 |
 |
to fill out a simple form to connect to Personal Injury Lawyers in your area.
|
|
|
|
|
Kadabra-Lord v. State Farm Mutual Automobile Insurance Co.8/6/2001
This appeal is from an order of summary judgment dismissing a bad faith claim against State Farm. The claimant was injured in two separate automobile accidents five months apart. State Farm paid some of the claimant's medical bills stemming from the first accident under her Personal Injury Protection (PIP) coverage. After learning of the second accident, State Farm asked for an independent medical examination to determine whether continued treatment was attributable to the first accident. State Farm then refused to pay for treatment incurred after the examination based on a statement in the examination report that the claimant had reached maximum medical stability. The examiner also stated, however, that the treatment was reasonable and necessary for the second injury. Litigation of the bad faith claim established that the examiner intended to give an opinion only as to treatment necessitated by the first accident. A jury could find that State Farm was unreasonable to cut off payment for the second accident based on an evaluation of the first accident without first seeking to clarify the writer's intent.
Accordingly, the summary judgment on the bad faith claim is reversed. The appellate court reviews grant of summary judgment de novo, engaging in the same inquiry as the trial court. Hayden v. Mutual of Enumclaw Ins. Co., 141 Wn.2d 55, 1 P.3d 1167 (2000). We consider the facts and all reasonable inferences from those facts in the light most favorable to the non-moving party. Reynolds v. Hicks, 134 Wn.2d 491, 495, 951 P.2d 761 (1998).
On June 23, 1998, and again on November 20, 1998, plaintiff Deborah Kadabra- Lord was injured in auto accidents. After the June accident, Lord began physical and massage therapy as prescribed by her physiatrist. This treatment continued after her November accident.
Lord was insured by defendant State Farm. Her policy included personal injury protection (PIP) of up to $10,000 per accident for 'reasonable and necessary' expenses incurred within three years of the date of the accident. The policy defined services as 'necessary' if they were 'essential in achieving maximum medical improvement for the bodily injury sustained in the accident.'
Not long after the June 23 accident, State Farm mailed Lord a letter explaining her PIP benefits and advising her that State Farm had the right to obtain a second medical opinion. State Farm began to pay her treatment bills.
Lori Green, the claim representative, became aware of Lord's November 20 accident in January, 1999. She wrote a letter to Lord's attorney documenting payments made thus far in connection with the June accident, and advising him that further payment of treatment bills would be withheld because of uncertainty about which accident they were related to. Green stated that an independent medical examination would be necessary 'in order to verify that expenses are reasonable, necessary, and related to the accident of June 23, 1998'. Green's letter referenced claim number 47-4010- 241, with the date of incident being June 23, 1998.
Beth Sams, a PIP claim representative for State Farm, contacted Haelan, a medical consulting firm that contracts with physicians to provide independent medical examinations. Haelan arranged for Lord to be seen by Dr. Robert Bernadez-Fu, a licensed physiatrist and independent contractor.
According to his deposition testimony, Dr. Fu received a letter dated February 19, 1999, posing a series of questions about Lord's condition to be answered in his report. Although that letter is not in the record, Dr. Fu testified that it was specific to the June accident. Dr. Fu's report of the examination, conducted on March
Page 1 2 3 4 5 Washington Personal Injury Attorneys
Personal Injury Lawyers
|
| |
to fill out a simple form to connect to Personal Injury Lawyers in your area.
|
|