Justia Insurance Law Opinion Summaries

Joann Enrique appealed the Superior Court’s grant of summary judgment for State Farm Mutual Automobile Insurance Company in an action she brought for bad faith denial of uninsured motorist (“UM”) coverage stemming from a 2005 car accident. In 2005, an uninsured driver crashed into Enrique’s car by improperly turning into her lane. Enrique suffered a fractured rib, trauma to the right knee requiring arthroscopic surgery, trauma to the left knee for which she was a candidate for arthroscopic surgery, abrasions, and soft tissue injuries. Throughout the settlement negotiations and the processing of Enrique’s claim, State Farm personnel expressed concerns about whether Enrique’s knee injuries were caused by pre-existing conditions. The record was unclear as to why there were large lapses in time during the settlement negotiations. While the parties were waiting for the Independent Medical Examiner report, in July 2008, Enrique filed suit against State Farm, seeking benefits up to the $100,000 policy limits, as well as punitive damages against State Farm for bad faith by refusing to pay up to those limits. In support of the bad faith claim, Enrique alleged that State Farm refused to compensate her up to the UM policy limits without any reasonable justification. In October 2008, the Superior Court severed and stayed the bad faith claim pending resolution of the UM damages claim. The parties then stipulated to a partial dismissal of the bad faith claim without prejudice. Due to the continuing impasse, in September 2008 State Farm decided to advance Enrique $25,000, as the parties both agreed the claim was worth at least that much. As trial approached, State Farm offered Enrique another $20,000 to settle the case, for a total of $45,000. Enrique also revised her demand, and as of January 2010, was willing to settle for an additional $65,000, representing a $90,000 demand. The parties could not bridge the gap, and the damages case went to trial in February 2010. The jury returned a $260,000 verdict. State Farm did not seek remittitur, but did appeal on an evidentiary issue. The Delaware Supreme Court affirmed, and State Farm paid the remaining $75,000 of their policy limits, costs and interests. Enrique then pursued her bad faith claim against State Farm, claiming as damages the unpaid $160,000 portion of the jury verdict, prejudgment interest, and punitive damages. The Superior Court granted State Farm summary judgment because Enrique failed to make a prima facie showing of bad faith. The court based its decision on causation issues arising from Enrique’s pre-existing knee problems (which gave State Farm a reasonable basis for its actions), State Farm’s multiple valuations of Enrique’s claim that put it below policy limits, and her failure to offer facts showing State Farm exhibited reckless indifference in handling her claim. Finding no reversible error as to the Superior Court's grant of summary judgment, the Supreme Court affirmed. View "Enrique v. State Farm Mutual Automobile Insurance Co." on Justia Law

Plaintiff Stephanie Buckley sought PIP benefits following an accident involving a school bus. Defendant State Farm insured the school bus that Buckley intended to take to school on March 27, 2012. Buckley was hit by another vehicle when, after receiving the signal from the bus driver, she crossed the street to board the bus. In a detailed opinion, the Superior Court explained why Buckley was entitled to PIP coverage from State Farm. The Supreme Court affirmed, finding that the Superior Court had no difficulty finding that the school bus was involved in the accident for purposes of 21 Del. C. 2118, "because the bus driver, by law, controlled the process by which Buckley entered and exited the bus, and the accident occurred after the bus driver signaled her to proceed and she followed that instruction." View "State Farm Mutual Automobile Insurance Co. v. Buckley" on Justia Law

A group of New York-based third party payor health insurers (“TPPs”) that provided prescription drug benefits to union members appealed a Superior Court judgment dismissing with prejudice their second amended complaint. At issue were claims brought by the TPPs under various state consumer fraud laws against AstraZeneca Pharmaceuticals LP, and Zeneca Inc. (collectively “AstraZeneca”). The TPPs alleged that AstraZeneca falsely advertised its more expensive patented prescription drug "Nexium" as superior to the less expensive generic drug "Prilosec," causing the TPPs to overpay for Nexium when generic Prilosec would have sufficed. After conducting an extensive choice of law analysis, the Superior Court determined that New York law controlled the TPPs’ claims. The court then held that the TPPs failed to state a claim under New York’s consumer fraud statute for failure to allege legally sufficient causation. The TPPs appealed, arguing the Superior Court's choice of law analysis was flawed, and that the Superior Court's causation analysis was equally flawed. After a careful review of the record on appeal, the Delaware Supreme Court affirmed the ultimate judgment of the Superior Court, finding it not necessary to discuss whether the Superior Court correctly analyzed the choice of law issue, because under either state consumer fraud statute the TPPs could not recover damages as a matter of law. View "Teamsters Local 237 Welfare Fund, et al. v. AstraZeneca Pharmaceuticals LP" on Justia Law

Christina Connelly appealed the dismissal of her claim against State Farm Mutual Automobile Insurance Company. She contended that a claim accrued only when the insured suffers a judgment in excess of policy limits, and that judgment becomes final and non-appealable. Connelly's appeal raised this question as it pertained to the applicable statute of limitations on Connelly's insurance claim. State Farm contended that the claim accrued when the insurer allegedly acts in bad faith and breaches its duty to the insured. Although the Delaware Supreme Court had never addressed that precise issue, courts in other states that have considered it, and the weight of expert authority on insurance law, were in accord that a bad-faith failure-to-settle claim accrued when an excess judgment became final and non-appealable. "That approach conserves litigant and judicial resources. It also properly aligns the incentives of the insurer and its insured by allowing them to join efforts in defending the underlying third-party insurance claim without a stayed breach-of-contract claim causing a conflict of interest between them. Further, to state a claim that the insurer breached its implied duty to act in good faith, the insured must plead damages, which she cannot do before there is a final excess judgment against her." In view of these considerations, the Delaware Court found that a claim against an insurer for acting in bad faith by failing to settle a third-party insurance claim accrued when an excess judgment against an insured becomes final and non-appealable. Accordingly, it reversed the Superior Court's decision. View "Connelly v. State Farm Mutual Automobile Insurance Co." on Justia Law

The plaintiffs both have policies with State Farm Mutual Automobile Insurance Company and both submitted claims that State Farm failed to pay within the statutory thirty-day period. The plaintiffs earlier alleged that State Farm had failed to make the required statutory interest payments to them and other claimants whose PIP claims had not been processed within thirty days. When that theory did not pan out and they faced summary judgment, the plaintiffs reformulated their pursuit of class-wide relief by proposing to file an amended complaint seeking a declaratory judgment from the Superior Court that State Farm must process all PIP claims within thirty days. The Superior Court denied the motion for leave to amend, reasoning that amending the complaint would be futile because no case or controversy existed because the plaintiffs had been paid the required statutory interest. The court then granted summary judgment to State Farm. In this appeal, the plaintiffs alleged that the Superior Court was wrong to dismiss their claim, arguing that they have a ripe disagreement with State Farm over its failure to comply invariably with the thirty-day deadline set forth in 21 Del. C. 2118B(c). After review, the Supreme Court affirmed the Superior Court, but on a somewhat different ground. The plaintiffs were correct that absent declaratory (or injunctive) relief, it may be that they and other class members will have a claim in the future processed by State Farm in more than thirty days. But, the Court agreed with the Superior Court that the amended complaint is futile because as plainly written, section 2118B(c) did not impose an invariable standard that every PIP claim must be processed within thirty days and, in fact, contemplated that will not be the case by establishing a statutory consequence for the failure to do so. View "Clark v. State Farm Mutual Automobile Insurance Co." on Justia Law

David Stoms was killed in an automobile accident by an uninsured driver. David was driving a car belonging to his employer, Diamond Motor Sports, Inc., which had purchased uninsured motorists coverage on its insurance policy only for a limited class of drivers. Under Diamond Motor's insurance policy, only directors, officers, partners, and owners of the corporation had uninsured motorists coverage. David Stoms was a finance manager at Price Toyota, one of Diamond Motor's dealerships. The insurance policy gave all drivers, including David, personal injury protection coverage up to $30,000 per accident. David had purchased no supplemental coverage of his own. Although Federated Insurance paid the entire $30,000 in personal injury protection on David's behalf, it denied Mrs. Stoms benefits for uninsured motorists coverage resulting from David's death. Mrs. Stoms sued Federated Insurance, demanding those benefits. The parties filed cross-motions for summary judgment and the Superior Court granted Federated Insurance's motion. Mrs. Stoms argued that the Superior Court erred in granting Federated Service Insurance Company's motion for summary judgment after concluding that the insurance policy it issued to Diamond Motor was neither contrary to public policy nor ambiguous. Finding no reversible error, the Supreme Court affirmed. View "Stoms v. Federated Service Insurance Company" on Justia Law

In 2013, the Delaware Supreme Court determined that Matthew Kelty was eligible for personal injury protection (PIP) benefits under an insurance policy between State Farm Mutual Automobile Insurance Company and John and Shirley Lovegrove after Kelty was injured in an accident involving the Lovegroves' vehicle. As a result, the Supreme Court reversed the Superior Court's earlier grant of summary judgment to State Farm and remanded the case for further proceedings. On remand, the parties argued about whether Kelty was entitled to receive only the statutory minimum of $15,000, or $100,000, including excess coverage the Lovegroves opted to pay for but which was expressly limited in the policy to the insureds and their relatives who lived with them. The Superior Court held that Kelty was entitled to receive the full $100,000 because the policy's limitation on who could benefit from the excess coverage was "void as against public policy." The Supreme Court reversed finding that the plain language of the statute, 21 Del. C. 2118, required PIP policies to provide only $15,000 of coverage. Imposing a higher minimum here simply because the Lovegroves chose to pay for additional coverage for themselves and their relatives "thwart[ed] Delaware's public policy to encourage drivers to purchase more than the statutorily-mandated minimum by increasing the cost of excess coverage.[. . .] It is not the role of the judiciary to alter that amount and thus disrupt the incentives that the General Assembly has itself set up for insurers and consumers. Accordingly, we reverse the judgment of the Superior Court." View "State Farm Mutual Automobile Insurance Co. v. Kelty" on Justia Law

RB Entertainment is one of a complicated web of at least seventeen different companies that Appellant Jeffrey Cohen allegedly owns and controls. Central to this appeal was one issue: whether the delinquency proceedings for Indemnity Insurance Corporation, RRG violated the constitutional due process rights of Cohen or Co-Appellant RB Entertainment Ventures. Co-Appellant IDG Companies, LLC (Indemnity's managing general agent), was also one of the Cohen-affiliated entities. After uncovering evidence that Cohen had committed fraud in his capacity as Indemnity's CEO and that Indemnity might be insolvent, the Delaware Insurance Commissioner petitioned the Court of Chancery for a seizure order. The Delaware Uniform Insurers Liquidation Act. Based on the detailed allegations and supporting evidence presented by the Commissioner, the Court of Chancery granted that seizure order, which, among other things, prohibited anyone with notice of the proceedings from transacting the business of Indemnity, selling or destroying Indemnity’s assets, or asserting claims against Indemnity in other venues without permission from the Commissioner. The seizure order also prohibited anyone with notice of the proceedings from interfering with the Commissioner in the discharge of her duties. Cohen, who founded Indemnity and had served as its President, Chairman, and CEO, resigned from Indemnity's board during the ensuing investigation and the board removed him from his managerial positions. After his resignation, Cohen interfered with the Commissioner's efforts to operate Indemnity in various ways. The Commissioner returned to the Court of Chancery several times, first seeking an amendment to the seizure order to address Cohen's behavior and then seeking sanctions against him. The Court of Chancery entered a series of orders that increased the restrictions on Cohen's behavior and imposed stiffer sanctions upon him. Cohen argued that he was denied due process at several junctures during the Court of Chancery proceedings. Because Cohen's claims alleged violations of his right to due process, the focus of the Supreme Court's opinion was on whether Cohen was given notice of the allegations against him and a fair opportunity to present his side of the dispute. Having carefully examined the record in this case, the Court concluded that he was given that opportunity: no violation of Cohen's or the affiliated entities' due process rights occurred. View "Cohen, et al. v. State of Delaware, et al." on Justia Law

The Superior Court dismissed the underlying complaint in this case based solely upon its determination that a 2011 Settlement Agreement barred the Plaintiffs’ claims as constituting an impermissible collateral attack on a 2009 Insurance Agreement. The Superior Court did not address the sufficiency of the Plaintiffs’ allegations supporting their claims. In this appeal, Plaintiffs contended that the Superior Court should not have dismissed their claims because the 2011 Settlement Agreement was reasonably susceptible to the Plaintiffs’ interpretation. Therefore, extrinsic evidence of the parties’ intent was necessary to resolve any dispute over the 2011 Settlement Agreement’s terms. After its review, the Supreme Court concluded the Superior Court erred in holding that, as a matter of law, the 2011 Settlement Agreement unambiguously precluded the Plaintiffs from asserting the claims that are at issue in this action. The intent of the parties in negotiating the 2011 Settlement Agreement was a factual question inappropriate for resolution on a Rule 12(b)(6) motion to dismiss. View "Nicholas, et al. v. National Union Fire Insurance Co. of Pittsburgh, PA, et al." on Justia Law

Claimant-appellee and cross-appellant-appellant Amanda Wyatt appealed a Superior Court judgment reversing an Industrial Accident Board finding that she had a compensable, work-related injury. The employer-appellant and cross-appellee-appellee is Wyatt’s former employer, Rescare Home Care. On appeal, Wyatt argued: (1) the Superior Court erred in reversing the Board’s decision that her injury was a compensable industrial accident, since the Board’s decision was based upon substantial evidence; and (2) the Board erred in denying the medical expenses for her emergency back surgery. After careful consideration, the Supreme Court concluded the Superior Court erred in reversing the Board’s decision that the Claimant had a compensable work related injury. Furthermore, the Court concluded the Board properly determined that her back surgery was not compensable. View "Wyatt v. Rescare Home Care" on Justia Law