Pilate v. American Federated Ins. Co.

• Decision Date: 10 February 2004
• Docket Number: No. 2002-CA-00657-COA.,2002-CA-00657-COA.
• Citation: 865 So.2d 387
• Parties: Daetrus L. PILATE, Appellant, v. AMERICAN FEDERATED INSURANCE COMPANY and Mark Guillory, as Agent, Servant and Employee of American Federated Insurance Company, Appellees.
• Court: Mississippi Court of Appeals

865 So.2d 387

Daetrus L. PILATE, Appellant, v. AMERICAN FEDERATED INSURANCE COMPANY and Mark Guillory, as Agent, Servant and Employee of American Federated Insurance Company, Appellees.

No. 2002-CA-00657-COA.

Court of Appeals of Mississippi.

February 10, 2004.

Ellis Turnage, Cleveland, attorney for appellant.

Robert P. Thompson, Ridgeland, Lyn Butler Dodson, attorneys for appellees.

EN BANC.

GRIFFIS, J., for the Court.

¶ 1. Daetrus L. Pilate filed a bad faith action against American Federated Insurance Company ("AmFed"), his employer's workers' compensation carrier, and Mark Guillory, the claims adjuster for and employee of AmFed, for failure to adequately and promptly investigate and timely pay Pilate's claim for temporary total disability workers' compensation benefits. The Circuit Court of Sunflower County granted the motion for summary judgment filed by AmFed and Guillory. Pilate now appeals. Finding no error, we affirm.

FACTS

¶ 2. On January 21, 1995, Pilate was employed at International Plastics Corporation ("IPC") in Drew, Mississippi. Pilate, a material handler, was instructed to move a large stack of chairs. While attempting to move the chairs, he felt a muscle pull in his back. He continued to work and completed the rest of his shift, but failed to immediately notify his supervisor about the injury he had suffered.

¶ 3. A day or two after he was injured, Pilate returned to IPC and informed his supervisor, Homer Fair, that he had injured his back while lifting chairs and was unable to work. The following day, Fair completed and delivered an on-the-job injury report to Dorothy Cummins, an IPC secretary.

¶ 4. Pilate was examined and treated by a several doctors for his injury. On January 23, 1995, Pilate sought initial medical treatment from Dr. Walter Gough. Dr. Gough diagnosed Pilate with low back pain and ordered x-rays. The x-rays revealed an old compression of the L1; otherwise, everything was normal.

¶ 5. On February 1, 1995, Pilate sought medical care from Dr. Nate Brown in Cleveland. Pilate visited Dr. Brown on February 8, February 20, April 19, May 3, and June 20, 1995. Dr. Brown's records indicated that he saw Pilate on February 1, 1995, and Pilate indicated he had a history of low back pain following a work accident on January 21, 1995. Dr. Brown diagnosed Pilate with lumbar strain and released him to return to work on February 15, 1995. Dr. Brown eventually referred Pilate to Dr. Rommel G. Childress, an orthopedic specialist in Memphis.

¶ 6. Dr. Childress diagnosed Pilate with an acute lumbar spine strain and provided medical care to Pilate from February 23, 1995 through July 31, 1996. Dr. Childress concluded that Pilate reached maximum medical improvement on May 3, 1995, and assigned Pilate a permanent partial impairment rating of five percent.

¶ 7. On April 10, 1995, Pilate filed a petition to controvert with the Mississippi Workers' Compensation Commission (the "Commission"). The Commission sent a copy of Pilate's petition to IPC. Upon receipt of the petition, IPC sent the petition to AmFed, its workers' compensation insurance carrier.

¶ 8. On April 27, 1995, Pilate's claim was assigned to Guillory.¹ Guillory was an employee of AmFed and was assigned as the claims adjuster with responsibility for Pilate's claim. On April 28, 1995, Guillory contacted Ellis Turnage, Pilate's counsel of record on the petition, and began communication on Pilate's claim. Guillory requested, and was granted, a thirty-day extension of time to file an answer to Pilate's petition. Guillory also requested that he be allowed to take Pilate's statement; Turnage refused this request. On May 10, 1995, the Commission entered an order granting the extension to respond to the petition.

¶ 9. On June 1, 1995, Guillory initiated AmFed's efforts to obtain medical records from Pilate's treating physicians.

¶ 10. On June 2, 1995, T.G. Bolen, as counsel for AmFed, filed AmFed's answer to Pilate's petition. In its answer, AmFed admitted that Pilate suffered an injury but denied the existence of a disability.

¶ 11. On June 21, 1995, AmFed received Pilate's answers to discovery. With the answer, Pilate failed to produce any medical records and refused to execute a medical authorization form.

¶ 12. From June 2, 1995 through September 15, 1995, Guillory was actively engaged in obtaining medical records from Pilate's doctors. On September 14, 1995, Guillory received the last of the medical records that he had been requesting.

¶ 13. On October 6, 1995, AmFed's counsel took Pilate's deposition. On October 17, 1995, Bolen wrote Guillory and provided a synopsis of Pilate's deposition testimony. Bolen advised AmFed that he was of the opinion that Pilate's claim was "probably" a compensable injury. Bolen advised Guillory to obtain all of Pilate's medical records and that an independent medical exam ("IME") should be scheduled before proceeding further, in order to determine the amount of the compensable disability. Bolen also indicated that Pilate was scheduled to again see Dr. Childress on October 30, 1995.

¶ 14. On December 6, 1995, Bolen wrote Guillory to advise that Pilate missed the scheduled IME and that it had been rescheduled.² Bolen also advised of an "outrageous settlement demand" and concluded that he believed that Pilate's claim was worth only a few weeks of temporary total disability.

¶ 15. On January 19, 1996, Guillory and Bolen discussed the status of the case. Based on the medical records and Dr. Childress's letter of May 13, 1995, AmFed decided to pay Pilate temporary total disability from January 21, 1995, through May 3, 1995. On January 22, 1996, Am-Fed tendered a check to Pilate in the amount of $2,635.18, for temporary total disability during this period. ¶ 16. Pilate's workers' compensation claim continued. On September 16, 1996, a hearing was held before an administrative law judge. The issues included a determination of (a) the date Pilate reached maximum medical improvement; (b) the existence and extent of any additional temporary total disability benefits due; (c) the existence and extent of any permanent disability benefits due; (d) whether any penalties under Mississippi Code Annotated Section 71-3-37(5) apply; and (e) whether IPC and AmFed have the right to direct the administration of a work hardening program as recommended by the IME physician.

¶ 17. On December 11, 1996, the administrative law judge issued an order finding that Pilate was entitled to temporary total disability benefits from January 21, 1995 through May 3, 1995, which had already been paid, plus a ten percent penalty for failure to timely pay benefits as provided by statute. The administrative law judge concluded that Pilate was not entitled to "any additional workers' compensation benefits beyond those he has already been paid," rejecting Pilate's claim for any permanent partial disability benefits. The penalty was paid on December 11, 1996.

¶ 18. Pilate appealed the administrative law judge's decision to the Commission, and on April 16, 1997, the Commission affirmed the administrative law judge. Pilate then appealed the Commission's decision, and on November 6, 1997, the circuit court affirmed the Commission. Pilate appealed the circuit court's decision, and on January 25, 1999, this Court affirmed the circuit court. Pilate v. Int'l Plastics Corp., 727 So.2d 771 (Miss.Ct.App.1999).

¶ 19. On April 8, 1999, Pilate filed the present complaint against AmFed and Guillory. In the complaint, Pilate alleged bad faith on the grounds of IPC's refusal to timely report Pilate's injury, AmFed's refusal to adequately and promptly investigate Pilate's claim, and AmFed's refusal to timely pay Pilate's claim for temporary total disability and medical benefits. Am-Fed and Guillory answered the complaint and subsequently filed a motion for summary judgment. The Circuit Court of Sunflower County granted the summary judgment. Pilate now appeals.

STANDARD OF REVIEW

¶ 20. The standard of review for summary judgments is well settled. We employ a de novo review of a trial court's grant or denial of a summary judgment and examine all the evidentiary matters before it—admissions in pleadings, answers to interrogatories, deposition, affidavits, etc. Hurdle v. Holloway, 848 So.2d 183, 185(¶4) (Miss.2003). The evidence must be viewed in the light most favorable to the party against whom the motion has been made. Id. If, in this view, there is no genuine issue of material fact, and the movant is entitled to judgment as a matter of law, summary judgment should be entered for the movant. Id. Otherwise, the motion should be denied. Id.

ANALYSIS

¶ 21. Pilate argues that the circuit court erred in its conclusion that no genuine issues of material fact existed as to whether AmFed and Guillory committed a willful or malicious wrong or acted with gross and reckless disregard for his contractual and statutory rights to timely payment of workers' compensation benefits. According to Pilate:

There are jury questions present as to whether appellees acted promptly, adequately and as to whether an arguable or legitimate basis for delaying the payment of Pilate's worker's compensation claim from January 21, 1995 to January 1996, as to whether appellees committed a wilful or malicious wrong, or acted with gross and reckless disregard for Pilate's contractual and statutory rights for worker's compensation benefits, and as to whether appellees made a prompt and adequate investigation to obtain all medical information relevant to Pilate's worker's compensation claim.

Pilate argues that the evidence presented was sufficient to create triable issues of material fact as to whether the actions of AmFed and Guillory constituted bad faith. AmFed and Guillory contend that Pilate failed to present evidence to establish the required elements of proof.

¶ 22. The Mississippi Workers' Compensation Law provides that workers' compensation is the exclusive remedy...