Cintron v. Universal Underwriters Group

601 A.2d 1051, 1990 Del. Super. LEXIS 479
CourtSuperior Court of Delaware
DecidedJuly 26, 1990
StatusPublished
Cited by2 cases

This text of 601 A.2d 1051 (Cintron v. Universal Underwriters Group) is published on Counsel Stack Legal Research, covering Superior Court of Delaware primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cintron v. Universal Underwriters Group, 601 A.2d 1051, 1990 Del. Super. LEXIS 479 (Del. Ct. App. 1990).

Opinion

OPINION

GEBELEIN, Judge.

The plaintiff in this action, Hector Cin-tron, was operating his motorcycle when he was injured in a motor vehicle accident. At the time of the accident he had motor vehicle insurance with the defendant. The personal injury protection (PIP) coverage purchased was for the minimum limits permitted by Delaware law: $15,000/$30,000.1 The policy, however, was subject to a $15,-000 deductible.

The insurance application stated that the “$15,000 deductible will apply before there is any payment due from the company....” The plaintiff’s medical bills and lost wages exceeded $15,000 and he sought no-fault PIP benefits from his insurer for those losses greater than $15,000, to the extent of the policy limits of $15,000 per person. The insurer denied the claim for benefits. The plaintiff now seeks summary judgment alleging that as a matter of law the defendant should pay him no-fault benefits for the expenses in excess of his deductible up to a maximum of $15,000, because the statute requires minimum coverage of $15,000.

Alternatively, he argues that the insurance policy is ambiguous regarding how deductibles affect the company’s liability and that the insurer’s interpretation of the manner in which the deductibles are to be applied are against the plaintiff’s reasonable expectations as created by the application.

The defendant also seeks summary judgment, alleging that as a matter of law the Code provides $15,000 for any one person injured; that the owner may elect coverage subject to deductibles;2 and that the plaintiff, the only person injured, elected $15,-000 in deductibles. It reads the provision as meaning that because there was only one person injured, and that person is entitled only to $15,000, which was also the amount of the deductible, that the plaintiff is not entitled to any payment.

The plaintiff argues that if the Court reads the law as the defendant suggests, then the plaintiff has paid a premium and in return received no coverage. He argues that would be contrary to the statutory language which requires minimum coverage and contrary to the statute’s public policy objective of enabling injured parties to receive from their own carrier the eco[1053]*1053nomic benefit of immediate payment without awaiting protracted litigation.

The defendant responds coverage would be available to a passenger injured while riding with him under identical circumstances and, therefore, he has not paid a premium without receiving coverage. It further argues that the plaintiff accepted the risk.

The Delaware Supreme Court has addressed the issue of whether deductible clauses which reduce coverage below the minimum required by the statute are illegal and void as against public policy. Barber v. Williams, Del.Supr., 445 A.2d 334 (1981) (Unpublished Order No. 120, 1981, Oct. 27, 1981).

In Barber, the medical expenses and lost wages of the two plaintiffs were less than $10,000 and the no-fault insurer denied benefits. The Court determined that although the statute provided that the minimum required insurance was $10,000 for one person per accident and $20,000 for two or more persons per accident, the statute also permitted coverage to be subject to a deductible. The Court held that while the deductible, in effect, eliminated the PIP coverage required by statute, the deductible provision was not against public policy, but rather reflected the public policy of allowing those insured to use other methods of insuring for the amount of the deductible or to minimize the cost of insurance.

Since Barber, the only legislative change to the provision was to the dollar amount, raising it from $10,000/$20,000 to $15,000/ $30,000. Presumably, the legislature was aware of the 1981 Barber decision when it amended the statute in 1983, yet it made no changes to preclude the use of deductibles that effectively eliminated the minimum coverage required.

Here, the plaintiff argues that Barber is distinguishable because the damages to the plaintiffs in Barber did not exceed their deductible amount, whereas, his damages exceed his deductible amount. He relies on the Superior Court decision that states that the plaintiffs’ “total out-of-pocket expenses did not exceed the deductible” and therefore they were not entitled to reimbursement in light of the deductible on the policy. He further interprets that as meaning that if the expenses exceed the deductible, then the insured would have been entitled to reimbursement.

In its decision, the Supreme Court stated that the plaintiffs contended that the statute which contains language relating to the use of deductibles cannot validly be applied to eliminate the personal injury protection required by statute. The Court stated that “we do not agree.” Thus, the Court in Barber looked at the effect of the deductible provision which effectively eliminated PIP coverage, under the facts of that case. The Court notes that the public policy argument made in Barber is the same argument made by this plaintiff. Therefore, this Court cannot conclude that the statute, as a matter of law, prohibits deductibles that would eliminate the minimum coverage required.

However, the plaintiff also argues that he was not advised of the implications of taking this deductible and that the language of the contract was ambiguous regarding the use of deductibles.

The language the plaintiff relies on is included on the application which states:

THE POLICY WILL CONTAIN THE FOLLOWING RESTRICTED PERSONAL INJURY PROTECTION KNOWN AS OPTION 5:
Personal Injury Protection (PIP) benefits as set forth in the Delaware Motorists Protection Act, with coverage restricted as follows: only accidents occurring on a highway, and wherein there is actual physical contact with another vehicle; a $15,000 deductible will apply before there is any payment due from the company: there is a 45 day waiting period for loss of earnings and such coveage thereafter is only to the extent of 50% of the maximum provided by the Act. (Emphasis added.)

The plaintiff alleges that he understood the provisions to mean that his PIP benefits would not be paid until his losses exceeded the $15,000 deductible. He believes [1054]*1054that this interpretation is a reasonable expectation because otherwise he would have paid a premium for no coverage.3 He also points out that the policy throughout refers to a minimum of $15,000 and refers to the policyholder as the “insured.”

The insurer submits the plaintiffs execution of the “Delaware Motorist’s Protection Act Required Statement to Policyholders” as evidence that the plaintiff selected a $15,000 deductible. However, the form gives no explanation of how the deductible will be applied, which is the actual issue in dispute in this case.

The insurer also submits the “Delaware Personal Injury Protection Benefits (PIP)” form which summarizes descriptions of the options available and shows that the plaintiff selected Option 5.

That form states that Option 5 has a premium of $10 which is included in all rate quotations and summarizes it as:

Included Premium. PIP Benefits containing the restrictions in Option No. 2 (coverage restricted to highway accidents), Option No.

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Related

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Cite This Page — Counsel Stack

Bluebook (online)
601 A.2d 1051, 1990 Del. Super. LEXIS 479, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cintron-v-universal-underwriters-group-delsuperct-1990.