Opinion ID: 867565
Heading Depth: 2
Heading Rank: 4

Heading: By an insured person

Text: ¶ 28 Given this interpretation of the statute, it is apparent that the enrollee who receives necessary treatment from the provider incurs expenses and is or may be legally liable for some of them but not others. Some of the charges are, in fact, those for which only the provider may be liable. Thus, expenses were actually incurred and a debt, albeit non-recourse, according to Andrews, was created for Lisa's treatment. But Allstate's policy requires that expenses not only be actually incurred but that they be actually incurred by an insured person. Does this mean actually incurred for treatment of an insured person or does it mean expenses for which the insured person is directly and legally liable? ¶ 29 The policy does not explain and does not define the terms. The case law cited above has uniformly held that expenses are actually incurred by an insured when he or she has become legally liable for them, even when those expenses have been paid by others. Id. at 484-85 ¶¶ 15-18, 19 P.3d at 625-26 ¶¶ 15-18. This rule has even been applied in cases in which the entity that paid the expenses was required by law to provide the services or pay the charges and when, as a pragmatic matter, the insured would not be held legally responsible. See Coconino County, 149 Ariz. 427, 719 P.2d 693; Hollister, 192 Neb. 687, 224 N.W.2d 164. ¶ 30 The difference, of course, is that in the present case not only were the bills paid by someone else, but the insured was immunized from direct action by a provider seeking payment. But if it makes no difference who pays the bills, why should it make a difference who can be sued? Neither Allstate nor any case cited to or found by us provides an answer. In fact, no case has addressed the precise issue arising from the provisions of A.R.S. § 20-1072(A) to (C), A.R.S. § 33-931 (the medical lien statute), and policy provisions such as those before us. We are thus left to our own analysis.