Summary
holding that plaintiff's filing of the complaint was sufficient notice of lost wages claim when the lost wages claim had not been provided to the insurer within 27 months of the accident
Summary of this case from Lukk v. State Farm Mut. Auto. Ins. Co.Opinion
C.A. No. 04C-02-030 WCC.
Submitted: April 22, 2005.
Decided: July 28, 2005.
Upon Defendant's Motions for Partial Summary Judgment. DENIED.
Francis J. Jones, Jr., Morris, James, Hitchens Williams, Wilmington, Delaware. Attorney for Plaintiff.
Thomas P. Leff, Casarino, Christman Shalk, P.A., Wilmington, Delaware, Attorney for Defendant.
ORDER
On November 15, 2001, Robert Salvatore ("Plaintiff") was involved in a motor vehicle accident. State Farm Mutual Automobile Insurance Company ("State Farm") is the no-fault carrier for Plaintiff, who suffered injuries in the accident and subsequently received treatment. State Farm paid some of Plaintiff's medical bills, and Blue Cross Blue Shield ("BCBS"), the health insurance carrier of Plaintiff's wife, paid the remaining expenses for which Plaintiff now seeks reimbursement.
Following a defense medical exam conducted by Dr. Donald R. Archer, Jr. on May 6, 2002, Plaintiff was released to light duty work. On June 10, 2002, State Farm sent Plaintiff a letter, that stated:
Vinnie G. McCoy, Team Manager, State Farm Mut. Auto. Ins. Co.
We will pay an additional two weeks (weeks of 6/10/02 and 6/17/02) in full-time wages and transition to part-time wages for an additional four weeks and we will review your lost wage claim again in 30 days. . . . It is your responsibility to work out your employment issues with your union and your employer.
Letter from McCoy to Salvatore of June 10, 2002, at 2.
Plaintiff was denied any further lost wage payments after July 26, 2002. On December 30, 2003, Plaintiff submitted a detailed claim to State Farm for PIP-eligible medical expenses but did not submit a similarly detailed claim for lost wages. On February 3, 2004, Plaintiff filed this complaint seeking medical and lost wages expenses and mailed Defendant a courtesy copy the following day. Defendant moves for partial summary judgment on two distinct issues. The Court will address each seriatim.
Summary judgment is appropriate when the moving party has shown there are no genuine issues of material fact and as a result, it is entitled to judgment as a matter of law. In considering such a motion, the court must evaluate the facts in the light most favorable to the non-moving party. Summary judgment will not be granted when the record reasonably indicates that a material fact is in dispute or if it seems desirable to inquire more thoroughly into the facts in order to clarify the application of law to the circumstances.
Moore v. Sizemore, 405 A.2d 679, 680 (Del. 1979); Schueler v. Martin, 674 A.2d 882, 885 (Del.Super.Ct. 1996).
Pierce v. Int'l Ins. Co. of Ill., 671 A.2d 1361, 1363 (Del. 1996).
Ebersole v. Lowengrub, 180 A.2d 467, 468-469 (Del. 1962).
In Defendant's first motion for partial summary judgment, it claims that Plaintiff is not entitled to recover additional lost wages because Plaintiff failed to make a timely and specific claim for additional lost wages, within 27-months of their receipt. Plaintiff argues that his complaint and the corresponding courtesy copy mailed to Defendant constitute a presentation of no-fault expenses. In addition, Plaintiff argues that Defendant's prior lost wage payments establish that Defendant was on notice for such claims. The Court agrees.
21 Del. C. § 2118(a)(2)(i)(1), (2). ("Expenses under subparagraph a. of this paragraph shall be submitted to the insurer as promptly as practical, in no event more than 2 years after they are received by the insured. . . . Expenses which are incurred within the 2 years but which have been impractical to present to an insurer within the 2 years shall be paid if presented within 90 days after the end of the 2-years period.")
In essence, what the Defendant is now claiming is that even though it advised Plaintiff that it had no intention of continuing to pay on his lost wage claim based upon its doctor's examination, there is some continuing obligation on the Plaintiff to submit claims he has already been told will not be honored. The Court cannot imagine that the General Assembly ever contemplated such an exercise in futility and frustration and finds that the Defendant was clearly on notice of the Plaintiff's wage claims when it terminated his benefits. Furthermore, there was no obligation for the Plaintiff to continue to submit claims so that the Defendant could deny them. Such folly would stretch the line of common sense and good faith. The Defendant had the right to advise its policy holder that it did not believe his injuries would continue to support his wage claim and that its doctor was of the opinion Plaintiff was able to return to work. Having made that decision however, Defendant cannot now claim it had no knowledge of additional wages. In effect, Defendant denied all future claims under the Plaintiff's policy through its actions. If Plaintiff's illogical reasoning is ever found to have some merit, the Court also finds the Defendant was put on notice of the additional wage claim by the filing of Plaintiff's complaint in this litigation within the statutory time period. Obviously, that is not the best or most appropriate mechanism for notice, but it is timely and the Defendant has still not paid. It is fair to assume that Defendant reaffirms its earlier denial of benefits through the submission of its answer in this litigation.
In Defendant's second motion for partial summary judgment, it argues that Plaintiff lacks standing to raise a claim for medical expenses already paid by BCBS and contends that BCBS's payment and any lien it may subsequently exercise are issues for subrogation between BCBS and State Farm. Plaintiff retorts that he has third-party standing because he has a substantial relationship with the subject matter of the litigation and BCBS, the holder of the rights to be litigated. In addition, Plaintiff asserts that any recovery he receives is subject to BCBS's claim for expenses already paid.
Unfortunately, the arguments before the Court in this issue have ranged from standing, to the collateral source rule, to a discussion of the payment mechanism of medical carriers and whether these payments would be reasonable and necessary. Since the Court finds that none of these arguments have been sufficiently developed in an appropriate factual context nor have they been fully and adequately briefed, the Defendant's second motion for partial summary judgment is denied without prejudice to re-file once counsel has figured out what it really wants the Court to decide. Perhaps counsel can figure a clever method to bring BCBS into the litigation so the parties who really have a dispute here could be heard. In any event, this issue needs some discovery work before it is ripe for summary judgment.
For the reasons set forth above, Defendant's Motions for Partial Summary Judgment are DENIED.
IT IS SO ORDERED.