Berrios v. State Farm Ins. Co

In Berrios v. State Farm Ins. Co., 98 Ohio St.3d 109, 2002 Ohio 7115, 781 N.E.2d 149, the Ohio Supreme Court held that an insurer could not seek reimbursement of medical payments from the proceeds of its insured's settlement when a portion of that settlement came from the insured's own underinsured motorist ("UIM") coverage. Berrios at P40-44. Berrios's insurance company, State Farm, paid for Berrios's medical bills under the medical payments provision of his policy before he settled his claim with the other driver in an automobile accident. After Berrios's claim against the other driver settled for the limit on that driver's policy, Berrios had to file a UIM claim with State Farm. Berrios and State Farm agreed to settle the UIM claim, but disagreed as to whether State Farm then could seek reimbursement for medical payments from the portion of Berrios's settlement that came from the other driver's policy. The Supreme Court held that State Farm could not seek reimbursement from Berrios for medical payments because State Farm was statutorily obligated to provide Berrios with UM/UIM coverage and because State Farm "treated UIM coverage separately from medical payments coverage by setting out separate conditions for payment under the contract and charging separate premiums." Id. at P34. The Court specified that Berrios "must recover under both the medical payments and UIM coverage" because if the same insurance company insures an individual for both UIM and medical payments coverage, that insurance company may not upset the "special protection" of UM/UIM coverage by offsetting that coverage using another provision in the insured's policy. Id. at P40-43.