Opinion ID: 1959678
Heading Depth: 2
Heading Rank: 4

Heading: The Meaning of Insured.

Text: Although the ALJ denied relief to Ms. Tesfamariam, in part, because he found her to be an owner of the vehicle, the principal focus of inquiry at the administrative hearing was whether she was an insured within the meaning of § 35-2114(c). Ms. Tesfamariam, as we have seen, had health insurance with Kaiser Permanente through her employer, but she did not seek treatment from Kaiser-affiliated physicians, apparently as a result of her misapprehension as to the coverage provided by the policy. The ALJ ruled that because Ms. Tesfamariam was covered by health insurance, she was an insured, and that she was therefore ineligible for compensation, either for her medical expenses or for her lost wages. The Insurance Administration concedes in this court that the ALJ's interpretation of the statute in this regard was incorrect, and we agree. The Compulsory/No Fault Motor Vehicle Insurance Act defines an insured as a named insured or any other person insured in an insurance policy ... D.C.Code § 35-2102(10). An insurance policy is not further defined, but language elsewhere in the statute, as well as the Act's legislative history, support the conclusion that an insurance policy means a motor vehicle insurance policy. An insurer is defined as any person, company, or professional association licensed in the District of Columbia that provides motor vehicle liability protection.... Id. § 35-2102(11) (emphasis added). The legislative history tracking the language of § 35-2114(c) is to the same effect: Persons excluded from compensation are ... (2) a victim who is an insured under an automobile insurance policy.... Councilman John Ray, Committee on Consumer & Regulatory Affairs, Report on Bill 6-249, The Compulsory/No-Fault Motor Vehicle Insurance Act of 1982 Amendments Act of 1985,  Oct. 8, 1985, at 16 (emphasis added) [hereinafter Ray Report]. Ms. Tesfamariam was not covered by an automobile insurance policy. Accordingly, she was not an insured within the meaning of the statute. Her health insurance did not disqualify her from receiving compensation. That insurance is relevant, however, because it constitutes a potential collateral source for her medical expenses (although presumably not for her lost wages) and might require a reduction in her ultimate recovery. The amounts of compensation awarded shall be equal to the amount of the victim's loss, decreased by all amounts received by or available to the victim from collateral sources. D.C.Code § 35-2114(e). As illuminated by the legislative history, collateral sources include any applicable insurance coverage [or] any other means available to compensate the victim for his or her loss. Ray Report, at 15. Having denied Ms. Tesfamariam's claim in its entirety, the agency has not addressed the issue of collateral source. We leave it to the agency to determine, in the first instance, the effect of Ms. Tesfamariam's health insurance coverage on the proper amount of her award.