Summary
noting that injured worker's burden before the Board was to show that his medical expenses "were reasonable, necessary, and related to the accident."
Summary of this case from Walton v. Radiology Asso.Opinion
C.A. No. 04C-07-265 RRC.
Submitted: September 19, 2006.
Decided: October 30, 2006.
On Defendant's Motion for Summary Judgment. GRANTED.
On Plaintiff's Motion in Limine DENIED AS MOOT.
Kenneth F. Carmine, Esquire, Potter Carmine Aaronson, P.A., Wilmington, DE, Attorney for Plaintiff.
Elizabeth A. Saurman, Esquire, Marshall, Dennehey, Warner, Coleman Goggin, Wilmington, DE, Attorney for Defendant.
Dear Counsel:
Before the Court is Defendant's motion for summary judgment. Plaintiff's claim against Defendant seeks personal injury protection ("PIP") benefits for medical expenses and lost wages arising from a work-related accident. The issue presented is whether the doctrine of collateral estoppel prohibits an injured employee, whose previous petition for workers' compensation benefits was denied by the Industrial Accident Board ("Board"), from bringing a new action, on identical facts, against the third party administrator of his employer's PIP program for PIP benefits. Because the Court finds that all the elements of collateral estoppel are met in this case, Defendant's motion for summary judgment is GRANTED.
Also before the Court is Plaintiff's motion in limine to exclude certain photographic evidence from being introduced at trial. Because Defendant's motion for summary judgment is granted, Plaintiff's motion in limine is DENIED AS MOOT.
I. FACTS AND PROCEDURAL HISTORY
Plaintiff was involved in an accident on February 12, 2004 while he was driving a DART bus during the course and scope of his employment. He subsequently filed a petition for workers' compensation benefits against DART for medical expenses and lost wages allegedly arising from that accident.
At his hearing before the Board, Plaintiff had the burden of proving that his medical expenses and lost wages were reasonable, necessary, and related to the accident. Plaintiff presented testimony of his wife and his expert, Dr. Bruce Katz. He also testified himself. In its September 28, 2004 decision, the Board found that Plaintiff was "not credible" and his expert's opinion was "unpersuasive." Thus, the Board held that Plaintiff did not meet his burden of proof and denied his petition.
Clark v. State, JAB Hearing No. 1247102 (Sept. 2, 2004).
Id.
Plaintiff appealed the decision of the Board, claiming that it had erred by admitting and considering a digital image video of the interior of the DART bus at the time of the accident. This Court affirmed the Board's decision on August 31, 2005. Plaintiff then appealed to the Supreme Court, which also affirmed the decision on February 24, 2006.
Clark v. State, 2005 WL 2143709 (Del.Super.).
Clark v. State, 2006 WL 454508 (Del.Supr.).
Plaintiff has now filed the present claim in this Court against Defendant, the third-party administrator of his employer's self-insured PIP program, for medical expenses and lost wages pursuant to 21 Del. C. § 2118.
II. PARTIES' CONTENTIONS
Defendant contends that the doctrine of collateral estoppel bars Plaintiff from relitigating the issues decided in the workers' compensation case before the Board. In particular, Defendant asserts that the issues in this case are identical to the issues that Plaintiff unsuccessfully litigated before the Board, that the Board's decision was final and on the merits, that Defendant is in privity with DART, and that Plaintiff had a full and fair opportunity to be heard before the Board. Therefore, Defendant argues that all of the elements of collateral estoppel are satisfied, thus barring Plaintiff's claim.
In response, Plaintiff contends that collateral estoppel does not apply in this case because the parties to this claim for PIP benefits are different than the parties to the workers' compensation action before the Board. Furthermore, Plaintiff claims that collateral estoppel should not apply because Plaintiff should have the opportunity to have his case heard before a jury.
III. STANDARD OF REVIEW
Summary judgment is appropriate where "the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law." Although the moving party has the burden of demonstrating that no material issues of fact are in dispute and it is entitled to judgment as a matter of law, the facts must be viewed "in the light most favorable to the nonmoving party."
Super. Ct. Civ. R. 56(c).
Mason v. United Servs. Auto. Ass'n, 697 A.2d 388, 392 (Del. 1997).
IV. DISCUSSION
"[W]here a court or administrative agency has decided an issue of fact necessary to its decision, the doctrine of collateral estoppel precludes relitigation of that issue in a subsequent suit or hearing concerning a different claim or cause of action involving a party to the first case."
Betts v. Townsends, Inc., 765 A.2d 531, 534 (Del. 2000).
In order for collateral estoppel to apply, the following factors must be present:
(1) the issue previously decided is identical to the issue at bar; (2) the prior issue was finally adjudicated on the merits; (3) the party against whom the doctrine is invoked was a party or in privity with a party to the prior adjudication; and (4) the party against whom the doctrine is raised had a full and fair opportunity to litigate the issue in the prior action.
City of Newark v. Unemployment Ins. Appeal Bd., 802 A.2d 318, 324 (Del.Super.Ct. 2002).
However, collateral estoppel should not be applied if there is a difference in the extensiveness or quality of procedures available in the two tribunals that warrants relitigation.
Id. See also Messick v. Star Enterprise, 655 A.2d 1209, 1213 (Del. 1995).
It is undisputed that the issue decided by the Board, whether Plaintiffs medical expenses and lost wages were reasonable, necessary, and related to the accident, is the identical issue in this case. Additionally, both parties agree that the Board's decision was final and on the merits, and that Plaintiff had a full and fair opportunity to litigate the issue in the prior action before the Board. Therefore, the only issues in dispute are whether Defendant in this case is the same party or in privity with a party to the workers' compensation case and whether Plaintiff should be allowed to relitigate the issue due to the procedural differences between proceedings in this Court and those before the Board.
The Delaware Supreme Court has held that collateral estoppel should not be used in a third-party civil action to bar the relitigation of factual issues previously decided by the Board where such an application would improperly force an election of remedies under workers' compensation law. Messick, 655 A.2d at 1213. However, Plaintiff here does not contend that an application of collateral estoppel in this case would result in an improper election of remedies.
If Defendant was a party in the previous action or is in privity with a party to the previous action before the Board collateral estoppel will bar Plaintiffs claim against Defendant for PIP benefits. The term privity, in the context of collateral estoppel, signifies that "the relationship between two or more persons is such that a judgment involving one of them may justly be conclusive on the others, although those others were not party to the lawsuit."
Higgins v. Walls, 901 A.2d 122, 138 (Del.Super.Ct. 2005) (quoting 18 James WM. Moore et. al, Moore's Federal Practice § 132.01[1][b] (3d ed. 2004)). See also Coca-Cola Co. v. Pepsi-Cola Co., 172 A. 260 (Del.Super.Ct. 1934) ("If the defendant's responsibility is necessarily dependent upon the culpability of another . . . who, in an action against him by the same plaintiff for the same act, has been adjudged not culpable, the defendant may have the benefit of that judgment as an estoppel. . . .").
Plaintiffs workers' compensation petition was filed against DART. The insurer in that action was PMA, a third-party administrator of the selfinsured workers' compensation program covering DART employees. The current claim is filed against Defendant, a third-party administrator of DART's self-insured PIP program. If DART had been found liable to Plaintiff for workers' compensation before the Board, Defendant would have been obligated to pay Plaintiffs PIP benefits. Moreover, any PIP benefits that Defendant paid would have been reimbursed by DART. Therefore, Defendant is in privity with DART.
See State v. National Auto. Ins. Co., 290 A.2d 675, 677 (Del.Ch. 1972) (stating that even though the insurer was not a party to an action against insured for injures sustained in a car accident, the insurer was in privity with the insured and therefore the determination of the insured's liability was final and binding on the insurer). See also Johnson v. Fireman's Fund, 1983 Del. LEXIS 762, at *3 (Del.Super.) (holding that it was the "good faith obligation" of the PIP insurer to pay additional PIP benefits "where after the PIP benefits have been paid to their maximum amount it is determined post hoc that workmen compensation would have paid all the claimed medical expenses, thus freeing up monies for additional benefits which could have been applied to the claimant's net lost earnings").
Burcham Aff. ¶ 2.
Plaintiff also claims he should be allowed to proceed with his PIP claim because his workers' compensation claim was not heard before a jury. However, the application of collateral estoppel is not limited to where an issue has previously been decided by a jury. The doctrine applies to administrative agency hearings as well and court proceedings. Courts have sometimes recognized an exception to collateral estoppel if relitigation is "warranted by differences in the quality or extensiveness of the procedures followed in the two courts," for example, if a party was limited in its ability to undertake full discovery of witnesses and parties, including document production, interrogatories and depositions. No such circumstances are alleged here. Plaintiff merely claims that he "should have the right to present the issue of his credibility to a jury of his peers." Plaintiff has already had a full and fair opportunity to litigate this issue before the Board. Therefore, he does not have the right to relitigate it before a jury.
Messick, 655 A.2d at 1211.
City of Newark, 802 A.2d at 324.
Messick, 655 A.2d at 1213.
Because all the elements of collateral estoppel are present in this case, Plaintiff's claim against Defendant for PIP benefits is barred.
V. CONCLUSION
For the reasons stated above, Defendant's motion for summary judgment is GRANTED. Accordingly, Plaintiff's motion in limine is DENIED AS MOOT.