State Farm Mutual Automobile Insurance v. Kulow

483 A.2d 1121, 1984 Del. LEXIS 401
Supreme Court of Delaware·Decided June 25, 1984·Published·Cited by 2 cases

Opinion

HORSEY, Justice:

In this appeal, an automobile insurer resists payment of personal injury protection (PIP) benefits to its insured and other covered persons, members of the armed services, because they received “free” medical-hospital care from the federal government. State Farm Mutual Automobile Insurance Company (State Farm) appeals Superior Court’s denial of its cross-motion for summary judgment and the Court’s grant of summary judgment for the plaintiff insured and the occupants of his automobile.

State Farm concedes that plaintiffs, members of the U.S. armed services and their spouses, are suing for the benefit of the federal government. The issue then is whether, under Delaware’s No-Fault Statute, 21 Del.C. § 2118, a no-fault insurer is required (within coverage limits) to reimburse a third party, the federal government, for medical costs incurred by it in the treatment of its employees and dependents for injuries sustained in a motor vehicle accident. Superior Court, relying upon this Court’s decision in International Underwriters, Inc. v. Blue Cross and Blue Shield of Delaware, Inc., Del.Supr., 449 A.2d 197 (1982), granted judgment for plaintiffs. We affirm.

There is no dispute of facts. At the time of their injury in Delaware, plaintiffs or their spouses were members of the United States Armed Forces. As federal employees, their employment benefits entitled them to receive without charge from feder[1123] al health facilities all reasonable and necessary medical services. 10 U.S.C. § 1071, et seq. As a result, plaintiffs received all necessary medical care and treatment for their injuries at Dover Air Force Base Hospital, Dover, Delaware.

The federal government’s cost in the care and treatment of plaintiffs for their injuries totaled about $12,000. State Farm’s no-fault policy issued to the plaintiff-insured provided $10,000 of no-fault coverage per person and $20,000 per accident. State Farm made payments under its no-fault coverage to certain of the plaintiffs for lost wages and other no-fault claims but refused to pay, within policy limits, plaintiffs’ health care costs.1 That sum amounts to about $9,000.

Following plaintiffs’ demand upon State Farm to pay their medical costs to the federal government and State Farm’s refusal, plaintiffs filed suit. Any recovery is stated to be “for the sole and exclusive benefit” of the federal government. Plaintiffs argue that the federal government, by paying their medical care costs, has become subrogated to plaintiffs’ claim against State Farm.2

State Farm seeks reversal on both contract and statutory grounds. Under the insurance contract, State Farm maintains, it is liable only to reimburse policyholders for their covered out-of-pocket expenses. Where, as here, plaintiff suffered no obligation to pay for the medical services they received, State Farm denies any contractual duty to pay the cost of the medical treatments. However, policy coverage must be coextensive with the minimum coverage required' by statute; hence, if the provisions of Delaware statute law require the federal government to be reimbursed under the facts of this case, State Farm’s policy must provide such coverage as well. 21 Del. C. § 2118(d).

As a matter of statutory construction, State Farm contends that the word “incurred” 3 as used in § 2118 means only obligations of the insured to pay for medical treatment. Again, State Farm asserts that its financial obligation is no greater than that of the insured. See Sanner v. Government Employees Insurance Co., 150 N.J.Super. 488, 376 A.2d 180 (1977), aff'd, 75 N.J. 460, 383 A.2d 429 (1978), and eases cited therein supporting State Farm’s narrow construction of “incurred.”

However, several jurisdictions with no-fault statutes similar to Delaware’s have ruled that “incurred” is not synonymous with “indebted.” In United States v. Criterion Insurance Co., 198 Colo. 132, 596 P.2d 1203 (1979), the Colorado Supreme Court rejected the same argument that State Farm here asserts. The Court held a no-fault insurer liable to the federal government for its costs in treating the insured, a National Guardsman injured in an automobile accident. The Court stated, “The fact remains that the United States incurred this expense as a result of an accident embraced within the policy provisions.” Criterion at 1206. Accord United [1124] States v. Government Employees Insurance Co., 2d Cir., 605 F.2d 669, 671-72 (1979). We find this more liberal construction of no-fault coverage to be persuasive.

We do not read 21 Del.C. § 2118(a)(2)a as exonerating a no-fault insurer from liability for payment of “reasonable and necessary expenses incurred within two years from the date of accident” simply because the expenses do not become the personal obligation of the insured. Plaintiffs received medical care for injuries sustained in an automobile accident. These services resulted in costs which were incurred; and they were incurred as a result of plaintiffs’ injuries. State Farm concedes that it would have been liable for their expenses had plaintiffs been taken to a private hospital. The mere fact that plaintiffs were taken to a military hospital and the costs absorbed by the federal government does not change the fact that the costs resulted from plaintiffs’ injuries. United States v. Criterion Insurance Co., supra; United States v. Government Employees Insurance Co., supra.

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State Farm Mutual Automobile Insurance v. Kulow, 483 A.2d 1121, 1984 Del. LEXIS 401 (Del. 1984).

483 A.2d 1121 (State Farm Mutual Automobile Insurance v. Kulow) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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