TIMOTHY D. DEGIUSTI, District Judge.
Before the Court is Defendant Allstate Fire and Casualty Insurance Company's Motion for Summary Judgment [Doc. No. 62], filed pursuant to Fed. R. Civ. P. 56. After a substantial period of time for discovery and after the resolution of multiple, protracted discovery disputes, Plaintiff Roy Jack Williams has responded in opposition to the Motion. Following Defendant's reply, the Motion is fully briefed and ripe for decision.
Plaintiff brings this diversity action asserting claims under Oklahoma law for breach of an insurance contract and breach of the insurer's duty of good faith and fair dealing. The case concerns medical payments ("med-pay") coverage of $25,000 that Plaintiff was entitled to receive under his automobile insurance policy with Defendant. Plaintiff was injured in January 2011 while riding as a passenger in a vehicle involved in a two-car collision in Texas. The accident was allegedly caused by the negligence of the other vehicle's driver, and resulted in litigation in that state. Plaintiff claims Defendant unreasonably delayed payment and then imposed unreasonable demands, such as requesting an independent medical examination, requiring peer review of his medical records, and demanding proof that other insurance coverage had been exhausted, even though there was no other coverage. Defendant contends the delay was caused by Plaintiff's personal injury lawyer, Ryan Cunningham, who instructed Defendant not to contact medical providers and not to issue any payment until requested by his firm. Mr. Cunningham sent copies of Plaintiff's medical records and bills to Defendant and requested an evaluation of the med-pay claim in October 2012. When the claim remained unpaid, this action was filed in August 2013. Defendant paid Plaintiff the full amount of his med-pay claim in September 2013.
Defendant seeks summary judgment in its favor on all claims.
Summary judgment is appropriate "if the movant shows that there is no genuine dispute as to any material fact and that the movant is entitled to judgment as a matter of law." Fed. R. Civ. P. 56(a). A material fact is one that "might affect the outcome of the suit under the governing law." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). A dispute is genuine if the evidence is such that a reasonable jury could return a verdict for either party. Id. at 255. All facts and reasonable inferences must be viewed in the light most favorable to the nonmoving party. Id. If a party who would bear the burden of proof at trial lacks sufficient evidence on an essential element of a claim, all other factual issues concerning the claim become immaterial. Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986).
The movant bears the burden of demonstrating the absence of a dispute of material fact warranting summary judgment. Celotex, 477 U.S. at 322-23. If the movant carries this burden, the nonmovant must then go beyond the pleadings and "set forth specific facts" that would be admissible in evidence and that show a genuine issue for trial. See Anderson, 477 U.S. at 248; Celotex, 477 U.S. at 324; Adler v. Wal-Mart Stores, Inc., 144 F.3d 664, 671 (10th Cir. 1998). "To accomplish this, the facts must be identified by reference to affidavits, deposition transcripts, or specific exhibits incorporated therein." Adler, 144 F.3d at 671; see also Fed. R. Civ. P. 56(c)(1)(A). "The court need consider only the cited materials, but may consider other materials in the record." See Fed. R. Civ. P. 56(c)(3). The Court's inquiry is whether the facts and evidence identified by the parties present "a sufficient disagreement to require submission to a jury or whether it is so one-sided that one party must prevail as a matter of law." Anderson, 477 U.S. at 251-52.
On January 8, 2011, Plaintiff was injured in a motor vehicle accident in Tarrant County, Texas, while riding as a passenger in an automobile owned and driven by Bruce Stout. Mr. Stout's vehicle was rear-ended by another vehicle driven by an allegedly negligent driver. Mr. Stout and Plaintiff were insured under separate policies issued by Defendant. Mr. Stout's policy did not include uninsured motorist or med-pay coverage. Plaintiff's policy provided med-pay coverage up to a limit of $25,000.
By letter dated September 2, 2011, Defendant was first contacted by an attorney representing Plaintiff for a personal injury claim, Ryan Cunningham, who requested information about the insurance coverages available under Mr. Stout's policy. Mr. Cunningham sent a second letter dated September 7, 2011, requesting a copy of Plaintiff's policy. In the letter, Mr. Cunningham stated, in relevant part, as follows:
See Def.'s Mot. Summ. J., Ex. 4 [Doc. No. 62-4].
In November, 2011, the adjuster, Dana Colvin, was advised by Mr. Cunningham's firm that copies of Plaintiff's medical records and bills would be provided when he had completed treatment for his injuries. Also, an entry was made in the claim record noting that Plaintiff was a passenger in a "non owned vehicle" at the time of the accident so his med-pay claim was an "excess coverage claim." See Pl.'s Resp. Br., Ex. 5 [Doc. No. 116-5], p.2 (ECF page numbering). The policy provided: "When [med-pay] coverage applies to a . . . non-owned auto, [Defendant] will pay only after all other collectible auto medical insurance has been exhausted." See Def.'s Reply Br., Ex. 3, [Doc. No. 120-3], p.4 (ECF page numbering).
On January 4, 2012, Mr. Cunningham submitted to Defendant the executed forms required by the policy (a "Notice of Injury-Proof of Loss" form and medical authorization forms), without completing the parts of the forms that would have identified treatment providers. See Pl.'s Resp. Br., Ex. 6 [Doc. No. 116-6], pp.3-4,6,8. No medical bills were provided at that time.
By correspondence dated October 17, 2012, Mr. Cunningham provided a "complete set of [Plaintiff's] medical records and bills" for his med-pay claim. See Pl.'s Resp. Br., Ex. 7 [Doc. No. 116-7]. Mr. Cunningham asked Ms. Colvin to review the documents and contact him with her evaluation. Mr. Cunningham repeated in this letter his prior instruction "not to issue medical payments directly to medical providers" but to "[m]ail all checks directly to our offices." Id. Ms. Colvin responded by letter dated November 7, 2012, requesting an independent medical examination ("IME"), and advising Mr. Cunningham that an IME vendor would contact him to schedule the exam. Also, at Ms. Colvin's request, Mr. Cunningham's firm faxed to her on November 20, 2012, a copy of the "exhaustion letter," that is, Defendant's letter stating there was no coverage under Mr. Stout's policy. See Pl.'s Resp. Br. [Doc. No. 115], p.7 ¶ 19; Ex. 15 [Doc. No. 116-15], p.1.
After the IME was scheduled, Mr. Cunningham advised Ms. Colvin by letter dated December 28, 2012, that Plaintiff would attend only if his attorney could accompany him and videotape the examination. The scheduled exam was cancelled. In February 2013, Mr. Cunningham inquired of Ms. Colvin about the status of the claim. He received a response from a different adjuster, Denise Nichols, explaining that the vendor had been unable to locate a physician who would agree to Plaintiff's terms, and proposing a peer review of his medical records as an alternative.
Charles J. Lancelotta, Jr., M.D., reviewed the records submitted to him and provided a written report dated March 29, 2013. Plaintiff views the report as favorable to him because Dr. Lancelotta found "nothing in the medical records . . . to suggest any preexisting conditions or prior injuries." See Pl.'s Resp. Br., Ex. 12 [Doc. No. 116-12], p.6.
Mr. Cunningham discussed Plaintiff's claim with Ms. Nichols by telephone on May 6, 2013. According to a notation in the claim record, Mr. Cunningham told Ms. Nichols the vehicle Plaintiff was riding in "was also insured by [Defendant] and had no coverage," and she told him a "copy of that letter will need to be faxed to me for review." See Pl.'s Resp. Br., Ex. 5 [Doc. No. 116-5], p.6 (ECF numbering). Mr. Cunningham recorded this telephone conversation. A transcript of the recording confirms that Mr. Cunningham said he would fax the letter to Ms. Nichols, and she said when she received the letter showing there was no coverage, she could "start issuing out payments on the initial care." See Def.'s Reply Br., Ex. 9 [Doc. No. 120-9].
Mr. Cunningham did not fax the letter after this conversation. Mr. Cunningham has testified that he realized the letter had previously been sent to Ms. Colvin and he decided not to fax it a second time.
Mr. Cunningham has also testified regarding his reasons for instructing Defendant to issue checks directly to him rather than to medical care providers. First, his representation of Plaintiff in the personal injury case required Mr. Cunningham to marshal all available funds for payment of medical providers, particularly those who had filed medical liens. Second, accumulating medical expenses was part of his litigation strategy for maximizing Plaintiff's recovery against the alleged tortfeasor. Plaintiff questioned Mr. Cunningham numerous times during the representation about unpaid medical bills, including by email on November 1, 2012. Mr. Cunningham advised Plaintiff not to pay outstanding medical bills and not to submit them to his health insurance carrier. Plaintiff testified that he followed this advice. Unfortunately, Plaintiff's debt to Oklahoma Radiology Group became delinquent in August 2012, was turned over to a collection agency in December 2012, and appeared on Plaintiff's credit report in February 2013.
This lawsuit was filed on August 7, 2013. Shortly thereafter, another adjuster, Dana Maness, reviewed Defendant's claim file and obtained authorization to pay Plaintiff the full amount of his med-pay benefit. Ms. Maness based this decision on Ms. Nichols' letter of May 3, 2013, which she understood to say that Plaintiff's medical treatment before 2012 was related to the accident, and her review of his medical bills for 2011, which exceeded the amount of his med-pay benefit. Defendant's check in payment of Plaintiff's med-pay claim was delivered to his counsel in September 2013. In keeping with Mr. Cunningham's plan to marshal funds and not to distribute the med-pay benefit to medical providers, Defendant's check remained in a file and was not deposited into the law firm's account until April 2014, when the personal injury case was resolved and Mr. Cunningham was ready to negotiate with medical providers for reduced payments.
Plaintiff claims Defendant failed to conduct a reasonable investigation of his insurance claim and delayed payment until his medical care providers had filed liens against him. Defendant contends Plaintiff cannot establish bad faith because it handled his med-pay claim in the manner requested by his attorney, conducted a reasonable investigation upon receiving Mr. Cunningham's instruction to proceed, and paid Plaintiff's claim in full upon determining there was no primary coverage — a fact which Mr. Cunningham had promised to confirm in his last communication before Plaintiff filed suit.
Under Oklahoma law, Defendant had an "`implied-in-law duty to act in good faith and deal fairly with the insured to ensure that the policy benefits are received.'" Badillo v. Mid Century Ins. Co., 121 P.3d 1080, 1093 (Okla. 2005) (quoting Christian v. Am. Home Assur. Co., 577 P.2d 899, 901 (Okla. 1977)). When processing an insurance claim, "the insurer must conduct an investigation reasonably appropriate under the circumstances." See Buzzard v. Farmers Ins. Co., 824 P.2d 1105, 1109 (Okla. 1991); accord Newport v. USAA, 11 P.3d 190, 195 (Okla. 2000). An insurer's duty "to timely and properly investigate an insurance claim is intrinsic to an insurer's contractual duty to timely pay a valid claim." Brown v. Patel, 157 P.3d 117, 122 (Okla. 2007) (emphasis omitted). The Oklahoma Supreme Court has summarized the law regarding a bad faith claim based on a delay in payment as follows:
Ball v. Wilshire Ins. Co., 221 P.3d 717, 724 (2009) (footnotes omitted). "[I]f there is conflicting evidence from which different inferences may be drawn regarding the reasonableness of [an] insurer's conduct, then what is reasonable is always a question to be determined by the trier of fact by a consideration of the circumstances in each case." McCorkle v. Great Atlantic Ins. Co., 637 P.2d 583, 587 (Okla. 1981).
Upon consideration of the summary judgment record in the light most favorable to Plaintiff, the Court finds that a genuine dispute of material facts relative to the second and third elements of a bad faith claim precludes summary judgment on the issue of bad faith conduct. Regardless whether the Court would reach the same conclusions, Plaintiff has presented
On the record presented, reasonable minds could
In October 2012, Mr. Cunningham provided the promised copies of medical records and bills, and asked Defendant to evaluate Plaintiff's med-pay claim. Defendant has provided reasonable explanations for many of the multiple delays that occurred in processing the claim after that time. Reasonable minds could differ, however, regarding whether Defendant undertook a reasonable investigation and made a reasonably prompt determination of Plaintiff's entitlement to the med-pay limit of his policy after it was requested. By Defendant's own account, Plaintiff's medical bills had exceeded that amount within the first year after the January 2011 accident. Thus, one might reasonably question Defendant's need for a medical opinion to determine whether additional medical treatment Plaintiff received in 2012 was related to the accident. Similarly, Defendant's explanation that it requested a second copy of the "exhaustion letter" because the first one had been misfiled and it expected Plaintiff to provide one, says nothing about why Defendant needed Plaintiff's attorney to supply information about Mr. Stout's policy that Defendant had provided to him in the first place.
For these reasons, the Court finds that Plaintiff has demonstrated a genuine dispute of material precluding summary judgment regarding bad faith conduct.
Defendant also contends Plaintiff's claim of delayed investigation and payment fails because his only alleged damages are emotional distress related to unpaid medical bills and a negative credit report, but these had nothing to do with his lack of payment from Defendant. As stated above, an essential element of Plaintiff's bad faith claim is proof that Defendant's "violation of its duty of good faith and fair dealing was the direct cause of [Plaintiff's] injury." Ball, 221 P.3d at 724.
On this point, Plaintiff has no effective response. He argues that if he had received Defendant's med-pay check in a timely manner, he might have been able to pay some of his medical bills, including the debt to Oklahoma Radiology Group before it appeared on his credit report in February 2013. See Pl's Resp. Br. [Doc. No. 116], p.26. Plaintiff also argues that by the time Defendant's check was received, the medical liens had far exceeded the amount of his med-pay benefit. But medical liens filed against Plaintiff exceeded $25,000 by August 2012, before Mr. Cunningham ever asked Defendant to pay the med-pay claim. See Def.'s Mot. Summ. J., Ex. 16 [Doc. No. 62-16]. Plaintiff's only other evidence consists of speculative testimony by Mr. Cunningham that timely payment of the med-pay benefit might have affected negotiations regarding the settlement of Plaintiff's personal injury case. See Cunningham Dep. 141:19-142:13.
Distilled to its essence, Plaintiff's alleged injury directly caused by Defendant's delay in paying his med-pay claim is his "emotional distress and frustration . . . based on what happened to Plaintiff's credit as a result of the medical liens and adverse credit reports as a result of the accident." See Pl's Resp. Br. [Doc. No. 116], p.28. Based on the undisputed facts shown by the summary judgment record, however, this injury was a result of Mr. Cunningham's strategy to accumulate unpaid medical expenses and liens, and Plaintiff's decision to follow Mr. Cunningham's advice not to pay a provider who later elected to assign the debt to a collection agency rather than filing a medical lien. Defendant's timely payment of a med-pay benefit would not have saved Plaintiff from medical liens or adverse credit reports. Nor does the record suggest that Mr. Cunningham would have used an earlier $25,000 payment to satisfy any of Plaintiff's medical debts.
In summary, Plaintiff presents no facts or evidence to suggest that Defendant's delay in paying his med-pay benefit had any causal effect on his emotional distress or frustration from unpaid medical bills and debts. From the record presented, no reasonable finding could be made that a med-pay check tendered earlier would have been handled any differently than it actually was — placed in a file and held until the underlying negligence action was resolved. Finally, Plaintiff points to no facts or evidence suggesting that Defendant's delay caused him to suffer any other sort of emotional distress or mental anguish.
For these reasons, the Court finds that Plaintiff has failed to demonstrate a genuine dispute of material fact regarding the damages element of his bad faith claim. Therefore, Defendant is entitled to summary judgment on this claim.
For the reasons set forth herein, the Court finds that Defendant is entitled to summary judgment on all claims asserted in the Complaint.
IT IS THEREFORE ORDERED that Defendant Allstate Fire and Casualty Insurance Company's Motion for Summary Judgment [Doc. No. 62] is GRANTED. Judgment shall be entered accordingly.
IT IS SO ORDERED.