Opinion
No. C9-00-1491.
Filed February 13, 2001.
Appeal from the District Court, Hennepin County, File No. CT99016361.
Michael D. Tewksbury, (for respondent)
Thomas H. Schaefer, (for appellant)
Considered and decided by Hanson, Presiding Judge, Shumaker, Judge, and Foley, Judge
This opinion will be unpublished and may not be cited except as provided by Minn. Stat. § 480A.08, subd. 3 (2000).
UNPUBLISHED OPINION
Appellant Farm Bureau Mutual Insurance Company (Farm Bureau) appeals from the district court's denial of its motion to vacate an arbitrator's decision and the court's confirmation of the arbitrator's award. Farm Bureau argues that the arbitrator lacked the power to hear an issue in the case. Because the district court did not err in denying Farm Bureau's motion, we affirm.
FACTS
Respondent Helen Heintz was involved in an automobile accident in March 1995. Farm Bureau was her no-fault insurer. In October 1999, Farm Bureau requested that Heintz undergo an independent medical examination (IME). Based on the results of the IME, Farm Bureau informed Heintz that it would deny any ongoing benefits and additional medical treatment that were inconsistent with the examiner's opinion.
In January 1998, in response to Farm Bureau's denial of ongoing benefits, Heintz filed a petition with the American Arbitration Association. During January and February of 1998, Heintz received treatment from Medical Advanced Pain Specialists (MAPS). In July 1998, the arbitrator issued an award in favor of Heintz. Because she was unaware that the MAPS bills had not been paid by Farm Bureau, Heintz did not include these bills in her submission to the arbitrator.
Heintz first learned in November 1998, approximately four months after the first arbitration hearing, that Farm Bureau had not paid for the MAPS treatments. She contends that the insurance company "never provided any indication to MAPS that the bills were being held, reviewed, or not going to be paid." Thus, in February 1999, Heintz again filed a petition for arbitration. In her statement of the case to the arbitrator, Heintz explained that Farm Bureau had not denied medical expenses for the MAPS treatment "by the time of the first arbitration. Only after the arbitration was concluded did [Farm Bureau] notify [MAPS] that it was denying the bills." Heintz argued that she had no reason to know that the bills were not being paid because she was given no notification of their denial.
After the second arbitration hearing, the arbitrator awarded Heintz payment for the MAPS bills. Farm Bureau moved the district court to vacate the award for the MAPS payments, arguing that the arbitrator exceeded his authority in determining that he had jurisdiction to consider billings that should have been included in the first arbitration. Farm Bureau's motion was denied, and the district court later confirmed the arbitration award. This appeal followed.
DECISION
An appeal from an arbitration decision is subject to an extremely narrow standard of review and the reviewing court must exercise "every reasonable presumption" in favor of the arbitration award's finality and validity. Hunter, Keith Indus., Inc. v. Piper Capital Mgmt., Inc., 575 N.W.2d 850, 854 (Minn.App. 1998) (citing State, Office of State Auditor v. Minnesota Ass'n of Prof'l Employees, 504 N.W.2d 751, 754 (Minn. 1993)). Farm Bureau, as the party seeking to vacate the arbitrator's award, had the burden of proving that the award is invalid. National Indem. Co. v. Farm Bureau Mut. Ins. Co., 348 N.W.2d 748, 750 (Minn. 1984). An award may be vacated where the arbitrator has clearly exceeded his or her powers. Id.; Minn. Stat. § 572.19, subd. 1(3) (2000). In no-fault proceedings, arbitrators are limited to deciding issues of fact, leaving interpretation of legal issues to the courts. Hippe v. American Family Ins. Co., 565 N.W.2d 439, 441 (Minn.App. 1997). Because the issue in this case of whether the arbitrator exceeded his authority is a question of law, this court is not bound by, and need not give deference to, the district court's decision. Id.
I. Doctrine of Satisfaction
Farm Bureau first contends that, because Heintz signed and returned a "satisfaction and acknowledgement" prior to accepting the award from the first arbitration, she is barred from reimbursement of the MAPS billings under the doctrine of satisfaction. An accord and satisfaction is an executed contract that discharges a contract or cause of action. Ladwig Ladwig, Inc., v. Orlin Ladwig, Inc., 372 N.W.2d 408, 411 (Minn.App. 1985). Farm Bureau argues that because
Ms. Heintz failed to include the monies for the MAPS billings at the first arbitration, then accepted payment from Farm Bureau in full satisfaction of the arbitration award * * * all claims whether asserted or not must be deemed fully satisfied and discharged through the date of the first award.
Whether there has been an accord and satisfaction is a question of fact. Webb Bus. Promotions, Inc., v. American Elec. Entm't Corp., 617 N.W.2d 67, 73 (Minn. 2000). Because the arbitrator determines fact issues, this court accepts his or her findings as final. Minn. Stat. § 572.19, subd. 1(3) (1998); Hippe, 565 N.W.2d at 441 (stating that arbitrator's factual findings are final in cases involving no-fault automobile insurance claims). The arbitrator awarded Heintz monies for the MAPS treatments, thereby determining that she was not barred from recovering under this doctrine.
Farm Bureau interprets the satisfaction and acknowledgement form to mean any claims through the date of the July 1998 hearing must be deemed satisfied in full. This would include the MAPS treatments that Heintz underwent in January and February 1998. But the document that Heintz signed states only that she releases Farm Bureau "from any further payment on these claims," that is, those claims that were before the arbitrator. (Emphasis added). The MAPS bills were not before the arbitrator. See Action Instruments Co. v. Hi-G Inc., 359 N.W.2d 664, 666 (Minn.App. 1984) (stating it "is fundamental that an accord and satisfaction is only concluded as to those matters actually included therein."). Further, in awarding Heintz payments in the first arbitration, the arbitrator stated that the "award is in full settlement of all claims submitted to this arbitration." Again, the MAPS bills were not submitted to the arbitrator. As Heinz argues, the signing of the document acknowledged payment of the award; it did not release all claims prior to that date.
II. Waiver
Farm Bureau next argues that Heintz waived any claim to the MAPS billings by failing to submit them at the first hearing in July 1998. In support of its argument, Farm Bureau cites Hippe for the proposition that if a claimant has knowledge, prior to arbitration, that the insurer has denied other medical benefits, any additional outstanding medical bills were claims that should have been included in any subsequent no-fault proceedings. Farm Bureau contends that Heintz had both actual and constructive knowledge of prior medical denials.
Actual Knowledge
Farm Bureau first argues that Heintz had actual knowledge that the MAPS billings would not be paid because she had been notified in October 1997, after the IME, that Farm Bureau "had no ongoing obligation" to pay. Because the MAPS treatments were administered in January and February of 1998, she was on notice that that the billings would not be paid and that those claims would have to be submitted to an arbitrator. Based on Hippe, Farm Bureau argues, the MAPS bills "must be deemed waived."
To establish waiver, Farm Bureau must show that Heintz (1) had full knowledge of the facts, (2) had full knowledge of her rights, and (3) intended to relinquish those rights. Freitag v. Wolf, 303 Minn. 139, 142, 226 N.W.2d 868, 870 (1975); see also Montgomery Ward Co., Inc. v. County of Hennepin, 450 N.W.2d 299, 304 (Minn. 1990) (explaining waiver is voluntary and intentional relinquishment or abandonment of known right). Evidence of both intent to waive and knowledge of the right to waive is required. Engstrom v. Farmers Bankers Life Ins. Co., 230 Minn. 308, 312, 41 N.W.2d 422, 424 (1950).
Farm Bureau failed to meet its burden of proving waiver because it did not establish that Heintz knew that the MAPS billings had not been paid. Heintz asserts that Farm Bureau did not acknowledge receipt of the MAPS billings, did not issue a denial of the billings, and did not communicate in any way to MAPS or Heintz that the billings had been denied. She was not notified until November 1998, four months after the first arbitration, that Farm Bureau had not paid the billings.
A MAPS employee submitted an affidavit supporting Heintz's allegations, which stated: (1) MAPS contacted Farm Bureau in February and March 1999, by telephone and mail, to inquire about the billings because they had not received notice regarding Farm Bureau's intention to pay; (2) the employee was told that the bills "could still be paid"; (3) later, in May 1999, MAPS received a letter from Farm Bureau indicating that arbitration had been filed and that it was denying payment of the billings until the arbitration was complete and they were "ordered to make payment"; and (4) MAPS finally sent the bill to Heintz in November 1999. Farm Bureau did not respond to the allegations in this affidavit. Heintz cannot be deemed to have waived her right to arbitrate this issue because Farm Bureau did not establish that she knew that the bills had not been paid or that she intended to waive her right to arbitrate the MAPS billings.
Further, it is not uncommon for an insured to continue seeking benefits after his or her insurer declines to continue paying ongoing benefits based on an independent medical examiner's determination that no future treatments are necessary. For example, in an opinion recently issued by this court, the insured underwent an IME at the request of her insurance company. Karels v. State Farm Ins. Co., 617 N.W.2d 432, 433 (Minn.App. 2000). After the examination, the company declined to continue paying the insured's no-fault benefits based on the independent medical examiner's determination that the insured did not need additional medical treatment. Id. Before a scheduled arbitration hearing, the insured underwent additional treatment for the same injury; the arbitrator issued an award on her behalf, which included payment for the additional treatment. Id. at 434. The district court vacated the arbitrator's award, but this court reversed because the later claims fell within the arbitrator's continuing jurisdiction. Id. at 436.
Constructive Knowledge
Farm Bureau also contends that Heintz had constructive knowledge that the MAPS billings had been denied because 30 days elapsed between the submission of the claim and its denial. See Minn. R. No-Fault Arb. 5 (stating that if insurer fails to respond to claim within 30 days, it is deemed denied). Therefore, it argues, the billings were constructively denied four months before the first arbitration.
In response, Heintz cites a provision of the Unfair Claims Practices Act that authorizes the Commissioner of Commerce to impose administrative remedies for various unfair settlement practices. Minn. Stat. § 72A.201 (2000). The relevant provision provides that an insurer engages in an unfair settlement practice when it fails
to complete its investigation and inform the insured or claimant of acceptance or denial of a claim within 30 business days after receipt of notification of claim unless the investigation cannot be reasonably completed within that time. In the event that the investigation cannot reasonably be completed within that time, the insurer shall notify the insured or claimant within the time period of the reasons why the investigation is not complete and the expected date and the expected date the investigation will be complete.
Minn. Stat. § 72A.201, subd. 4(3) (2000) (emphasis added). Farm Bureau correctly states that the Act does not create a private right of action against the insurer. Morris v. American Family Mut. Ins. Co., 386 N.W.2d 233, 235 (Minn. 1986). Because there is no private right of action, Farm Bureau argues the provision is inapplicable to this case.
Farm Bureau fails to note that Heintz did not bring her claim under the Unfair Claims Practices Act. She merely asserts that Farm Bureau should have notified her or MAPS within 30 days that it was denying the billings. Farm Bureau was under a statutory obligation either to state its coverage position within 30 business days after receiving notice of the claim or to advise Heintz that it could not reasonably complete its investigation of the claim within 30 days. Minn. Stat. § 72A.201, subd. 4(3). In its order, the district court noted that
Farm Bureau never notified Heintz or MAPS of its refusal to pay these bills until late 1998, despite the fact that an insurer is required to notify the insured of a denial within thirty days of receipt of the claim.
Further, as the district court noted, Hippe is distinguishable because the insured in that case had submitted several claims to her insurer and received formal denials prior to filing for arbitration. Hippe, 656 N.W.2d at 441.
The district court did not err in denying Farm Bureau's motion to vacate. Heintz did not waive her right to seek reimbursement of the MAPS billings by failing to raise them at the first arbitration hearing because she was unaware that they had not been paid.
Impermissible Splitting of Cause of Action
Farm Bureau's final argument is that Heintz split her cause of action by failing to include the MAPS billings in her first arbitration. A claimant seeking no-fault benefits cannot impermissibly split his or her cause of action where his or her purpose is to avoid jurisdictional limits. Charboneau v. American Family Ins. Co., 481 N.W.2d 19, 21 (Minn. 1992). In Charboneau, the court determined that the insured impermissibly split her cause of action in order to avoid the jurisdictional limit provided for by Minn. Stat. § 65B.525, subd. 1. Id. The court also stated that by "splitting no-fault damages, claimants are manipulating the system beyond what seems fair." Id.; see also Hippe, 565 N.W.2d at 442 (recognizing that there was no impermissible splitting of cause of action where "the evidence [did] not indicate that Hippe was attempting to manipulate the system."). Farm Bureau does not allege that Heintz engaged in any manipulation. There is also no evidence that she split her claims to evade a jurisdictional limit. She had no reason to know that the MAPS bills should have been a subject of the earlier arbitration. Because Heintz had not received the bills by the time of the hearing, and because there was no evidence of manipulation or that she was attempting to evade the jurisdictional limit, the district court did not err in confirming the arbitration award.
The district court did not err in denying Farm Bureau's motion to vacate the arbitration award, as the arbitrator had the authority to hear this issue.