{ "id": 1902475, "name": "Oliver Doyle ROY v. FARMERS & MERCHANTS INSURANCE COMPANY", "name_abbreviation": "Roy v. Farmers & Merchants Insurance", "decision_date": "1991-11-11", "docket_number": "91-170", "first_page": "213", "last_page": "217", "citations": [ { "type": "official", "cite": "307 Ark. 213" }, { "type": "parallel", "cite": "819 S.W.2d 2" } ], "court": { "name_abbreviation": "Ark.", "id": 8808, "name": "Arkansas Supreme Court" }, "jurisdiction": { "id": 34, "name_long": "Arkansas", "name": "Ark." }, "cites_to": [ { "cite": "14 A.L.R. 4th 761", "category": "reporters:specialty", "reporter": "A.L.R. 4th", "opinion_index": 0 }, { "cite": "376 A.2d 224", "category": "reporters:state_regional", "reporter": "A.2d", "year": 1977, "opinion_index": 0 }, { "cite": "150 N.J. Super. 576", "category": "reporters:state", "reporter": "N.J. Super.", "case_ids": [ 869283 ], "year": 1977, "opinion_index": 0, "case_paths": [ "/nj-super/150/0576-01" ] }, { "cite": "292 Ark. 1", "category": "reporters:state", "reporter": "Ark.", "case_ids": [ 1871434 ], "weight": 2, "year": 1987, "opinion_index": 0, "case_paths": [ "/ark/292/0001-01" ] }, { "cite": "300 Ark. 317", "category": "reporters:state", "reporter": "Ark.", "case_ids": [ 1886873 ], "weight": 2, "year": 1989, "opinion_index": 0, "case_paths": [ "/ark/300/0317-01" ] }, { "cite": "300 Ark. 390", "category": "reporters:state", "reporter": "Ark.", "case_ids": [ 1886867 ], "weight": 2, "year": 1989, "opinion_index": 0, "case_paths": [ "/ark/300/0390-01" ] }, { "cite": "302 Ark. 51", "category": "reporters:state", "reporter": "Ark.", "case_ids": [ 1884265 ], "weight": 2, "year": 1990, "opinion_index": 0, "case_paths": [ "/ark/302/0051-01" ] }, { "cite": "304 Ark. 632", "category": "reporters:state", "reporter": "Ark.", "case_ids": [ 1881017 ], "weight": 2, "year": 1991, "opinion_index": 0, "case_paths": [ "/ark/304/0632-01" ] }, { "cite": "Ark. Code Ann. \u00a7 23-89-208", "category": "laws:leg_statute", "reporter": "Ark. Code Ann.", "year": 1987, "opinion_index": 0 } ], "analysis": { "cardinality": 512, "char_count": 8356, "ocr_confidence": 0.889, "pagerank": { "raw": 2.2855797413413769e-07, "percentile": 0.7856678130655493 }, "sha256": "c9c7c911dec37d8ea0144ddd245621bb0af59a9cf2fde144ac2d13927beb7be1", "simhash": "1:8dbc9637228a8879", "word_count": 1407 }, "last_updated": "2023-07-14T22:45:32.876763+00:00", "provenance": { "date_added": "2019-08-29", "source": "Harvard", "batch": "2018" }, "casebody": { "judges": [ "Glaze, J., not participating." ], "parties": [ "Oliver Doyle ROY v. FARMERS & MERCHANTS INSURANCE COMPANY" ], "opinions": [ { "text": ".\nDavid Newbern, Justice.\nIn this case we interpret, for the first time, a provision in Ark. Code Ann. \u00a7 23-89-208 (1987) requiring \u201creasonable proof of all benefits\u201d be made to an insurance company. The issue stems from a further provision of the Statute that the insurer is liable for sanctions if a claim is not paid within 30 days after receipt of \u201creasonable proof as to all benefits accrured.\u201d We hold that sending a hospital bill, unaccompanied by any sort of signed application proving that the medical expense entitles the sender to an insurance policy \u201cbenefit\u201d is not sufficient to satisfy the \u201creasonable proof\u2019 requirement.\nOliver Roy, the appellant, was a pedestrian crossing a street when he was struck by Cheri Rogers\u2019 car. The appellee, Farmers & Merchants Insurance Company [F & M], is Rogers\u2019 insurer.\nRoy was transported to Cleburne Memorial Hospital where his care resulted in a charge of $6911.75. F & M assigned the claim to Tim Pipkins of L & R Adjusting Company. A bill for ambulance services provided to Roy was delivered to Pipkins on January 17,1991. On February 1,1991 the hospital sent a bill to F& Mfor the entire amount of services rendered, $6911.75. The bill showed F & M as \u201cpayer\u201d and recited that \u201cThe patient [Roy] was hit by a car on 1-15-91. The owner or the person who hit this patient is Bobby & Sheri Rogers.\u201d No signature or other authentication appeared on the bill.\nOn March 5, 1991, Roy filed a complaint against F & M alleging that more than 30 days had passed since F & M received reasonable proof of Roy\u2019s medical bill, and it had not paid the $5000 medical payments limit authorized by the policy. The complaint sought the policy limit of $5000 for medical payments, 12% penalty, interest, and attorney\u2019s fees as permitted in \u00a7 23-89-208(f).\nF & M confessed judgment for $5000 on March 19, 1991. The question of F & M\u2019s liability for the interest, penalty, and attorney\u2019s fees was submitted to the Trial Judge who found the statutory sanctions inapplicable because payment was made within 30 days of the date Roy\u2019s application for benefits was received by F & M.\nRoy challenges the Trial Court\u2019s interpretation of the Statute alleging the Court erred in it\u2019s determination that \u201creasonable proof\u2019 was not sent more than 30 days before payment. We agree with the Trial Court that sending a hospital bill is not sufficient.\nThe Statute provides:\nPayments.\n(a) Payment under the coverages enumerated in \u00a7 23-89-202(1) and (2) shall be made on a monthly basis as benefits accrue.\n(b) Benefits for any period are overdue if not paid within thirty (30) days after the insurer received reasonable proof of the amount of all benefits accruing during that period.\n(c) If reasonable proof is not supplied as to all benefits accrued, the portion supported by reasonable proof is overdue if not paid within thirty (30) days after the proof is received by the insurer.\n(d) Any part or all of the remainder of the benefits that is later supported by reasonable proof is overdue if not paid within thirty (30) days after the proof is received by the insurer.\n(e) In the event the insurer fails to pay the benefits when due, the person entitled to the benefits may bring an action in contract to recover them.\n(f) In the event the insurer is required by the action to pay the overdue benefits, the insurer shall, in addition to the benefits received, be required to pay the reasonable attorneys\u2019 fees incurred by the other party, plus twelve percent (12%) penalty, plus interest thereon from the date the sums became overdue.\nThe Trial Court wrote:\nIt appears to this Court that the mere mailing or submission of a hospital bill alone to an insurer is not sufficient to establish \u201creasonable proof\u2019 of benefits accruing. An application by an injured person would need to be submitted along with a medical authorization and medical bills. This would allow the insurer to possess the basic information to investigation the claim.\nThe Court finds that the PIP application was dated 2-15-91 and was faxed by the Plaintiffs attorney to the Defendant\u2019s claim adjuster, Tim Pipkins, on February 16, 1991, as reflected in the statement for professional services rendered. Reasonable proof of benefits was received by the Defendant on February 16, 1991. The benefits were received by the Plaintiff on March 14, 1991. The benefits were paid within thirty (30) days after the proof was received by the Defendant. The benefits are not overdue under A.C.A. \u00a7 23-89-208 (f).\nRoy argues the Trial Court has created a requirement not found in the statute and contrary to legislative intent. True, there is no specific requirement in this subsection of the Insurance Code which requires submission of an application for benefits prior to payment of benefits, but \u201creasonable proof of benefits\u201d means more than proof of a charge or loss.\nRoy correctly asserts the basic rule of statutory construction to which all other interpretive guides must yield, and that is to give effect to the intent of the General Assembly. Graham v. Forrest City Housing Auth., 304 Ark. 632, 803 S.W.2d 923 (1991); Holt v. City of Maumelle, 302 Ark. 51, 786 S.W.2d 581 (1990); In Re Adoption of Perkins/Pollnow, 300 Ark. 390, 779 S.W.2d 531 (1989). When a statute is clear, it is given it\u2019s plain meaning, Cash v. Arkansas Comm\u2019n on Pollution Control & Ecology, 300 Ark. 317, 778 S.W.2d 606 (1989), and we do not resort to a search for legislative intent. Legislative intent must be gathered from the plain meaning of the language used. Hinchey v. Thomasson, 292 Ark. 1, 727 S.W.2d 836 (1987).\nRoy\u2019s further argument, that the lack of a statutory requirement of an insurance application or claim form showing \u201cproof of loss\u201d implies legislative intent not to require an initial showing by a claimant is not persuasive. The requirement is \u201creasonable proof . . . as to all benefits accrued.\u201d Black\u2019s Law Dictionary 158, (6th. ed. 1990) defines \u201cbenefit\u201d for contract purposes as follows:\nWhen it is said that a valuable consideration for a promise may consist of a benefit to the promisor, \u201cbenefit\u201d means that the promisor has, in return for his promise, acquired some legal right to which he would not otherwise have been entitled, [citation omitted] \u201cBenefits\u201d of contract are advantages which result to either party from performance by other.\nBecause a \u201cbenefit\u201d is an advantage arising only as a result of some action on the part of another, a requirement of a showing of the occurence of that activity is implicitly required to determine whether there are \u201cbenefits.\u201d The hospital bill showed the amount of the charge or loss incurred by Roy, but a loss only becomes a benefit for Roy if he is legally entitled to recover under the policy.\nThe reason for enactment of a Statute like the one in question is encouragement of prompt payment of no fault insurance claims. See Hagains v. Government Employees Ins. Co., 150 N.J. Super. 576, 376 A.2d 224 (1977). While there is an annotation dealing with the varying statutory provisions having to do with presenting proof of a no fault claim, there are very few cases that even come close to being on point with the one before us. See Annot., Automobile Insurer\u2019s Liability for Statutory Excess Interest for Delayed Payment of No-Fault Claim, 14 A.L.R. 4th 761, \u00a7 \u00a7 2 (a), 4 (b) (198 2). We agree with the statement made by the Judge in the Hagains case, a reported trial court decision, that no fault insurance provisions should be interpreted liberally to prevent injured persons from having to bear the burden of payment while the insurer considers contesting a claim with no basis for doing so. Even so, it would be wrong to say the insurer must pay a claim based on presentation of a bill without the claimant asserting in writing or perhaps through counsel that he or she is entitled to a policy \u201cbenefit.\u201d It is not inconsistent with the remedial purpose of the legislation to require such an assertion along with the documentation.\nAffirmed.\nGlaze, J., not participating.", "type": "majority", "author": "David Newbern, Justice." } ], "attorneys": [ "Pope, Shamburger, Buffalo, & Ross, by: Brad A. Cazort, for appellant.", "Jacob Sharp, Jr., and Brian Allen Brown, for appellee." ], "corrections": "", "head_matter": "Oliver Doyle ROY v. FARMERS & MERCHANTS INSURANCE COMPANY\n91-170\n819 S.W.2d 2\nSupreme Court of Arkansas\nOpinion deliverd November 11, 1991\n[Rehearing denied December 16, 1991.]\nPope, Shamburger, Buffalo, & Ross, by: Brad A. Cazort, for appellant.\nJacob Sharp, Jr., and Brian Allen Brown, for appellee.\nGlaze, J., not participating." }, "file_name": "0213-01", "first_page_order": 239, "last_page_order": 243 }