NITZA I. QUIÑONES ALEJANDRO, District Judge.
Presently before this Court is a motion for partial summary judgment
Briefly, the procedural posture of this protracted matter is as follows: On June 17, 2010, Dr. Schatzberg, D.C., ("Dr. Schatzberg") only filed a complaint against State Farm asserting claims for defamation and false light. [ECF 1]. Before a response was filed, on July 22, 2010, Dr. Schatzberg and Philadelphia Pain Management, Inc., filed an amended complaint and asserted claims for: defamation, false light invasion of privacy, violation of the Pennsylvania Motor Vehicle Financial Responsibility Law, statutory bad faith, violation of the civil Racketeering Influenced and Corrupt Organizations Act ("RICO"), and conspiracy to violate RICO. [ECF 9]. On August 30, 2010, State Farm filed a motion to dismiss each of these claims, [ECF 14], which the Schatzberg Entities opposed. [ECF 15]. By Order dated July 12, 2012, with its accompanying Memorandum Opinion, [ECF 24 and 23, respectively], the Honorable Gene E.K. Pratter granted State Farm's motion, in part, and dismissed all but the Schatzberg Entities' claim for defamation.
Thereafter, on August 9, 2012, State Farm filed an answer and counterclaim to the amended complaint. [ECF 28]. In the counterclaim, State Farm asserted claims against each of the Schatzberg Entities for violations of the Pennsylvania Insurance Fraud statute, 18 Pa. C.S. §4117 et seq. (Count I), common law fraud (Count II), violation of RICO (Count III), unjust enrichment (Count IV), and restitution (Count V). On August 20, 2012, the Schatzberg Entities filed a motion to dismiss State Farm's counterclaims. [ECF 32]. Judge Pratter heard oral argument on the motion to dismiss on October 25, 2012. [ECF 46]. However, before the motion to dismiss was adjudicated, this matter was reassigned on July 19, 2013, to the undersigned's docket. [ECF 71]. In the interim, on November 13, 2012, State Farm filed an amended answer and counterclaim to the amended complaint, incorporating by reference the counterclaim in its original answer. [ECF 47]. By Order dated February 21, 2014, this Court denied the Schatzberg Entities' motion to dismiss State Farm's counterclaims. [ECF 89].
On March 11, 2014, the Schatzberg Entities filed an answer and a "counterclaim" to State Farm's counterclaim (hereinafter, the "Schatzberg Entities' Counterclaim"). [ECF 95]. The Schatzberg Entities' Counterclaim was amended on April 8, 2014, [ECF 100], and again on July 7, 2015. [ECF 231]. The counterclaim, as amended, included additional claims for defamation premised on statements made by State Farm to the National Insurance Crime Bureau ("NICB"), the Pennsylvania Attorney General's Office, and to other third parties, as well as numerous claims couched under the Pennsylvania Motor Vehicle Financial Responsibility Law ("MVFRL").
On November 21, 2014, State Farm filed the instant motion for partial summary judgment seeking to dismiss the defamation claims asserted by the Schatzberg Entities in the amended complaint and in their second amended counterclaim. [ECF 180]. When deciding this motion for partial summary judgment, this Court has considered all relevant facts in this matter in the light most favorable to the nonmoving party, i.e., the Schatzberg Entities. See Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 255 (1986). These relevant facts are summarized as follows:
Rule 56 governs the summary judgment motion practice. Fed. R. Civ. P. 56. Specifically, this rule provides that summary judgment is appropriate "if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Id. A fact is "material" if proof of its existence or non-existence might affect the outcome of the litigation, and a dispute is "genuine" if "the evidence is such that a reasonable jury could return a verdict for the nonmoving party." Anderson, 477 U.S. at 248. Under Rule 56, the court must view the evidence in the light most favorable to the nonmoving party. Id. at 255; Galena v. Leone, 638 F.3d 186, 196 (3d Cir. 2011).
Rule 56(c) provides that the movant bears the initial burden of identifying the basis for the motion and those portions of the record which the movant "believes demonstrate the absence of a genuine issue of material fact." Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). This burden can be met by showing that the nonmoving party has "fail[ed] to make a showing sufficient to establish the existence of an element essential to that party's case." Id. at 322.
After the moving party has met its initial burden, summary judgment is appropriate if the nonrnoving party fails to rebut the moving party's claim by "citing to particular parts of materials in the record, including depositions, documents, electronically stored information, affidavits or declarations, stipulations . . ., admissions, interrogatory answers, or other materials" that show a genuine issue of material fact or by "showing that the materials cited do not establish the absence or presence of a genuine dispute." See Fed. R. Civ. P. 56(c)(l)(A-B). The nonmoving party must "do more than simply show that there is some metaphysical doubt as to the material facts." Matsushita Elec. Indus. Co., Ltd v. Zenith Radio Corp., 475 U.S. 574, 586 (1986). The nonmoving party may not rely on bare assertions, conclusory allegations or suspicions, Fireman's Ins. Co. of Newark v. DuFresne, 676 F.2d 965, 969 (3d Cir. 1982), nor rest on the allegations in the pleadings. Celotex, 477 U.S. at 324. Rather, the nonmoving party must "go beyond the pleadings" and either by affidavits, depositions, answers to interrogatories, or admissions on file, "designate `specific facts showing that there is a genuine issue for trial.'" Id.
"[A] complete failure of proof concerning an essential element of the nonmoving party's case necessarily renders all other facts immaterial." Celotex, 477 U.S. at 323. In such a situation, the moving party is entitled to judgment as a matter of law. Id.
In their amended complaint and counterclaim, Plaintiffs allege that State Farm defamed Dr. Schatzberg and the Schatzberg Entities through various oral and written statements, made to third parties, which represented that Plaintiffs were engaged in fraudulent billing practices. These defamatory statements were made to: (1) former employees of the Schatzberg Entities; (2) attorneys for various insureds and/or claimants of State Farm who were patients of the Schatzberg Entities; and (3) the NICB and the Pennsylvania Office of Attorney General.
In its motion for partial summary judgment, State Farm has moved to dismiss all of the Schatzberg Entities' defamation claims on the sole ground that the alleged defamatory statements are subject to various statutory and/or common law privileges and immunities.
In responding to State Farm's motion, the Schatzberg Entities have not challenged that the representations at issue are subject to the various privileges and/or immunities identified by State Farm. Rather, the Schatzberg Entities argue that the exception for actual malice applies, and, therefore, State Farm remains liable for its defamatory statements.
The burden of showing actual malice is substantial. Blackwell v. Eskin, 916 A.2d 1123, 1125 (Pa. Super. 2007). To establish malice, the Schatzberg Entities must show that State Farm knew that the statements were false or recklessly disregarded their falsity. Id. A showing of actual malice requires "sufficient evidence to permit the conclusion that the defendant in fact entertained serious doubts as to the truth of his publication." Id (citations omitted). Evidence of ill-will or of defendant's desire to harm the plaintiffs reputation, although probative of the defendant's state of mind, without more, does not establish actual malice for defamation purposes. Id. at 1126. "Failure to check sources, or negligence alone, is simply insufficient to maintain a cause of action for defamation. Recklessness generally and in the context of actual malice is not easily shown." Tucker v. Philadelphia Daily News, 848 A.2d 113, 135 (Pa. 2004). Mere proof of a failure to investigate, without more, cannot establish a publisher's reckless disregard for the truth which would constitute "actual malice;" rather, the publisher must act with a high degree of awareness of probable falsity. Gertz v. Robert Welch, Inc., 418 U.S. 323, 332 (1974); see also Blackwell, 916 A.2d at 1126 (rejecting plaintiffs argument that the defendant's deliberate failure to investigate evidenced actual malice).
Here, to meet their burden of proof that actual malice exists, the Schatzberg Entities rely on the report of their purported expert, James Schratz, in which he opines that State Farm's investigation was inadequate as it fell below the insurance industry standard for proper claims handling and fraud investigation. Specifically, Mr. Schratz is critical of the overall depth and scope of Mr. Babin's investigation, Mr. Babin's failure to interview witnesses other than former employees, and State Farm's failure to provide adequate oversight to the investigation. This reliance, however, is misplaced.
The mere presence of an expert opinion supporting a non-movant's position (here, the Schatzberg Entities) does not necessarily defeat a motion for summary judgment, such as that filed by State Farm. Rather, there must be sufficient facts in the record to validate the opinion rendered. In re TM/Litigation, 193 F.3d 613, 716 (3d Cir. 1999); Advo, Inc. v. Philadephia Newspapers, Inc., 51 F.3d 1191, 1198-99 (3d Cir. 1995); Kosierowski v. Allstate Insurance Co., 51 F.Supp.2d 583, 595 (E.D. Pa. 1999) (rejecting plaintiffs argument that expert's report opining that insurer engaged in bad faith created genuine issue of material fact). As the First Circuit Court of Appeals aptly stated in Hayes v. Douglas Dynamics, Inc., 8 F.3d 8, 92 (1st Cir. 1993):
While the Schatzberg Entities' purported expert may be able to assist a jury in determining the industry standard for insurance fraud investigations, Mr. Schratz cannot, and has not opined on the ultimate legal question of whether State Farm acted with actual malice, i.e., with knowledge that the alleged statements were false.
Consistent with their expert report, Plaintiffs contend that State Farm's investigation of the Schatzberg Entities' suspected fraud was inadequate. In particular, Plaintiffs highlight that State Farm interviewed, or attempted to interview, only nine individuals, each of whom was a former, rather than current, employee of the Schatzberg Entities, that each of the interviews was generally only brief in duration and provided no substantive information, and that the investigation was led by Doug Babin, who was neither a doctor nor an insurance adjuster. These described inadequacies do not amount to the actual malice required to overcome the applicable privileges and immunities asserted by State Farm, and are belied by the evidence of record.
The fact that State Farm sought interviews of only former employees, and not current employees of the Schatzberg Entities, is of little significance and provides no evidence as to actual malice. In fact, had State Farm intentionally sought out current employees of the Schatzberg Entities after State Farm retained counsel, as the Schatzberg Entities seem to suggest they should have, such contacts might possibly have breached various ethical considerations which preclude such contacts when made in the realm of anticipated litigation. See, e.g., Pa. R. Prof. C. 4.2. In light of this ethical constraint, State Farm's decision to limit its investigatory interviews to former, rather than current employees, is reasonable and, thus, cannot be construed as evidence of actual malice. Although State Farm's interviews of the former employees of the Schatzberg Entities provided little, if any, information relevant to State Farm's investigation, evidence in the reviewed claim files in State Farm's possession reasonably supported State Farm's suspicions.
Similarly, the fact that State Farm's internal investigation was led by Mr. Babin, who is neither a doctor nor an adjuster, is of little import, and provides no reasonable inference that State Farm acted with actual malice. It is undisputed that, at the time of the underlying investigation, Mr. Babin had worked in State Farm's SIU for more than 10 years, and was tasked with applying and identifying specific "indicators" of suspected fraud when reviewing claim files. Plaintiffs have offered no reasonable explanation for why one must be either a doctor or an adjuster to identify these indicators. Identifying such indicators of fraud was at the very essence of the SIU's and Mr. Babin's responsibilities.
As stated, State Farm's investigation of the Schatzberg Entities' suspected fraudulent billing practices began in 2009 when Mr. Babin noticed a pattern of standardized treatment in claim files in his inventory that involved the Schatzberg Entities. (Ex. 5, Babin Tr. 144:7-10). In applying the NICB indicators of fraud, Mr. Babin found a specific, similar pattern of standardized treatment that was questionable. After specific NICB indicators of fraud were identified by Mr. Babin in the initial review of the Schatzberg Entities' claim files, State Farm retained an attorney, Cy Goldberg, and his law firm in 2009, to assist in the investigation and to provide an opinion as to whether the evidence found supported the existence of fraud. (Ex. 5, Babin Tr. 113:19-114:4). State Farm's investigation continued and was ongoing when Dr. Schatzberg filed his lawsuit in 2010. (Ex. 6, Babin Tr. 95:11-96:4). State Farm's investigation continued up until the time State Farm filed its counterclaim. (Ex. 6, Babin Tr. 106:21-107:2; 114:14-22).
While Plaintiffs contend that State Farm's retention of Attorney Goldberg and his law firm somehow evidences actual malice because Attorney Goldberg and his firm have a history of bringing claims against medical providers for fraud, this Court sees otherwise. Hiring a third party, be it a law firm, private investigator or some other entity, to assist in an investigation of suspected fraud cannot be reasonably construed as evidence of actual malice, i.e., recklessness as to the truth of the alleged statements. To the contrary, retention of a third party to assist in an investigation evidences the retaining party's exercise of reasonable diligence. The Schatzberg Entities cite to the fact that Attorney Goldberg has been retained by State Farm in a number of other matters in which State Farm has alleged fraud by medical providers, and identify several of these matters in their amended complaint at Paragraph 67. Plaintiffs allege in their amended complaint: "Mr. Goldberg has enjoyed very public success as an attorney who sues doctors for fraud on behalf of State Farm." (Am. Comp. ¶ 84).
Though Plaintiffs challenge the adequacy of State Farm's investigation, the Schatzberg Entities do not dispute that State Farm's investigation included the review of hundreds of claim files and bills and the retention of a law firm (the Goldberg firm), experienced in such matters, and which had successfully prosecuted fraud claims against various health care providers. The Goldberg firm itself spent numerous hours reviewing claim files. While the parties may dispute the ultimate findings of State Farm's investigation, the undisputed facts that State Farm undertook such an investigation and hired specialized counsel to assist in the investigation, refutes any reasonable inference that State Farm acted with actual malice. Cf Gertz v. Robert Welch, Inc., 418 U.S. 323, 332 (1974) (finding that the "failure to investigate, without more, cannot establish reckless disregard for the truth. . . ."); Blackwell, 916 A.2d at 1126 (rejecting plaintiff's argument that the defendant's deliberate failure to investigate evidenced actual malice).
Plaintiffs also argue that State Farm's decision to wait until August 9, 2012, to file its counterclaim in this matter is evidence of actual malice. Specifically, Plaintiffs argue that State Farm's decision to wait more than two and a half years after State Farm determined it had enough evidence to start a "project" regarding its suspicions can only be attributed to State Farm's knowledge that no such fraud existed. Plaintiffs' argument, however, amounts to nothing more than speculation and is not evidence of the actual malice required to overcome the applicable privileges and immunities. Procedurally, State Farm's answer to Plaintiff's complaint was not due until after State Farm's motion to dismiss was disposed of, an event that occurred on July 12, 2012. Thus, State Farm's filing of its answer and counterclaim when it became due can hardly be construed as evidence of actual malice.
Finally, Plaintiffs also point to State Farm's eventual changing of the wording on State Farm's letters to insureds and/or their counsel as evidence of actual malice. As stated, in August 2012, State Farm began denying all bills of the Schatzberg Entities pursuant to its TIN block. Concurrent with each denial, State Farm sent a form letter which stated, in part, as follows:
Despite Plaintiffs' speculation as to the motive behind the imprecise wording of State Farm's original letters, this change in the wording does not evidence the actual malice required to overcome the privileges and immunities applicable to State Farm's alleged statements.
After a comprehensive review of the record and case law, this Court opines that no reasonable factfinder could conclude that State Farm acted with actual malice during the course of its investigation and/or when the statements were allegedly made. Under the circumstances noted, Plaintiffs have not overcome the privileges and/or immunities that apply to State Farm's alleged statements.
For the foregoing reasons, Defendants' motion for partial summary judgment is granted. An Order consistent with this Memorandum Opinion follows.
The Pennsylvania legislature has also created by statute within the Office of Attorney General "a Section of Insurance Fraud to investigate and prosecute insurance fraud ...."40 P.S. §325.41. A subsection of this chapter contains a similar immunity provision: "In the absence of malice, persons or organizations providing information to or otherwise cooperating with the section, its employees, agents or designees shall not be subject to civil or criminal liability for supplying the information."40 P.S. §325.47(a). Similar immunity is provided in the Insurance Companies chapter of the Pennsylvania Code:
40 P.S. §474.1. As stated above, the Schatzberg Entities concede that these privileges and immunities apply to State Farm's alleged defamatory statements, but argue that each is subject to an exception for actual malice.