Enrique v. State Farm Mutual Automobile Insurance Co.

142 A.3d 506, 2016 Del. LEXIS 349, 2016 WL 3344580
CourtSupreme Court of Delaware
DecidedJune 14, 2016
Docket618, 2015
StatusPublished
Cited by21 cases

This text of 142 A.3d 506 (Enrique v. State Farm Mutual Automobile Insurance Co.) is published on Counsel Stack Legal Research, covering Supreme Court of Delaware primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Enrique v. State Farm Mutual Automobile Insurance Co., 142 A.3d 506, 2016 Del. LEXIS 349, 2016 WL 3344580 (Del. 2016).

Opinions

SEITZ, Justice,

for the Majority:

I. INTRODUCTION

Joann Enrique appeals from the Superi- or Court’s grant of summary judgment for State Farm Mutual Automobile Insurance Company in an action brought by Enrique for bad faith denial of uninsured motorist (“UM”) coverage stemming from a 2005 car accident. According to Enrique, the Superior Court erred because disputed issues of material fact existed whether State Farm should be liable for bad faith while handling Enrique’s UM insurance claim. After a careful review of the record on appeal, we agree with the Superior Court that the record does not support a bad faith claim against State-Farm. Accordingly, we affirm the Superior Court’s decision.

II. STATEMENT OF FACTS AND PROCEDURAL HISTORY

In 2005, an uninsured driver crashed into Enrique’s car by improperly turning into her lane. Enrique suffered a fractured rib, trauma to the right knee requiring arthroscopic surgery, trauma to the left knee for which she was a candidate for arthroscopic surgery, abrasions, and soft tissue injuries. Enrique, who was a cafeteria worker, was out of work -for about nine months after the accident. Although she returned to work in a limited capacity in February, 2006, she was only capable of light duty until June 2006.

Enrique retained an attorney to assist with her insurance claim. She exhausted her personal injury protection benefits, and then sought to recover additional money for her injuries and losses through the State Farm UM policy covering her car. The UM policy limits were $100,000. State Farm initially assigned Enrique’s insurance claim to a Delaware adjuster. Due to a high volume of Delaware claims at the time, in August 2006, State Farm reassigned the- claim to- J.R. Roach, an adjuster in West Virginia. . ,

Roach consulted a number of State Farm employees for advice on handling the claim: John Rogin, a Delaware State Farm representative, Paul Gerlitz, the Delaware State Farm team manager, and Roach’s. supervisor, Mary Adkins. After the initial review, in August 2006, Adkins authorized Roach to settle the claim in a range between $17,500 and $22,500. In September 2006, State Farm offered Enrique $17,500 to settle her claim, which she rejected. At the time, Roach valued the claim between $25,000 and $30,000.: Roach had some reservations about this range due to incomplete information about the nature and extent of Enrique’s injuries. [509]*509The Delaware team manager, Gerlitz, also expressed concerns about preexisting knee problems, and valued her claim in the range of $19,000 and $25,000. State Farm then made another settlement offer, this time for $19,000. In March 2007, Enrique rejected the $19,000 offer.

, Throughout the settlement negotiations and the processing of Enrique’s claim, ■State Farm personnel expressed concerns about whether Enrique’s knee injuries were caused by pre-existing conditions. These concerns were based on Enrique’s medical records obtained by State Farm sometime before January 2008. In January 2008, Joan Barker, a State Farm injury claim trainer, questioned- whether Enrique’s knee injuries were pre-existing, based on photographs, MRIs, and other records, and made note of the outstanding causation issues.1 Roach also took another look at Enrique’s medical history and condition, and made note of her chondro-malacia patellae (a degenerative knee condition), Lyme disease, knock-knees, hypothyroidism, smoking, obesity, and other issues. Roach also remarked , that it was not clear to what extent the accident had caused Enrique’s knee problems, but noted that the claim could be valued between $35,080 and $50,080 after the causation issue was clarified.

The record is unclear about the reasons for the large lapses in time ! during the settlement negotiations. ’ In any event, in January, 2008, Enrique made her first demand for $165,000. In March 2008, Roach contacted Dover attorney Brian McNelis, and sought his opinion on the value of Enrique’s claim. McNelis believed the claim could be worth up to $50,080 if the accident caused Enrique’s knee injuries. State Farm then offered Enrique $25,000 to settle her claim. She rejected the offer and instead continued to demand $165,-000-$65,000 more than the policy limits.

After Enrique’s demand, .in May 2008, the parties agreed to hire a doctor for an independent medical examination (“IME”) to examine Enrique and to evaluate her medical condition. Dr. Lawrence Piccioni issued a report on July 23, 2008, and concluded-that “[t]he chondromalaeie changes would definitely pre-exist the injuryof September 26, 2005'and likewise, most likely the meniscus tear would predate the September 26,2005 injury.”2 But Dr. Pic-cioni also believed that the accident had aggravated Enrique’s 'degenerative knee condition. Dr. Piccioni based his conclusions on an exámination of Enrique, “records from Dr. Eric Schwartz, Dr. Glenn Rowe, Dynamic Physical Therapy, Kent General Hospital, vehicle pictures from the accident, and [the] State of Delaware Uniform Traffic Collision report.”3 Dr. Pic-cioni could not determine the extent to which Enrique’s condition could be attributed to the accident, however, because certain records pre-dating the accident appeared to be missing.

While the parties were waiting for the IME report, in July 2008, Enrique filed suit against State Farm; -She sought UM benefits up to the $100,000 policy limits, as well as punitive damages against State Farm for bad faith by refusing to pay up to those limits. In support of the bad faith claim, Enrique alleged that State Farm refused to compensate her up to the UM policy limits without any reasonable justifi[510]*510cation. In October 2008, the Superior Court severed and stayed the bad faith claim pending resolution of the UM damages claim. The parties then stipulated to a partial dismissal of the bad faith claim without prejudice.

State Farm retained Delaware attorney Colin Shalk to defend the UM lawsuit. In August 2008, Shalk evaluated the case, including the IME report, and valued Enrique’s claim between $85,000 and $50,000.4 At about the same time, after seeing the IME report, Roach increased his value from his earlier range of $35,000 to $50,000 to between $62,080 and $94,960. Roach seems to have erroneously concluded from the IME report that Enrique’s injuries were indisputably caused by the accident.5 In August 2008, Betsy Hanson, a State Farm claim manager, expressed her disagreement with Roach’s estimate of $62,080 to $94,960 because of the outstanding causation issues. Hanson was especially concerned because she knew that Enrique had swelling of the legs and physical therapy before the accident, and believed these facts could be further evidence that the knee injuries were not caused entirely by the accident.6 Roach, Shalk, and Hanson all had access to the same IME report and records, were all experienced in valuing insurance claims, and arrived at different values.7 Due'to the continuing impasse, in September 2008 State Farm decided to advance Enrique $25,000, as the parties both agreed the claim was worth at least that much.

As trial approached, State Farm offered Enrique another $20,000 to settle the case, for a total of $45,000. Enrique also revised her demand, and as of January 2010, was willing to settle for an additional $65,000, representing a $90,000 demand.8

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Cite This Page — Counsel Stack

Bluebook (online)
142 A.3d 506, 2016 Del. LEXIS 349, 2016 WL 3344580, Counsel Stack Legal Research, https://law.counselstack.com/opinion/enrique-v-state-farm-mutual-automobile-insurance-co-del-2016.