Justia Insurance Law Opinion Summaries

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

The issue before the Supreme Court in this case centered on whether Delaware’s personal injury protection (PIP) statute requires insurers to reserve PIP benefits for lost wages when requested. The plaintiff suffered severe injuries as a passenger in a car accident. While he was in a coma, his mother signed an assignment of insurance benefits in favor of the hospital. Plaintiff did not challenge the validity of the assignment. The hospital was promptly paid by the insurance company. When plaintiff later requested the insurers to reserve his PIP benefits for his past and future lost wages, he was informed that the benefits had been exhausted by the payment to the hospital. The Superior Court held sua sponte that the unchallenged assignment to the healthcare provider was invalid. Upon review of the facts of this case, the Supreme Court concluded the Superior Court erred as a matter of law in deciding that uncontested issue. Because the assignment on behalf of the plaintiff resulted in the exhaustion of his PIP benefits before the plaintiff requested the reservation of PIP benefits for his lost wages, the legal issue of whether the insurer was required to reserve PIP benefits for lost wages is moot. View "State Farm Mutual Automobile Insurance Co. v. Davis" on Justia Law

Plaintiffs Kylie and Michael D. Shuba appealed the Superior Court's denial of their cross-motion for summary judgment and its grant of summary judgment in favor of Defendant United Services Automobile Association's ("USAA") motion for summary judgment. The Shuba's sought to be covered persons for the wrongful death of their mother under an insurance policy issued by USAA and held by the Shubas' step-mother. It was undisputed that their mother was not a named insured under the policy or a resident of the stepmother's household as the Shubas were. The Shubas claimed the trial court erred in finding the Shubas could not recover uninsured motorist benefits under the USAA policy. In making their claim, the Shubas asked the Supreme Court to overrule two Superior Court cases, "Temple v. Travelers Indemnity Co" and "Adams-Baez v. General Accident Co.," the latter of which the Supreme Court affirmed based on the trial court opinion. The Supreme Court declined to overrule those cases as precedent, and affirmed the Superior Court's judgment. View "Shuba v. United Services Automobile Association" on Justia Law

A plaintiff who was injured in an accident sought PIP benefits from an insurance carrier. The Superior Court applied Delaware's current three-part test and analyzed: (1) "whether the vehicle was an 'active accessory' in causing the injury," (2) "whether there was an act of independent significance that broke the causal link between use of the vehicle and the injuries inflicted," and (3) "whether the vehicle was used for transportation purposes." After concluding that the insured vehicle was not used for transportation purposes, the court granted the insurance carrier's motion for summary judgment. Upon reexamination of the statutory framework for PIP coverage, the Supreme Court concluded that the test's "transportation purposes" element should have been rejected. Therefore, the Court reversed the Superior Court judgment and remanded the case for further proceedings. View "Kelty v. State Farm Mutual Automobile Insurance Co." on Justia Law

Claimant-appellant Stephen Arrants appealed a superior court order that affirmed an Industrial Accident Board's order granting employer-appellee Home Depot's petition to terminate appellant's total disability benefits. Appellant raised two claims on appeal: (1) the Board's decision was in error because all experts agreed that his condition had not improved since the 2007 Board finding of total disability; and (2) the Board's decision was not supported by competent evidence in the record. Upon review, the Supreme Court concluded that both arguments were without merit, and affirmed the superior court. View "Arrants v. Home Depot" on Justia Law

Appellant Mary E. Spellman ("Spellman") petitioned the Industrial Accident Board (the "Board") for a workers' compensation award against her employer, Appellee Christiana Care Health Services ("Christiana"). The Board denied the petition and the Superior Court affirmed. Appellant worked as a home health aide, where she used her personal vehicle to attend to Christiana's clients at their homes. While Appellant was reimbursed for mileage between client appointments, she was not reimbursed for travel to the first appointment, from the last appointment, or "off the clock" when she attended to personal business. In the middle of her work day, Appellant was off the clock when her car hit a patch of ice causing Appellant to crash her car. She sustained injuries to her head and hip. In her petition, Appellant argued that her status as a traveling employee exempted her from the "going and coming" rule that precludes workers' compensation for injuries suffered while going or coming from work. Alternatively, Appellant argued her injuries were compensable because she was engaged in a "mixed purpose" trip at the time of her accident. Having "no difficulty" sustaining the judgment of the Superior Court, the Supreme Court affirmed. View "Spellman v. Christiana Care Health Services" on Justia Law

Two employees of Connections CSP, Inc. were killed in an automobile collision during the course and scope of their employment. Connections owned the vehicle and had purchased underinsured motorist insurance (UIM) for the vehicle and also worker's compensation insurance which covered the employees. The UIM insurer paid its policy limit of $1,000,000. The worker's compensation insurer also paid benefits to the representatives of the decedents. The worker's compensation insurer then sought to enforce a lien upon the UIM payment equal to the worker's compensation benefits it paid. But the UIM policy specifically excluded the direct or indirect benefit of any insurer or self-insurer under a worker's compensation claim. Notwithstanding this exclusion, the Superior Court enforced the lien based upon its interpretation of 19 Del. C. 2363(e), which allows reimbursement of a worker's compensation carrier "from the third party liability insurer." The UIM insurer appealed. Upon review, the Supreme Court held that General Assembly eliminated the ability of a worker's compensation insurer to assert a lien against the UIM payments made pursuant to the employer's UIM policy. Because the Superior Court erred as a matter of law in enforcing a lien, the Supreme Court reversed its decision and remanded the case for further proceedings. View "Simendinger v. National Union Fire Insurance Co." on Justia Law

Pro se appellant Holly Noel-Liszkiewicz appealed a superior court's decision to affirm the Industrial Accident Board's denial of her claim for worker's compensation benefits. Appellant was a customer service representative for Employer La-Z-Boy before being laid off. Almost two years after the lay off, Appellant petitioned the board seeking compensation for occupational asthma, pulmonary fibrosis, and respiratory failure allegedly caused by exposure to chemicals at La-Z-Boy’s facility. La-Z-Boy denied that Applicant suffered any illness or injury that was causally related to her work. Finding Appellant's arguments to be without merit, the Supreme Court affirmed both the Board and the superior court. View "Noel-Liszkiewicz v. La-Z-Boy" on Justia Law

Defendants-Appellants National Grange Mutual Insurance Company and The Main Street Insurance Group (collectively "NGM") appealed a Superior Court's grant of summary judgment in favor of Plaintiff-Appellee Elegant Slumming, Inc. in this property insurance coverage dispute. NGM raised two claims on appeal: (1) NGM contended the trial court erred in finding that the property insurance policy at issue requires only "some evidence," rather than "physical evidence," to show what happened to lost property; (2) and that the trial court erred in finding the amount of Elegant Slumming’s attorney’s fees reasonable. Upon review, the Supreme Court found that the trial court erred in concluding that testimonial evidence, by itself, fulfills the "physical evidence" requirement of the policy, and that Elegant Slumming did present physical evidence in addition to testimonial evidence to show what happened to the lost property and therefore coverage was not barred by the policy exclusion. Furthermore, the Court found no abuse of discretion in the award of attorney’s fees pursuant to statute in this case. Accordingly, the Court affirmed. View "National Grange Mutual Insurance Co. v. Elegant Slumming, Inc." on Justia Law