Justia Insurance Law Opinion Summaries

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

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