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One Beacon Insurance Co. v. Dambacher

September 27, 2010


The opinion of the court was delivered by: Schiller, J.


Plaintiff OneBeacon Insurance Company ("OneBeacon")brings this action against its insured, Defendant Joann Dambacher, for a declaratory judgment that it has no obligation to pay certain claims submitted under an automobile insurance policy. OneBeacon asserts that it has no obligation to pay these claims pursuant to a release agreement ("the Release") Dambacher executed in 1986 following an earlier lawsuit against OneBeacon's predecessor-in-interest, Commercial Union. On September 9, 2010, the Court conducted a bench trial. At trial, the parties agreed that the Court would determine whether Dambacher is entitled to future home renovations, van modifications, and nursing services in excess of $4,000 per month under the Release.The Court now enters the following Findings of Fact and Conclusions of Law as required by Federal Rule of Civil Procedure 52(a). For the reasons that follow, the Court finds that Plaintiff OneBeacon must provide for Dambacher's reasonable expenses for nursing services, van modifications, and home renovations, including for nursing services in excess of $4,000 per month under the Release.


A. Ms. Dambacher

On November 3, 1977, fourteen-year-old Joann Dambacher was involved in a single vehicle automobile accident that left her a quadriplegic. (Id.) Since the accident, she has required extensive nursing, hospital, and rehabilitative care. (Tr. at 31, 32, 51, 53.) Her needs have increased in recent years to the point that she currently requires twenty-four-hour nursing care to attend to her medical needs, personal hygiene, and household tasks. (Tr. at 54-55.) She is currently unable to work due to complications from her disability. (Id. at 52.) In 1979, Dambacher sued Commercial Union for benefits she claimed under an automobile insurance policy held by her father. (Joint Pretrial Stipulation, Agreed Facts ¶ 3 [Agreed Facts].) The parties settled the case in 1986. (Pl's Trial Ex. 6, Opinion of the Court in Dambacher v. Commercial Union, dated February, 1985 [1985 Opinion].) Although there have been delays in processing claims, Commercial Union/OneBeacon has paid all of Dambacher's nursing care and medical bills since the 1986 settlement, including for nursing care in excess of $4,000 per month. (Tr. at 49-51; 91.)

At the time of the accident, Dambacher was living in Philadelphia with her parents. (Id. at 31.) Her parents were her sole caretakers in the period after the accident until she settled her lawsuit against Commercial Union. (Id. at 32.) She remained in that home until her father died in 1986. (Id.) That home was not disabled-accessible, and as a result, she was confined to the first floor, had to be carried up the stairs to bathe, and was unable to use the kitchen. (Id. at 31-32.)

In approximately 1988, Dambacher purchased a home with her mother in Medford, New Jersey, where they both lived. (Id. at 32-33.) Dambacher engaged two contractors, M & D Home Improvement and Barrington Door, to provide modifications to the home to accommodate her disability, including an automatic door opener and a modified bathroom. (Id. at 34-35.) Dambacher submitted two bills for the renovations in the amounts of $5,980.52 and $2,422.00 in September 1988, both of which Commercial Union paid. (Id. at 34-36.) Dambacher testified that the Medford house, despite the modifications, is not fully accessible because no modifications have been made to the kitchen and because she has no access to the raised area in the loft of the house. (Id. at 37-38.)

Several years after purchasing the Medford home, Dambacher purchased another home with her mother in Stone Harbor, New Jersey, where Dambacher currently lives by herself. As with the Medford home, she arranged for modifications, including an automatic door and a modified bathroom. (Id. at 38.) OneBeacon paid for these renovations. (Id.) Dambacher testified that she is not able to live independently in the Stone Harbor house because it is not fully accessible. (Tr. at 41.) She also testified that the location of the Stone Harbor house on the New Jersey shore isolates her from friends and family during the colder months of the year. (Id. at 41.) For these reasons, Dambacher would like to construct a new, fully accessible home in Shamong, New Jersey, near Medford. (Id. at 41-42.) In April 2009, Dambacher submitted a claim to OneBeacon for modifications to a newly constructed house in Shamong in the amount of $491,584. (Id.; Agreed Facts ¶ 7.) OneBeacon denied the claim because her claims for home renovations were extinguished under the terms of the 1986 Release signed by the parties. (Agreed Facts¶ 8.)

Dambacher also requires a specially modified van so that she can transport herself. In the years following the signing of the Release, Commercial Union and/or OneBeacon paid for van modifications on multiple occasions.*fn1 In 1993, Dambacher purchased a Chrysler van and had modifications made by Del-Val Enterprises. (Id. at 42.) Commercial Union paid this bill in the amount of $30,968. (Id. at 43.) Approximately five years later, Dambacher purchased another Chrysler van. (Id. at 44.) Commercial Union and/or OneBeacon paid for the modifications. (Id.) In approximately 2001, she purchased another van, and had Performance Vans make the necessary modifications. Commercial Union paid the Performance Vans bill in the amount of approximately $30,000-$40,000. (Id. at 44-45.) Again, in 2006, Dambacher purchased a van, with modifications made by Accessible Vans in the amount of $36,873.75. (Id. at 46-47.) OneBeacon also paid this bill. (Id. at 47.)

B. Dambacher's State Court Litigation

At the time of her accident, Dambacher was covered by an automobile insurance policy issued to Dambacher's father by Commercial Union. (Agreed Facts¶2.) In 1979, Dambacher filed a lawsuit against Commercial Union in the Philadelphia Court of Common Pleas, alleging that certain expenses were covered by the policy, including renovations to her parents' home, transportation expenses, van modifications, and home nursing care. (Id. ¶ 3.) In February of 1985, a jury awarded Dambacher $28,471 for home renovations, $13,565 for a van, $963,053.62 for past nursing services and $7,200 per month in future nursing care. (Id. ¶ 4; 1985 Opinion.) On post-trial motions filed by both parties, the Court of Common Pleas vacated the jury award on the grounds that certain of Dambacher's claims were barred by the statute of limitations. (1985 Opinion.) While this decision was on appeal, the parties settled the case in April, 1986. (Agreed Facts ¶¶ 2-6.) On April 22, 1986, Dambacher executed the Release, which included a lump sum payment of $480,000 and $4,000 per month in nursing care for the remainder of her life. (Id. ¶ 6; Pl's Trial Ex. 2, Release in Full of All Claims dated April 22, 1986 [Release].) The Release was drafted by Commercial Union's attorney, David M. McCormick, and reviewed and approved by Dambacher's attorney, Gustine J. Pelagatti. (Agreed Facts ¶ 6.)

C. The 1986 Settlement Negotiations and Terms of the Release

In April 1986, Norman Whitton, Senior Claims Analyst for Commercial Union, entered into settlement negotiations with Pelagatti while cross-appeals from both parties were pending in Dambacher's state court lawsuit. On April 10, 1986, Whitton sent a letter to Pelagatti confirming that the two had met on April 3, 1986 and settled Dambacher's case. (Pl's Trial Ex. 1, Letter from Norman B. Whitton to Gustine J. Pelagatti dated April 10, 1986 [Whitton Letter].) McCormick was copied on the letter. (Id.) The letter stated:

The settlement agreement is contingent upon court approval in the amount of $480,000 . . . which shall release all claims to include, but not limited to, claims for prior nursing services, renovations, a van, attorney fees, and costs, interest, transportation expenses, and is inclusive of all prior and future claims, except future nursing services . . . . It is also agreed that we [Commercial Union] would pay $4,000 per month for future nursing services for Joann Dambacher. (Id.) On April 9, 1986, Dambacher filed a Petition for Approval of Settlement with the Court of Common Pleas, which the court granted on April 11, 1986. (Pl's Trial Ex. 3, Petition for Approval of Settlement of No-Fault Benefits [Petition].) Paragraphs 23 and 24 of the Petition are similar, but are not identical to the language in the Release. Paragraph 23 provides that "Plaintiff is aware that by accepting the $480,000.00 cash settlement . . . she is forever waiving her right to make additional claims for past nursing services, home renovations, a van, transportation expense [sic] and work-loss benefits prior to the date of this settlement." (Id.) Paragraph 24 provides, "Plaintiff is aware that irrespective of this settlement, Commercial Union Assurance Companies will have a continuing duty to provide her the costs of reasonable and necessary services, products and accommodations as per the Pennsylvania No-Fault ...

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