAA sought a determination that it was not a third-party payer under § 1095.

The parties stipulated that there were no disputed facts and filed cross-motions for summary judgment. The district court ruled in USAA's favor, holding that Medpay is not no-fault insurance and USAA is therefore not a third-party payer liable to the government under § 1095. The government timely appealed.

II.

The government contends that USAA is a "third-party payer" under § 1095, required to reimburse the government for health care the military provides its insureds. We must determine whether USAA is a "third-party payer" because of the inclusion of its Medpay coverage in its automobile policy.

Before 1990, § 1095 defined "third-party payer" as "an entity that provides insurance, medical service or health plan by contract or agreement." Congress amended the statute in 1990, adding the words "including an automobile liability insurance or no-fault insurance carrier." The government and USAA have already litigated the issue of whether USAA is a third-party payer because of Medpay under § 1095 as it was prior to 1990. In United States v. United Services Auto. Ass'n, 5 F.3d 204 (7th Cir.1993), the Seventh Circuit held that USAA was not such a third-party payer.

We are, of course, not bound by the Seventh Circuit's decision. Principles of estoppel, however, preclude the government from re-litigating against the same party an issue upon which another circuit has ruled against the government. United States v. Stauffer Chem. Co., 464 U.S. 165, 171, 104 S.Ct. 575, 578-79, 78 L.Ed.2d 388 (1984). Thus, if the government is to prevail in its view that USAA is now a third-party payer, it must do so under the 1990 amendments. 3

Page 298

We must, therefore, determine whether USAA is an "automobile liability insurance or no-fault insurance carrier."

We conclude that USAA is a no-fault insurance carrier because Medpay is a form of no-fault insurance. DOD is entrusted to administer § 1095, and it has issued regulations interpreting the term "no-fault insurance" as

an insurance contract providing compensation for health and medical expenses relating to personal injury arising from the operation of a motor vehicle in which the compensation is not premised on who may have been responsible for causing such injury. No-fault insurance includes personal injury protection and medical payments benefits in cases involving personal injuries resulting from operation of a motor vehicle.

32 C.F.R. § 220.12(i) (1995). USAA urges us to reject this definition, arguing that "no-fault insurance" refers only to a state-adopted regime of automobile insurance that pays without regard to fault.

When an agency has issued an interpretation of a statute it is entitled to administer, our own interpretation of the statute is not entirely de novo. The Supreme Court has given us guidance, in Chevron, U.S.A. v. Natural Resources Defense Council, Inc., 467 U.S. 837, 104 S.Ct. 2778, 81 L.Ed.2d 694 (1984), in reviewing such agency regulations:

When a court reviews an agency's construction of the statute which it administers, it is confronted with two questions. First, always, is the question whether Congress has directly spoken to the precise question at issue. If the intent of Congress is clear, that is the end of the matter; for the court, as well as the agency, must give effect to the unambiguously expressed intent of Congress. If, however, the court determines Congress has not directly addressed the precise question at issue, the court does not simply impose its own construction, as would be necessary in the absence of administrative interpretation. Rather, if the statute is silent or ambiguous with respect to the specific issue, the question for the court is whether the agency's answer is based on a permissible construction of the statute.

Id. at 842-43, 104 S.Ct. at 2781-82 (footnotes omitted).

Accordingly, our first task is to determine whether the statute is ambiguous. If we determine that Congress has directly spoken to the precise issue, then our job is done; we will "give effect to the unambiguously expressed intent of Congress." Id. at 843, 104 S.Ct. at 2781. If, however, we find that Congress has not plainly spoken to the issue and the statute is ambiguous on its face, we then will determine whether the agency's construction of the statute is a permissible one.

A statute is ambiguous if it is susceptible to more than one meaning. NORMAN J. SINGER, 2A SUTHERLAND STATUTORY CONSTRUCTION § 45.02 (5th ed. 1992). In interpreting a statute, we begin with its plain language. Phillips v. Marine Concrete Structures, Inc., 895 F.2d 1033, 1035 (5th Cir.1990). At first glance, either USAA's or the government's interpretation of § 1095 seems plausible. Recourse to dictionaries does not clarify the issue, but only serves to prove that the term "no-fault insurance carrier" is ambiguous. One authority defines no-fault as "[o]f or indicating a system of automotive insurance in which accident victims are compensated by their insurance companies without assignment of blame." WEBSTER'S II NEW RIVERSIDE UNIVERSITY DICTIONARY 797 (1988). This definition supports USAA's position, as it considers "no-fault" as referring to a system of insurance. Another source supports the government's view by defining "no-fault" as "of, or relating to, or being a motor vehicle insurance plan under which an accident victim is compensated ... by his own insurance company regardless of who is responsible for the accident." WEBSTER'S NINTH NEW COLLEGIATE DICTIONARY 801 (1989).

Both parties can (and do) claim assistance from a third reference, which defines "no-fault auto insurance" as the

[t]ype of automobile insurance in which claims for personal injury ... are made

Page 299

against the claimant's own insurance company (no matter who was at fault) rather than against the insurer of the party at fault. Under such state 'no-fault' statutes only in cases of serious personal injuries and high medical costs may the injured bring an action against the other party or his insurer. No-fault statutes vary from state to state in terms of scope of coverage, threshold amounts, etc.

BLACK'S LAW DICTIONARY 723 (5th ed. 1979). Still another authority defines "no-fault" as "designat[ing] a form of motor vehicle insurance." OXFORD ENGLISH DICTIONARY 462 (2d ed. 1989). In its examples of usage, however, it leans toward USAA's definition. Id. at 462 ("[A] no-fault compensation system in being discussed.... [a] strong no-fault insurance bill."). A final source lends credence to the government's position, defining "no-fault" as "a form of automobile insurance enabling the policyholder in case of an accident to collect a certain basic compensation ... from his own insurance company without determination of liability." RANDOM HOUSE COLLEGE DICTIONARY 902 (1982).

Based on this review of definitions of "no-fault," we determine that the word is commonly used in both ways, to denote either (1) an insurance policy or (2) a state-imposed insurance system that...

To continue reading

Request your trial
2 practice notes
  • United Services Auto. Ass'n v. Perry, No. 95-50512
    • United States
    • United States Courts of Appeals. United States Court of Appeals (5th Circuit)
    • December 13, 1996
    ...Western District of Texas. Page 145 Before SMITH, DUHE and DeMOSS, Circuit Judges. PER CURIAM: The opinion originally issued in this case, 92 F.3d 295 (5th Cir.1996) (per curiam), is hereby withdrawn, and the following opinion is substituted for purposes of In this case of first impression,......
  • Harris County, Tex. v. Gist, Civil Action No. H-96-3515.
    • United States
    • United States District Courts. 5th Circuit. United States District Courts. 5th Circuit. Southern District of Texas
    • December 13, 1996
    ...the court would have adopted, the court must defer to the agency's interpretation. See also United Services Auto. Ass'n v. Perry, 92 F.3d 295, 298 (5th Cir.1996). Thus, under Chevron, the County must prove either that the BJA misinterpreted an unambiguous statute or that the BJA adopted an ......
2 cases
  • United Services Auto. Ass'n v. Perry, No. 95-50512
    • United States
    • United States Courts of Appeals. United States Court of Appeals (5th Circuit)
    • December 13, 1996
    ...Western District of Texas. Page 145 Before SMITH, DUHE and DeMOSS, Circuit Judges. PER CURIAM: The opinion originally issued in this case, 92 F.3d 295 (5th Cir.1996) (per curiam), is hereby withdrawn, and the following opinion is substituted for purposes of In this case of first impression,......
  • Harris County, Tex. v. Gist, Civil Action No. H-96-3515.
    • United States
    • United States District Courts. 5th Circuit. United States District Courts. 5th Circuit. Southern District of Texas
    • December 13, 1996
    ...the court would have adopted, the court must defer to the agency's interpretation. See also United Services Auto. Ass'n v. Perry, 92 F.3d 295, 298 (5th Cir.1996). Thus, under Chevron, the County must prove either that the BJA misinterpreted an unambiguous statute or that the BJA adopted an ......

VLEX uses login cookies to provide you with a better browsing experience. If you click on 'Accept' or continue browsing this site we consider that you accept our cookie policy. ACCEPT