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Holland v. State Farm Mutual Automobile Insurance Co.

United States District Court, D. Nevada

March 27, 2014

WILBER GLENN HOLLAND, Plaintiff,
v.
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant.

ORDER

LLOYD D. GEORGE, District Judge.

This matter comes before the court on defendant's renewed motion for summary judgment (#46, errata #49, plaintiff's supplement #50). As indicated by defendant's renewed motion and plaintiff's supplement, incorporated by reference is the prior briefing on defendant's original summary judgment motion (#12, response #14, partyreply #16).

A grant of summary judgment is appropriate only where the moving has demonstrated through "the pleadings, the discovery and disclosure materials on file, and any affidavits" that there is no genuine issue of material fact. Fed.R.Civ.P. 56©; Anderson v. Liberty Lobby, 477 U.S. 242, 248 (1986). All justifiable inferences must be viewed in the light most favorable to the non-moving party. County of Tuolumne v. Sonora Cmty. Hosp., 236 F.3d 1148, 1154 (9th Cir. 2001).

The moving party bears the initial burden of showing the absence of a genuine issue of material fact. Fairbank v. Wunderman Cato Johnson, 212 F.3d 528, 531 (9th Cir. 2000). The burden then shifts to the non-moving party to go beyond the pleadings and set forth specific facts demonstrating there is a genuine issue for trial. Id . The party opposing summary judgment "must cite to the record in support of the allegations made in the pleadings to demonstrate that a genuine controversy requiring adjudication by a trier of fact exists." Taybron v. City & County of San Francisco, 341 F.3d 957, 960 (9th Cir. 2003). If the non-moving party meets its burden, summary judgment must be denied. Fed.R.Civ.P. 56(c). Celotex Corp. v. Catrett, 477 U.S. 317, 324 (1986).

Background

This lawsuit arises out of an automobile accident that occurred in Clark County, Nevada, on November 26, 2010. Michael Long rear-ended plaintiff Wilber G. Holland, who had stopped at an intersection. At the time of the accident, Long was insured with a bodily injury liability policy that provided liability limits of $15, 000 per person. Holland had underinsured motorist ("UIM") coverage under an automobile policy issued by defendant State Farm Mutual Automobile Insurance Company which provided limits of $100, 000 per person.

State Farm was first notified of Holland's UIM clam on July 26, 2011, eight months after the accident. That day, State Farm also received a letter from William Birardi, Holland's attorney, enclosing a restricted/limited medical records release authorization that permitted State Farm to obtain Holland's medical records from providers specified in the authorization, and regarding treatment occurring only after the accident. Birardi's letter directed that State Farm must request additional restricted/limited authorizations from him for any new providers Holland would potentially see after the accident.

On July 28, 2011, State Farm sent a letter to Birardi confirming the UIM coverage and including a separate letter to Holland which explained Holland's obligations under the policy to provide executed medical records authorizations as requested by State Farm. State Farm also enclosed within its letter to Holland a medical authorization from Holland to sign and return. On that day, State Farm requested medical records from the providers listed by Holland in his July 26, 2011 letter. Holland settled with Long on November 4, 2011, for $15, 000.

On April 11, 2012, State Farm contacted Birardi's office and left a voicemail, requesting among other things, the status of the medical authorization, medical questionnaire, and medical provider lists that State Farm had initially requested. On April 12, 2012, Birardi faxed to State Farm the medical provider questionnaire with several of Holland's medical providers listed, a partially completed injury questionnaire, and another restricted/limited medical records authorization allowing State Farm to obtain only Holland's medical records after the accident from certain medical providers.

On April 24, 2012, Birardi submitted a time limit demand for Holland's $100, 000 UIM policy limits. The letter also noted that one doctor recommended cervical reconstruction surgery for Holland, and that a second opinion would be sought. State Farm reviewed the claim on May 8, 2012, and determined that it needed to obtain further information, including the second opinion regarding the cervical surgery before completing the evaluation of Holland's claim. On May 10, 2012, a section manager at State Farm evaluated the claim and noted that the accident photos supported a low-impact collision, and that Holland had delayed two weeks before seeking treatment for a possible cervical injury. The section manager suggested obtaining an IME before considering claims for treatment beyond chiropractic.

Also on May 10, 2012, State Farm left a message with Birardi's paralegal advising that State Farm would be sending additional medical authorizations for Holland's signature and a new provider list. State Farm sent a letter to Birardi, informing him that, at that time, it would not agree to the demand as it required additional information. The letter enclosed the medical authorization and provider list, which would allow State Farm to collect records and bills from all of Holland's providers for the past five years, as well as from all of Holland's providers who had ever seen him for neck and back-related injuries.

Birardi responded by sending another demand letter for policy limits, giving State Farm one day to respond, and stating that his client would file suit if the demand were not accepted. This demand letter, for the first time, confirmed that Holland did have "some" lower back pain in August 2009, prior to the accident. However, Birardi insisted that Holland's current symptoms were due entirely to the auto accident. State Farm replied by letter the next day indicating that it still required signed medical authorizations and provider list before it could fully evaluate Holland's claim.

Holland filed suit against State Farm on May 16, 2012, for breach of contract and bad faith. On May 18, 2012, Birardi sent a letter to State Farm stating that Holland would not sign such "carte blanche" authorizations, and that Holland had not received any prior treatment for neck or back issues. In discovery, however, Holland described that he "primarily injured [his] back and neck as a result of the accident." Holland also revealed that, with respect to any back or neck injury prior to the accident, he had made complaints of pain or discomfort to the doctors and medical personnel at a medical provider in San Diego and the Veterans Administration Hospital. Further, in response to State Farm's discovery, Holland admitted that he made a claim for disability benefits with the Social Security Administration and Navy which was "primarily due to my neuropathy and vascular/heart conditions." Finally, in supplemental discovery disclosures, Holland's medical records indicated that he suffered from a pre-existing chronic neck and back condition dating back to December of 2007, and had received treatment for such on a host of occasions. Prior to the initiation of the lawsuit, Holland had not provided State Farm with any of these medical records, nor had Holland executed the medical records authorization which would have allowed State Farm to obtain the records.

Discussion

In its motion for summary judgment, State Farm asserts that, in violation of the terms of the law and the terms of the policy, Holland refused to provide medical authorizations to enable State Farm to investigate and evaluate Holland's pre-existing medical history in order to determine whether his claimed injuries were attributable to the car accident. Furthermore, State Farm argues that for Holland to file suit before complying with the policy conditions, ...


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