Brethren insurance

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About Brethren Mutual Insurance Co. Brethren Mutual Insurance Co is located at 149 N Edgewood Dr in Hagerstown, Maryland . Brethren Mutual Insurance Co can be About Brethren Mutual Insurance Company. Established in 1897, Brethren Mutual Insurance Company is a property-casualty insurance company headquartered in Hagerstown

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Download PDF REPORTED IN THE COURT OF SPECIAL APPEALS OF MARYLAND No. 1787 September Term, 2011 BRETHREN MUTUAL INSURANCE CO. v. KENNETH SUCHOZA Meredith, Woodward, Matricciani, JJ. Opinion by Woodward, J. Filed: May 29, 2013 The instant appeal arises from a lawsuit filed on March 12, 2010, in the Circuit Court for Prince George s County by appellee, Kenneth Suchoza, against appellant, Brethren Mutual Insurance Company ( Brethren ), alleging that Brethren failed to pay benefits under an uninsured motorist ( UM ) policy between Brethren and appellee s employer, Matrix Mechanical, Inc. ( Matrix ). Appellee s UM claim resulted from injuries sustained during a May 29, 2007 motor vehicle accident caused by an uninsured motorist while appellee was driving within the scope of his employment with Matrix. On August 15 and 16, 2011, a trial was held in circuit court, at the conclusion of which a jury returned a verdict in favor of appellee for $535,876.00. Following the entry of judgment, Brethren filed a Motion for New Trial and to Alter or Amend Judgment, seeking, among other things, to have the judgment reduced by the amount of workers compensation benefits previously received by appellee. On January 19, 2012, the circuit court denied Brethren s motion for a new trial but amended the judgment by reducing the amount thereof from $535,876.00 to $356,669.03 to reflect the amount of workers compensation benefits received by appellee as of the time of trial. On appeal, Brethren presents three questions for our review, which we have slightly rephrased: I. Did the trial court err or abuse its discretion by refusing to admit testimony of the payment of appellee s medical expenses by his workers compensation carrier and the acceptance thereof as full payment by his health care providers? II. Did the trial court err by failing to reduce the judgment in favor of appellee by the amount of workers compensation benefits received by appellee from the trial date to the date of the court s ruling on Brethren s post-trial motion? III. Did the trial court err by entering judgment in favor of

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Was received by appellee. Appellee s Uninsured Motorist Claim Matrix maintained a UM policy with Brethren that, according to appellee, was specifically contracted for by [Matrix] to provide for all medical treatment, lost wages, and any other relevant damages and injuries rendered to their employees as a result of an uninsured driver. The insurance policy contained a provision limiting Brethren s liability in the event that an employee recovered workers compensation benefits stemming from the same accident for which UM benefits were sought. The relevant provision states: We will not pay for any element of loss [i]f a person is entitled to receive payment for the same element of loss under any workers compensation, disability or similar law. However, this applies only to that amount for which the provider of the workers compensations [sic] benefits has not been reimbursed. Appellee filed a claim with Brethren under its UM policy, which Brethren denied. On March 12, 2010, appellee filed a complaint in circuit court, asserting that Brethren s 3 denial of UM benefits pursuant to Brethren s UM insurance policy with Matrix constituted a breach of contract. In light of the UM provision limiting Brethren s liability based upon workers compensation recovery by appellee, the parties filed a Consent Motion to Stay Proceedings on January 11, 2011, requesting that the circuit court case be stayed pending the resolution of appellee s workers compensation claim. On January 25, 2011, the trial court entered an order denying the request. On August 15 and 16, 2011, a jury trial was held in the circuit court. At trial, appellee introduced into evidence the medical bills, totaling $129,876.00, that he incurred as a result of the accident, along with the testimony of his treating physician that such bills were fair, reasonable, and necessary. Brethren sought to introduce evidence of the reasonable value of the medical services rendered to appellee by proffering evidence of the actual payments made by appellee s workers compensation carrier1 and accepted as full payment by the health care providers. The trial court did not allow the admission of the evidence of such

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Will treat Brethren s motion as filed under that rule. Of course, if Brethren s motion had been filed within 10 days after the entry of the judgment, its motion under Rule 2-535(a) would have been treated as a motion under Rule 2-534. See Miller v. Mathias, 428 Md. 419, 442 n.15 (2012) (noting that a Rule 2-535 motion, if filed within 10 days of the entry of judgment by the court, will be treated as a Rule 2-534 motion (citations omitted)); see also footnote 11, infra. 17 Court is aware that since the trial, [a] fifty six thousand six hundred dollar award has been entered and nine thousand three hundred and thirty nine of those dollars have been paid in workers[ ] comp. [APPELLEE S COUNSEL]: That s accurate, Your Honor. THE COURT: Okay. So you want, what s the number you want me to reduce it by? [APPELLEE S COUNSEL]: Well, the number that [appellee] would like to reduce by, what we feel is accurate is the amount as of the day of the trial. (Emphasis added). On January 19, 2012, the circuit court entered an amended judgment, reducing the original judgment amount of $535,876.00 to $356,669.03, reflecting the $179,206.97 in workers compensation received by appellee at the time of trial, but not the additional $56,639.00 awarded thereafter, or the $9,339.00 actually received by appellee between the date of trial and January 13, 2012. In declining to reduce the judgment by the amount awarded or received after trial, the circuit court reasoned that the reduction was limited to the amount of workers compensation received as of the date of trial, relying on Md. Code (1995, 2011 Repl. Vol.), § 19-513(e) of the Insurance Article ( Ins. ) and the court s view that [w]e have to have some finality to this. In the instant appeal, Brethren contends that it is not obligated to pay uninsured 18 motorist benefits for the same benefits that appellee is entitled to recover pursuant to workers compensation law. Thus, according to Brethren, the trial court erred in not deducting an additional $56,639.00 from. About Brethren Mutual Insurance Co. Brethren Mutual Insurance Co is located at 149 N Edgewood Dr in Hagerstown, Maryland . Brethren Mutual Insurance Co can be About Brethren Mutual Insurance Company. Established in 1897, Brethren Mutual Insurance Company is a property-casualty insurance company headquartered in Hagerstown

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Has not cited to any authority, nor have we found any, that is contrary to this conclusion. Thus, our affirmance of the trial court s judgment will not result in a double recovery by appellee of future workers compensation benefits. For the foregoing reasons, Brethren breached its policy with appellee s employer by failing to pay UM benefits due to appellee, and the trial court properly entered judgment on the jury verdict (less the workers compensation benefits actually received by appellee as of the date of trial).12 12 After oral argument before this Court, Brethren filed a Motion Concerning Relevant Law Issued by the Court of Appeals on February 25, 2013. In that motion, Brethren cites to TravCo Insurance Co. v. Williams, 430 Md. 396 (2013), not for the principles discussed earlier in this opinion, but for the Court s holding on a separate issue namely, whether, assuming that the law applicable to the underlying automobile accident and to the WC claim treats write-downs of medical bills as WC benefits, such write-downs would reduce the benefits payable under § 19-513(e) of the Insurance Article. Id. at 412. The Court held that, [a]ssuming, arguendo, that the write-downs were the actual benefits paid out by the WC provider and recovered by [the insured] under the WC laws of the District of Columbia, the UM benefits, which [the insured] is entitled to receive, shall be reduced to the extent that the write-downs were un-reimbursed. Id. Brethren claims that under TravCo, the (continued...) 34 JUDGMENT OF THE CIRCUIT COURT FOR PRINCE GEORGE S COUNTY AFFIRMED. APPELLANT TO PAY COSTS. 12 (...continued) judgment in the instant case should be reduced by the write-offs in appellee s medical bills, totaling $69,248.12. Brethren, however, acknowledges that a reduction for write-offs was not requested in the trial court. Nor was the issue raised in Brethren s opening brief in this Court. Given the clear lack of preservation of this issue, as well as the fact that the holding of TravCo on this issue is based on the assumption that under the workers compensation laws of the District of

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Allowed to stand, appellee will succeed in obtaining a double recovery. Brethren explains that, under Md. Code (1991, 2008 Repl. Vol.), §§ 9-902(c) & 9-903 of the Labor and Employment Article ( LE ), if an injured party is awarded a judgment in the tort case and subsequently [is] awarded workers compensation benefits, the workers compensation provider would not be required to pay until [appellee] s entitlement to workers compensation benefits exceeded the amount of the tort judgment. Brethren contends that such rule would not apply to the instant case, thus allowing appellee to receive the judgment entered on the jury s verdict plus any future workers compensation benefits awarded to him. We disagree that LE §§ 9-902(c) & 9-903 would not apply to the instant case to preclude a double recovery for future workers compensation benefits received by appellee. LE § 9-902(c) permits a covered employee, under certain circumstances, to bring an action for damages against [a] third party. A third party is defined as the party who is liable for the injury or death of the covered employee. LE § 9-902(a). LE § 9-903 then provides that the amount received in such action is in place of any award that otherwise could be made under the workers compensation law, unless the amount received in a tort action is less than the amount of workers compensation benefits to which the covered employee is 33 entitled. Because an insurance carrier under a UM policy steps into the shoes of the tortfeasor, Andrew Janquitto, Maryland Motor Vehicle Insurance 324 (3d ed. 2011), and a plaintiff must prove his or her negligence claim against the tortfeasor in order to recover under such policy, it follows that the third party who is liable for the injury or death of the covered employee under LE §§ 9-902(a), (c) & 9-903 includes both the tortfeasor and the insurance carrier under a UM policy. See Kritsings v. State Farm Mut. Auto. Ins. Co., 189 Md. App. 367, 376 (2009) (noting that an injured insured can maintain actions against both a tortfeasor and a UM carrier). Brethren

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And reasonable value of the medical services rendered to appellee was the amounts paid and accepted by the health care providers, and not the amounts charged as stated on the medical bills. It is clear that under Kujawa, Shpigel, and Desua, evidence of the payment of 11 appellee s medical bills does not establish the reasonable value of the services for which the bills were rendered, and thus is irrelevant to the issue of reasonableness. See Md. Rule 5401. For the evidence of payment of appellee s medical bills to be admissible, Brethren had to adduce expert testimony or other competent evidence that the amount of such payment was the fair and reasonable value of the medical services rendered to appellee. Brethren did not proffer to the trial court any expert testimony or other competent evidence of reasonableness.4 In addition, the mere acceptance by a medical provider of the payment of a lesser amount on a bill is not probative of the reasonable value of the medical services reflected in that bill. There are many reasons (e.g., managed care contracts, Medicaid contracts, private insurance agreements, etc.) why medical providers would accept a lesser amount than the amount charged. Indeed, in his deposition testimony,5 Dr. Urban stated: I think that the 4 We recognize that Kujawa, Shpigel, and Desua involved a plaintiff seeking to introduce medical bills as special damages for injuries caused by the defendant tortfeasor. Brethren has not cited to us any authority in Maryland, however nor have we found any why the requirement imposed on a plaintiff to adduce expert testimony or other competent evidence of the reasonable value of medical services reflected in the plaintiff s bills should not apply to a defendant who attempts to show the reasonable value of such services by introducing evidence of payment of an amount less than the amount charged. 5 In light of the trial court s ruling that excluded Brethren s proffered evidence of payments made on appellee s medical bills, the portion of Dr. Urban s deposition where Brethren s counsel cross-examined Dr. Urban about those payments was. About Brethren Mutual Insurance Co. Brethren Mutual Insurance Co is located at 149 N Edgewood Dr in Hagerstown, Maryland . Brethren Mutual Insurance Co can be About Brethren Mutual Insurance Company. Established in 1897, Brethren Mutual Insurance Company is a property-casualty insurance company headquartered in Hagerstown