MATTHEW W. BRANN, District Judge.
The Hartford Life and Accident Insurance Company moved for summary judgment on both counts of Ronald E. Long's complaint. It also moved to strike an affidavit submitted by Mr. Long in opposition to summary judgment. For the reasons that follow, Hartford's motion for summary judgment will be denied in part and granted in part, and its motion to strike will be denied.
On February 20, 2013, Mr. Long's severely infected left foot was amputated at the Williamsport Hospital.
Mr. Long was diagnosed with diabetes in 1974.
Mr. Long testified in deposition that, in early February 2013, he injured himself after slipping and falling on some rocks.
The antibiotics apparently did not help, so several days later, on February 12, 2013, Mr. Long saw Dr. Schlorff in person. The records from that visit indicate that there was a "blister," or "abscess formation," on the "medial aspect of [Mr. Long's] left arch" with "positive signs of system infection beyond the area of chief complaint." The records do not mention any accidental injury. Because of the severity of the infection, Dr. Schlorff suggested that Mr. Long seek treatment at the Williamsport Hospital.
Mr. Long went to the emergency room that same day. The intake records from the ER, as well as the ER doctors' reports, list Mr. Long's malady as a "diabetic ulcer."
The next day, February 13, 2013, Mr. Long saw a Dr. Sajja, whose report indicated that Mr. Long was "hospitalized with [a] severe left diabetic foot infection."
After the surgery, Mr. Long was admitted to a rehabilitation center, from which he was released on March 1, 2013. His "Discharge Summary" from the center claims that his amputation was due to an "infected left diabetic foot ulcer."
As noted above, Mr. Long could recover under the accidental death and dismemberment policy if an "injury result[ed] in" a lost foot. The policy defined "injury" as "bodily injury resulting directly from accident, and independently of all other causes," and noted that "loss resulting from . . . sickness or disease" was "not considered as resulting from injury." The policy, however, excluded "a pus-forming infection which occurs through an accidental would" from this "sickness or disease" exemption.
On February 11, 2014, Mr. Long submitted a claim for recovery under this provision. His "Statement of Claim" indicated that his amputation was the result of an "accident"; specifically, he averred that he had "injured [the] ankle of [his] left foot" after he "slipped on rocks while cleaning a stove pipe of soot." The attached "Physician's Statement," however—which was signed by Dr. Sajja— indicated that the "injury" at issue was a "left foot diabetic infection and ulcer."
Hartford first responded to Mr. Long's claim on June 5, 2014.
Hartford decided Mr. Long's appeal on December 22, 2015.
Mr. Long initiated the above-captioned action against Hartford by filing a two-count complaint on January 26, 2016.
After discovery, Hartford moved for summary judgment.
After the summary judgment briefing was complete, Mr. Long moved for leave to supplement the record with the report of his expert, Dr. Ajay Rao.
Summary judgment is granted when "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."
In breach of insurance contract cases, the insured bears the burden of establishing that his claim comes within the policy's coverage.
In Pennsylvania, insurance policies excluding coverage where a loss is "caused directly or indirectly by disease" are construed broadly against the insured, and "there can be no recovery [under such policies] if pre-existing disease contributed to the [loss]."
The policy in this case, however, does not neatly align with the policies discussed in the cases cited by Hartford. Here, Mr. Long was entitled to recover if his "[i]njury result[ed] in [the] loss of . . . either . . . foot."
To defeat Hartford's motion for summary judgment, Mr. Long must point to sufficient evidence for a jury to find that he suffered an accidental injury, not caused in any way by sickness or disease, and that the injury resulted in the amputation.
As noted above, there is a discrepancy between Mr. Long's deposition and his affidavit about the location of his injury, and Hartford has moved to strike the affidavit on the basis of that discrepancy. The photographs of Mr. Long's injury show an area of severe infection beginning perhaps two inches below the inside of his left ankle. While this testimonial inconsistency is certainly ripe for rigorous cross-examination, it is not impervious to innocent explanation, such as faulty memory, confusion, or imprecise language. In any event, it is not significant enough for this Court to conclude that the affidavit should be stricken.
Mr. Long's affidavit, then, provides sufficient evidence for a jury to find that he suffered an accidental injury to the inside of his left foot. Hartford does not argue that this injury was in some way caused by his diabetes—e.g., it does not argue that his diabetes somehow made him more susceptible to falls—nor does this Court see any evidence in the record to support such an argument. There is also sufficient evidence for a jury to find that the wound from this injury became infected and, consequently, resulted in amputation. After all, there is no dispute that Mr. Long's amputation was due to a foot infection, or that the infection was located primarily on the area where Mr. Long alleges his injury occurred. And as discussed above, it is irrelevant whether Mr. Long's diabetes increased the severity of the consequences of his injury.
This Court, therefore, will deny Hartford's motion for summary judgment on Count I of Mr. Long's complaint. It will also deny Hartford's motion to strike Mr. Long's affidavit.
To prevail on his claim for bad faith, Mr. Long must show, by clear and convincing evidence, that Hartford "did not have a reasonable basis for denying benefits under the policy," and that Hartford "knew of or recklessly disregarded its lack of a reasonable basis in denying the claim."
Mr. Long cannot sustain this claim. As noted, none of the medical records reviewed by Hartford mentioned an injury, and most of them specifically identified diabetes as the cause of his amputation. The only evidence in front of Hartford regarding any alleged injury was Mr. Long's own words on his "Statement of Claim." Whether or not the medical records are accurate remains to be seen, of course. But an insured cannot sustain a bad faith claim with merely ipse dixit. Therefore, summary judgment will be granted to Hartford on Count II of Mr. Long's complaint.
For the reasons discussed above, this Court will deny Hartford's motion for summary judgment on Count I of Mr. Long's complaint, but will grant it on Count II of that complaint. This Court will deny Hartford's motion to strike and, because it did not need to rely on Dr. Rao's report, will deny Mr. Long's motion to supplement the record as moot.
An appropriate Order follows.