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Loza v. State Farm Mutual Automobile Insurance Co.11/13/1997
JUDGMENT AFFIRMED
Ney and Marquez, JJ., concur
Defendant, State Farm Mutual Automobile Insurance Company (State Farm), appeals the summary judgment entered in favor of the plaintiff, Corazon Loza, (insured) for $6,423.90 premised on the court's determination that State Farm had breached the automobile insurance policy between it and the insured by failing to pay certain no-fault benefits. State Farm also appeals from an award of statutory treble damages for a willful and wanton breach of the insurance contract and from an award of damages for bad faith breach of an insurance contract. We affirm.
On November 4, 1992, insured was in an automobile accident shortly following which she was treated for various minor complaints including neck and back pain. On April 15, 1993, more than five months after the accident, insured told her treating physician that her jaw began to ache "one week ago suddenly while chewing." Her physician referred her to a dentist who began treating insured for temporomandibular joint dysfunction (TMD).
State Farm requested that insured submit to an independent medical examination (IME) with respect to the TMD treatment. The IME dentist expressed the opinion that insured had an extended pre-accident history of bruxism, or teeth grinding. The IME dentist further opined that the TMD was "30% due to the motor vehicle accident and 70% due to a parafunctional habit [bruxism] per Ms. Loza's current diagnosis." Based on the IME dentist's opinion, State Farm agreed to pay, and paid, 30% of the medical and dental expenses incurred by the insured for the treatment of TMD.
The bruxism had been previously detected by insured's treating dentist, who had referred her for treatment, but no treatment had been administered. There was no evidence that insured had suffered from any of the symptoms of TMD prior to the accident or that the TMD resulted from trauma suffered in the accident. Rather, the IME dentist's opinion was that the accident caused increased stress, which in turn exacerbated the bruxism, resulting in the TMD.
Thereafter, insured commenced these proceedings seeking unpaid medical and dental bills under the Colorado Auto Accident Reparations Act (the No-fault Act), Section10-4-701, et seq., C.R.S. 1997, for the treatment of TMD, and seeking damages for the willful and wanton denial of Personal Injury Protection (PIP) benefits and for bad faith breach of insurance contract.
Insured filed a motion for partial summary judgment as to the breach of contract claim arguing there was no genuine issue as to any material fact. Insured asserted that it was undisputed that, while she may have been more susceptible to, or had a preDisposition for, TMD, she had not suffered from TMD or any symptoms of TMD prior to the accident. The trial court granted insured's motion, entered judgment for the benefits withheld, and the parties proceeded to trial on the remaining claims.
The jury found that State Farm's conduct was willful and wanton based upon which the trial court awarded statutory treble damages. The jury further found State Farm had acted in bad faith breach of an insurance contract, and awarded damages.
I.
State Farm contends that the trial court erred in granting insured's motion for partial summary judgment on insured's breach of contract claim for benefits. We disagree.
Summary judgment is appropriate only when the movant clearly demonstrates that there is no genuine issue as to any material fact. C.R.C.P. 56; Aspen Wilderness Workshop, Inc. v. Colorado Water Conservation Board, 901 P.2d 1251 (Colo. 1995).
A material fact is one that affect
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