Perez-Garcia v. State Farm Mut. Auto. Ins. Co., CIVIL ACTION NO. 18-3783
| Decision Date | 13 January 2021 |
| Docket Number | CIVIL ACTION NO. 18-3783 |
| Parties | EDELMIRO PEREZ-GARCIA, JR., Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. |
| Court | U.S. District Court — Eastern District of Pennsylvania |
Henry S. Perkin, M.J.
Before the Court is the Motion for Partial Summary Judgement filed by Defendant, State Farm Mutual Automobile Insurance Company, seeking dismissal of the bad faith claim (Count II) of Plaintiff's Complaint. For the reasons that follow, the motion will be granted.
Plaintiff was involved in a motor vehicle accident on October 7, 2016, with Domingo Gonzalez-Padilla in Reading, Pennsylvania. Mr. Gonzalez-Padilla, the tortfeasor, possessed liability insurance in the amount of Fifteen Thousand Dollars ($15,000.00). As a direct and proximate result of this accident, Plaintiff sustained injuries to his right knee and left ankle. At the time of the accident, Plaintiff was insured under a policy of automobile insurance issued by Defendant that provided first party medical payments coverage in the amount of Ten Thousand Dollars ($10,000.00) and underinsured motorist coverage in the aggregate amount of One Hundred Thousand Dollars ($100,000.00).
On February 10, 2017, plaintiff's counsel wrote to Defendant advising of his representation of Plaintiff. In the letter, counsel requested that Defendant send him copies of the payment log indicating medical benefits and wage benefits paid to date. Counsel also stated that he was unaware of limits of the tortfeasor's liability insurance, and requested that Defendant accept the letter as notice of a potential claim for underinsured ("UIM") motorist benefits. It was also requested that the adjuster assigned to the UIM claim contact him within thirty (30) days. See Mot., Ex. 2.
On February 20, 2017, UIM claim specialist Brandon Strittmatter wrote to plaintiff's counsel acknowledging counsel's representation of the plaintiff and enclosing a certificate of coverage. Plaintiff's counsel received the letter. See Mot., Ex. 3. On March 1, 2017, plaintiff's counsel wrote to State Farm requesting copies of certain forms pertaining to the plaintiff's policy. See Mot., Ex. 4.
On March 15, 2017, claim specialist Strittmatter wrote to counsel enclosing the underwriting documents requested, and Plaintiff's counsel received both the letter and requested documents. See Mot., Ex. 5. On March 30, 2017, claim specialist Strittmatter wrote to Plaintiff's counsel advising, among other things, that Defendant had been unable to conclude the claim as the company awaited the demand package and supporting documentation to complete its evaluation. Defendant would continue processing the claim once it received the information. Plaintiff's counsel received the March 30, 2017 letter. See Mot., Ex. 6.
On March 31, 2017, Plaintiff's counsel wrote Defendant advising that the tortfeasor's carrier offered its policy limits of $15,000.00 to settle that claim. Counsel requested that State Farm provide consent to settle. Counsel also noted that the plaintiff's policy provides a total of $100,000 in UIM benefits, and that his client was diagnosed with a right torn meniscus, chondromalacia patella, and medial femoral condyle, chondromalacia. It was also noted that Plaintiff had undergone an arthroscopy of his right knee involving partial medial meniscectomy, chondroplasty medial femoral condyle and chondroplasty trochlea and the plaintiff was released to work. Counsel requested that Defendant assign an adjuster to handle the UIM claim. No medical records were enclosed with the letter, and counsel did not mention any left ankle/foot injuries in the letter. See Mot., Ex. 7.
On April 6, 2017, Brandon Strittmatter wrote to plaintiff's counsel advising that Defendant was granting the Plaintiff permission to settle the tortfeasor claim and Defendant was waiving its subrogation claim. Plaintiff's counsel received the April 6, 2017 letter. See Mot., Ex. 8.
On May 8, 2017, Brandon Strittmatter wrote to counsel advising, among other things, that Defendant was unable to conclude the UIM claim as the company awaited the Plaintiff's demand package and supporting documentation to complete its evaluation. Defendant would continue processing the claim once it received the information. Plaintiff's counsel received the May 8, 2017 letter. See Mot., Ex. 9.
On June 20, 2017, plaintiff's counsel wrote to Defendant enclosing some medical records concerning the Plaintiff's knee treatment. Among other things, counsel noted thatPlaintiff continued to suffer from pain and restrictions, and that he continued to treat with Orthopaedic Associates of Reading. The letter does not mention any left ankle/foot injuries. Counsel indicated that he was not requesting records from Orthopaedic Associates at that time, as he would request the records upon Plaintiff's discharged from Orthopaedic Associates' care. Counsel further stated that Defendant should "not consider this a demand letter at this time." See Mot., Ex. 10.
On August 17, 2017, claim specialist Jack Little wrote to counsel advising, among other things, that Defendant was unable to conclude the UIM claim as the company awaits the demand package and supporting documentation to complete its evaluation. Once the information is received, Defendant would continue processing the claim. Plaintiff's counsel received the August 17, 2017 letter. See Mot., Ex. 11.
On November 30, 2017, claim specialist David Mullen wrote to counsel advising, among other things, that Defendant was unable to conclude the claim as the company awaited the demand package and supporting documentation to complete its evaluation. Once the information is received, Defendant would continue processing the claim. Plaintiff's counsel received the November 30, 2017 letter. See Mot., Ex. 12.
On January 24, 2018, claim specialist David Mullen wrote to counsel advising, among other things, that the plaintiff's claim was pending receipt of requested documents or information. Specifically, it was indicated that supporting documents and medical records were needed for evaluation of the UIM injury claim. Plaintiff's counsel received the January 24, 2018 letter. See Mot., Ex. 13.
On March 9, 2018, claim specialist David Mullen wrote to counsel advising,among other things, that the plaintiff's claim was pending the "demand for evaluation of this UIM claim." Plaintiff's counsel received the March 9, 2018 letter. See Mot., Ex. 14.
On April 25, 2018, claim specialist David Mullen wrote to counsel advising, among other things, that the plaintiff's claim was pending due to "demand pends for evaluation of this UIM injury claim." Plaintiff's counsel received the April 25, 2018 letter. See Mot., Ex. 15.
On June 7, 2018, plaintiff's counsel wrote to Defendant enclosing records concerning Plaintiff and demanding payment of the $100,000.00 UIM policy limits. In this correspondence, plaintiff's counsel indicates that the plaintiff injured his right knee in the accident. Plaintiff's counsel also alleged, for the first time, that "[r]ecords indicate that [Plaintiff] also had significant pain from the accident in his left ankle." Counsel also claimed that the "the left ankle injury was worsened by the amount of stress that was placed on the ankle due to the right knee injury and surgery..." and Plaintiff had a severe ankle injury, including a non-union of a navicular bone fracture, along with other injuries to the ankle. It was also alleged that the left ankle injury forced additional weight-bearing to be placed on the right leg, which then aggravated the injury to the right knee and tore additional meniscus in the right knee. "At this point in time, [Plaintiff] is suffering from a badly damaged ankle and a deteriorating right knee." Counsel also stated the Plaintiff was undergoing injections "to try to calm down the degenerative arthritis that he has in the knee, which has been worsened, not only as a result of the accident, but also through the strain put on the right knee due to the left ankle injury." Plaintiff's counsel further stated that, "[a]lthough Plaintiff is being treated with injections at this point in time, it is clearthat the right knee is badly damage[d], and that more likely than not, he will be needing knee replacement surgery." "He will probably also need additional ankle surgery in the future." Counsel closed the letter by stating that he was "demanding the $100,000 policy limit in this matter, which is more than justified in light of the severe injuries to the right knee and left ankle, and the continuing deterioration of the right knee and ankle." See Mot., Ex. 16.
Plaintiff's counsel did not provide any medical records to Defendant from June 20, 2017 to June 7, 2018. Plaintiff's counsel also did not communicate with Defendant concerning the plaintiff's alleged injuries during that time period because Plaintiff was continuing to receive treatment for the injuries he sustained as a direct and proximate result of the motor vehicle accident.
Plaintiff's counsel did not mention that Plaintiff's ankle treatment was related to the accident before June 7, 2018. Prior to that date, plaintiff's counsel never alleged any injury to Plaintiff's ankle, but Plaintiff previously advised Melissa Collins, Defendant's adjuster for his first party benefits, of his ankle injuries and treatment in 2017. See Resp., Ex. A; Collins Dep., Bates Label 1360. Plaintiff's treating doctor opined that Plaintiff's ankle injury was directly and proximately caused by the injuries sustained during the accident. See Resp., Ex. B.
On June 7, 2018, Defendant's team manager Linda Kushnerock (David Mullen's supervisor) instructed in the claim activity log that Mr. Mullen should "complete your evaluation, keeping the insured atty aware of status as well as any additional information you may need to complete same." See Mot., Ex. 17 at bates-stamp 1357. On June 8,2018 claim specialist David Mullen wrote to plaintiff's counsel...
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