ROBIN J. CAUTHRON, District Judge.
Plaintiff Kevin Mobley asserts the present bad faith claim against Defendant American Home Assurance Company ("AHA") for its alleged wrongful refusal to authorize medical treatment as ordered by the Oklahoma Workers' Compensation Court. Plaintiff seeks a summary judgment ruling on his bad faith claim and asks that damages be determined at trial. Defendant responded to Plaintiff's Motion and also filed a counter Motion for Summary Judgment arguing that it, not Plaintiff, was entitled to judgment.
On June 3, 2008, Plaintiff Kevin Mobley injured his back during his employment with Noble Contractors, LLC. Thereafter, Plaintiff filed a workers' compensation claim with the Oklahoma Workers' Compensation Court ("WCC"). On October 31, 2008, WCC Judge Foster found that Plaintiff had sustained a cervical spine and thoracic spine injury during his employment and ordered Noble Contractors or Defendant AHA, Noble Contractors' workers' compensation carrier, to pay for Plaintiff's reasonable and necessary medical care. (Pl.'s Br., Dkt. No. 11 Ex. 1.) Defendant AHA had 20 days from the issuance date to comply with this order. (
Thereafter, on April 26, 2010, Judge Foster found that Plaintiff sustained a lumbar spine injury and ordered Defendant AHA to pay for reasonable and necessary medical expenses to remedy that injury. (
On August 6, 2010, Plaintiff's attorney sent a letter to Defendant stating that "he and David [Reid] agreed at Court to Dr. Nees as the treating physician. . . . It is our understanding the appointment was not authorized due to the filing of the appeal. Can we get him an appointment authorized and rescheduled with Dr. Nees without the necessity of returning to the Court?" (Pl.'s Br., Dkt. No. 37 Ex. 4.)
On September 3, 2010, Plaintiff's attorney sent another letter to Defendant, wherein Plaintiff's attorney stated that he had "not heard from you or the adjuster in regard to an appointment being scheduled for Mr. Mobley with Dr. Jeffrey Nees" (Pl.'s Br., Dkt. No. 37 Ex. 5), and asked again for allowance to schedule an appointment, to which Defendant responded in the affirmative on September 22. (Def.'s Br., Dkt. No. 24 Ex. 12.) In this letter, Defendant's counsel again expressed its authorization of Dr. Nees and also stated that "it is necessary for [Mr. Tracy] to contact Dr. Nees' office to arrange the date, time, etc. At that point the doctor's office will contact our client regarding authorization." (
After the July 15 affirmation, Plaintiff's counsel and Dr. Nees's staff attempted to contact the claim adjuster assigned to Plaintiff's workers' compensation claim. On October 27, 2010, Joanna West, one of Dr. Nees's staff, sent a fax to Plaintiff's attorney stating that "[she] cannot get a hold of Tyler Dawson [the claims adjuster] at the 214-932-2714 [number]." (Pl.'s Br., Dkt. No. 37 Ex. 11.) Ms. West goes on to state that the above number "[is] always busy[, and that she] really need[s] to get an auth for a new MRI for this patient before we see him on 11-8-10," and asks Mr. Tracy's staff if they "have any other contact info for his w/c adjuster?" (
On November 8, 2010, Dr. Nees examined Plaintiff. Seven days prior to this examination, Defendant deposed Plaintiff about a possible intervening accident that occurred in September of 2010, wherein Plaintiff sought emergency health care after feeling a pop in his back while standing from being seated. On November 17, 2010, Plaintiff filed a Form 13 requesting that the WCC order an MRI by Dr. Nees. (Pl.'s Br., Dkt. No. 37 Ex. 18.)
On January 25, 2011, the parties again appeared before Judge Foster at a WCC hearing regarding Defendant's request that an independent medical examiner ("IME") investigate the possible intervening accident that occurred in September of 2010 and Plaintiff's request for enforcement of medical treatment requested by Dr. Nees. (Pl.'s Br., Dkt. No. 11 Ex. 5, at 4.) In the transcript of this hearing, Judge Foster denied Defendant's request for an IME and stated that
(Pl.'s Br., Dkt. No. 11 Ex. 5, at 15-16.) Defendant's counsel went on to point out to Judge Foster that the en banc ruling was not issued until July 15—not quite three months after the April 26 order—to which Judge Foster responded by pointing out the two-month delay after the appeal and the lack of evidence that this delay was caused by anything other than Defendant's delinquency. At the time of this hearing, the parties were unaware that both Plaintiff's attorney and Dr. Nees's office staff were calling an inoperable phone number. Defendant did not appeal the January 25 findings.
Summary judgment is proper if the moving party shows that there is "no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(a). "Under the summary judgment standard, a mere factual dispute will not preclude summary judgment; instead there must be a genuine issue of material fact."
The party seeking summary judgment bears the initial burden of demonstrating the basis for its motion, and identifying those portions of "`the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any,'" that demonstrate the absence of a genuine issue of material fact.
If a party does not sufficiently support its own asserted facts or address the other party's asserted fact, a court may allow "opportunity to properly support or address the fact . . . consider the fact undisputed for purposes of the motion . . . grant summary judgment if the motion and supporting materials—including the facts considered undisputed—show that the movant is entitled to it . . . or issue any other appropriate order." Fed. R. Civ. P. 56(e). While addressed in the same Order, Plaintiff's and Defendant's motions will be considered separately by this Court carefully drawing all reasonable inferences against the party whose motion is then under consideration.
Under Oklahoma law, "an insurer has an implied duty to deal fairly and act in good faith with its insured and that the violation of this duty gives rise to an action in tort for which consequential and, in a proper case, punitive, damages may be sought."
Generally, "[a] common law tort action exists for an insurance carrier's bad faith in refusing to pay a workers' compensation award."
The insurer does not breach this duty by simply "refusing to pay a claim or by litigating a dispute with its insured if there is a `legitimate dispute' as to coverage or amount of the claim, and the insurer's position is `reasonable and legitimate.'"
Plaintiff argues that he is entitled to summary judgment on his bad faith claim because the WCC's ruling that the Defendant acted "in an unreasonable and bad faith delay in [providing] treatment" is a binding ruling regarding the claims before this Court. The WCC, however, does not have jurisdiction to find bad faith, and, therefore, the WCC Judge's statement that "[i]f there was any intervening injury [it was a] result [of] an unreasonable and
Defendant also moves for summary judgment on Plaintiff's claim arguing that it has discharged its duty under the WCC order and authorized treatment and that Plaintiff is unable to provide sufficient facts to survive summary judgment. Defendant also argues that Plaintiff has failed to obtain the requisite certification from the WCC to assert his claim. Because the Court finds the Plaintiff's bad faith claim cannot survive the present Motion, whether Plaintiff obtained the requisite certification is moot.
Defendant argues that it actually gave authorization for Plaintiff to be treated by Dr. Nees: After the July 15 en banc order, David Reid verbally authorized Dr. Nees to treat Plaintiff during a conversation with Plaintiff's workers' compensation attorney, Jack Tracy; and, on September 22, 2010, Defendant's counsel sent Mr. Tracy a letter again expressing its authorization of Dr. Nees. (Def.'s Br., Dkt. No. 24, at 4;
As evidence that Defendant did not authorize treatment, Plaintiff points to the fax sent on October 27, 2010, from Dr. Nees's office wherein Ms. West asks Plaintiff's counsel for more contact information because she was unable to reach the claims adjuster at the telephone number provided by Plaintiff. (
Plaintiff does not contest Ms. West's testimony that the WCC order was all the authorization needed or that if Mr. Tracy communicated to Dr. Nees's office that the respondent authorized Dr. Nees to provide reasonable and necessary care that too would be sufficient. Accordingly, the question of whether Mr. Tracy actually communicated this authorization to Dr. Nees does not create a factual dispute regarding Defendant's prior authorization of Dr. Nees, which both parties agreed occurred. Plaintiff argues that Defendant was required to communicate directly with Dr. Nees's office, but provides no support for this contention beyond Mr. Tracy's deposition testimony. (
Additionally, Plaintiff argues that instead of authorizing an MRI and complying with the WCC order, Defendant demanded that Mr. Mobley be deposed. Defendant admits that it sought to and did depose Mr. Mobley, but contests that this deposition in any way interfered with its obligations pursuant to Mr. Mobley's other treatment. Rather, Defendant sought to depose Mr. Mobley about a possible intervening injury in preparation for the WCC hearing Defendant requested regarding a possible appointment of an independent medical examiner.
Plaintiff has not shown any evidence supporting the culpability necessary on Defendant's part to survive Defendant's Motion: Defendant paid for Plaintiff's visit to Dr. Nees on November 8 and all visits thereafter—in addition to paying the ordered temporary total disability benefits since 2008 and Plaintiff's September 6, 2010, hospital bills. (
Neither Plaintiff's counsel nor anyone from Dr. Nees's office attempted to contact Defendant by mail, fax, or 800 number regarding Plaintiff's appointment.
For the above-stated reasons, Plaintiff's Motion for Summary Judgment (Dkt. No. 11) is DENIED; Defendant's Motion for Summary Judgment (Dkt. No. 24) is GRANTED. A Judgment will enter accordingly. All other pending motions are stricken as moot.
IT IS SO ORDERED.