Opinion
C.A. No. 98C-06-032-WTQ.
Argued: August 3, 2000.
Decided: August 7, 2000.
Letter Opinion and Order on State Farm's Motion for Partial Summary Judgment — MOTION GRANTED
Dear Ms. Willette and Mr. Carmine:
This is the Court's Letter Opinion and Order on State Farm Automobile Insurance Company's Motion for Partial Summary Judgment. For the reasons stated herein, the Motion is GRANTED.
FACTS
This case began as a dispute over medical bills for chiropractic care received by the Defendant Thomas Smith. Mr. Smith has been involved in two accidents that interplay in this case. Mr. Smith was first injured in September of 1995 as a result of work-related accident. Mr. Smith injured his neck and lower back in the work accident. There is no dispute in this case that he was disabled for a period of time as a result of that accident. Mr. Smith settled his worker's compensation claims with his employer and he was paid $30,000. In that settlement, Mr. Smith's disability benefits were commuted. This settlement was approved by the Industrial Accident Board on January 16, 1997. Dkt. No. 24, Ex. A. The doctor's report provided states that Mr. Smith was "released from active treatment for this condition on 2/26/97 having reached maximum medical improvement." W. Albert Forwood Report at 2-3, Dkt. No. 24, Ex. C.
In January of 1996, five months after Mr. Smith suffered his work-related accident and while he remained disabled, he was in an automobile accident. Mr. Smith apparently sustained injuries to his neck and lower back as a result of the airbag deploying at impact. Mr. Smith claims that the injuries sustained in the automobile accident were an aggravation of the neck injury he suffered at work. Mr. Smith also claims that he suffered a new injury to his lower back in the automobile accident.
In December of 1997, Mr. Smith's treating physician, Albert W. Forwood, D.C. wrote a report that stated:
The auto accident of 1/28/96 caused aggravation to Mr. Smith's pre-existing condition related to his work injury of 9/2/95 and had additional injuries in the lumbodorsal spine that is in the lower thoracic spine and in the lumbar spine.
It is with a reasonable medical probability that the automobile accident occurring on 1/28/96 is causally related to Mr. Smith's current lumbodorsal condition and that the injury he received as a result of that accident is causally related to his current treatment and residuals.
Mr. Smith then submitted medical claims to State Farm under PIP that he argues were related to the automobile accident. State Farm refused to pay. On December 30, 1997, Mr. Smith filed a petition with the Insurance Commissioner under PIP in an attempt to recover medical expenses incurred due to the automobile accident. That petition did not include a claim for lost wages and was only for medical expenses. A hearing was held with the Insurance Commission Arbitration Panel. Mr. Smith was awarded $11,816 plus the $30 filing fee. The ruling of the arbitration panel was appealed by State Farm to the Superior Court.
On November 12, 1998, two years and ten months after the automobile accident, Dr. Forwood wrote a letter as "clarification of work loss for Tom Smith concerning his auto accident of 12/28/96." That letter stated:
As you know, Mr. Smith was released from work on February 26, 1997 from his work related injury of 9/1/95. To clarify the disability concerning the auto accident, Mr. Smith would have been released for work on February 26, 1997, but for injuries sustained in his auto accident of January 28, 1996.
Forwood Nov. 12, 1998 Letter, Dkt. No. 24, Ex. E.
Mr. Smith then moved to amend his Superior Court Complaint on the PIP coverage issue to include a claim for lost wages. In this Motion, State Farm argues that because it was not presented with a claim for lost wages until more than ten months after the second anniversary of the accident, Mr. Smith's claim for lost wages must be denied under the PIP statute.
Mr. Smith filed his Motion to Amend the Complaint in this case on December 8, 1998. The Motion to Amend was granted on December 21, 1998.
Mr. Smith argues that the three-year statute of limitations should apply to actions to recover personal injury benefits. Smith states that his claim for lost wages falls under the three-year statute of limitations as announced in Harper v. State Farm Mutual Ins. Co., Del. Supr., 703 A.2d 136 (1997). Alternatively, Mr. Smith argues that even if the Harper three year statute of limitations does not apply, under the PIP statute, expenses shall be submitted to the insurer as promptly as practical, in no event more than two years after they are received by the insured. 21 Del. C. § 2118(a)(2) a.i.1.
STANDARD OF REVIEW
When considering a Motion for Summary Judgment, the Court's function is to examine the record to determine whether genuine issues of material fact exist. Oliver B. Cannon Sons, Inc. v. Dorr-Oliver, Inc., Del. Super., 312 A.2d 322, 325 (1973). If, after viewing the record in a light most favorable to the non-moving party, the Court finds that there are no genuine issues of material fact, Summary Judgment will be appropriate. Id. Summary Judgment will not be granted if the record 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. Ebersole v. Lowengrub, Del. Supr., 4 Storey 463, 180 A.2d 467 (1962).
DECISION
The public policy of Delaware's financial responsibility laws favors full compensation to all victims of automobile accidents. Nationwide General Ins. Co. v. Seeman, Del. Supr., 702 A.2d 915, 918 (1997). Title 21 Del. C. § 2118 of the Delaware Code is entitled to liberal construction in order to achieve that purpose. Gray v. Allstate Ins. Co., Del. Super., 668 A.2d 778, 779 (1995). The PIP statute states:
1. 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.
2. Payments of expenses under subparagraph a. of this paragraph shall be made as soon as practical after they are received during the period 2 years from the accident. 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-year period.21 Del. C. § 2118 (a)(2)i.
In discussing this provision, the Delaware Supreme Court has opined:
The insured now has a general statutory right to receive PIP benefits for defined expenses that are incurred within two years of the accident. . . . The exceptions to that general rule are also defined by statute. . . . The insured has a reciprocal statutory obligation to submit claims for benefits promptly within two years of receipt or within two years and ninety days of the accident.
Harper, 703 A.2d at 139-140.
The statute sets an outside limit for submission of expenses, no "more that 2 years after they are received by the insured." 21 Del. C. § 2118 (a) i. 1. But more importantly, the statute also, perhaps indirectly, requires that expenses shall be paid if they "are received during the period of 2 years from the accident" or "incurred within 2 years" and "presented within 90 days after the end of the two year period." 21 Del. C. § 211 8(a)(2) i.2. The apparent broad brush of the word "received" in the first subsection is necessarily modified by the second subsection. Thus, if one reads the statute as a whole, it appears that the insurer is required to pay only those expenses incurred within two years of the accident and submitted to the insurer within two years and ninety days of the accident. See Carriere v. Peninsula Indemnity Co., Del. Super., Civ. A. No. 99C-02-2 10, Herlihy, J. (June 12, 2000). Here, it is clear that while Mr. Smith may have incurred some lost wages within the two year time limitation under PIP, he did not submit his claim for lost wages until seven months after he was required to do so under the statute.
Mr. Smith alternatively argues that Harper mandates a three-year statute of limitations for bringing a claim for PIP benefits. In Harper, the Plaintiff was in an automobile accident in October of 1992. Shortly after the accident, she submitted bills to State Farm for payment. Harper, 703 A.2d at 137. In May of 1995, State Farm refused to make payment for medical treatment received by the Plaintiff on September 20, 1994 and September 26, 1994. Id. Plaintiff did not file suit until July 29, 1996, and State Farm claimed that a two-year statute of limitations barred Plaintiffs claims. Id.
In Harper, the bills were submitted within the two-year PIP period.
The Delaware Supreme Court held that the Plaintiff's cause of action accrued when State Farm denied the Plaintiffs request for benefits and not the date of the accident. Additionally, the Court held that a Plaintiff has three years after the date of the denial of benefits to file a claim.
Harper, however, does not control here because the statute requires submission of claims by the insured within two years and ninety days of the accident. Harper deals with an entirely different issue, timely filing of a lawsuit after the rejection of a claim. Mr. Smith did not submit his lost wages claim until after the two year and ninety day limitation, as described in the statute, had passed. Therefore, Mr. Smith's claim for recovery of lost wages under PIP must fail and partial Summary Judgment is GRANTED in favor of State Farm. IT IS SO ORDERED.