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Valentine v. State Farm Mutual Automobile Insurance Co.

United States District Court, D. Nevada

April 27, 2015



ROBERT C. JONES, District Judge.

This case arises from Defendant State Farm's alleged refusal to pay a claim submitted by Plaintiff Christy Valentine, one of its insureds. Before the Court is State Farm's Motion for Summary Judgment (ECF No. 21). Plaintiff filed a Response (ECF No. 24) and State Farm filed a Reply (ECF No. 27). For the reasons contained herein, the Motion is GRANTED.


At all times relevant to this action, Plaintiff owned an automobile insurance policy purchased from State Farm ("the Policy"). The Policy included Uninsured/Underinsured Motorist ("UM/UIM") coverage. On July 23, 2012, Plaintiff was involved in an automobile accident in Las Vegas, Nevada when a third-party struck the rear end of her vehicle ("the Accident"). (Compl. ¶ 6, ECF No. 1). The Accident caused only minor damages to Plaintiff's vehicle and in her initial report to State Farm she stated that no injuries were suffered. (Claim Record, ECF No. 21, Ex. C, at 168). The other vehicle was a rental car that had been loaned by the renter to the third-party driver, who was uninsured. (Id. ). The party who rented the vehicle was insured by Allstate.

On July 25, 2012, Plaintiff contacted State Farm and stated that she had begun feeling back pain allegedly due to the Accident. (Id. ). On August 2, 2012, State Farm Claims Representative Debbie Bridgeman ("Bridgeman") sent a letter to Plaintiff acknowledging her claim under the UM/UIM coverage portion of the Policy and requested that Plaintiff sign a "Medical Authorization for Release of Information" so that State Farm could investigate Plaintiff's medical claims. (Hooker Decl. ¶ 7, ECF No. 23). Bridgeman also included a "Medical Provider List and Injury Questionnaire" so that Plaintiff could list her current and past medical providers. (Id. ).

On August 6, 2012, State Farm received a letter from Plaintiff's counsel notifying it that Plaintiff was represented in the potential UM/UIM claim and directing State Farm to send any future correspondence to counsel. (Id. ¶ 8). Thereafter, on September 24, 2012, Bridgman sent a letter to Plaintiff's counsel requesting verification of the Allstate liability limits and the available limits through the rental company. (Id. ¶ 9). When Bridgeman received no response, she sent another letter to Plaintiff's counsel on December 11, 2012 inquiring whether Plaintiff would be making a UM/UIM claim and against requesting verification of the liability limits for Allstate. (Id. ¶ 10). Again, no response was forthcoming. On May 13, 2013, Bridgeman sent yet another letter to Plaintiff's counsel inquiring whether Plaintiff would be submitting a UM/UMI claim based on the Accident and requesting that Plaintiff provide all medical records and bills associated with the injury sustained during the Accident, along with the information Bridgeman previously requested. (Id. ¶ 11).

Finally, on May 20, 2013, Plaintiff's counsel sent a formal demand letter to State Farm with an attachment indicating Allstate's rejection of liability and listing Plaintiff's medical expenses in relation to the injury she allegedly sustained on July 23, 2010. The expenses listed totaled $21, 850. (Demand Letter, ECF No. 21-2, Ex. I). The letter also included notes from Plaintiff's doctor visit following the accident. The examination was characterized as a "followup" visit and the doctor noted that Plaintiff's lower back was "feeling better" with injections "until [she] was struck" in a motor vehicle accident. (Medical Notes, ECF No. 21-2, Ex. J). The doctor also "renewed" a number of medical prescriptions for Plaintiff. (Id. ). The other piece of medical history provided by Plaintiff's counsel showed that Plaintiff suffered from degenerative disc disease and lumbosacral. (Id. ).

Based on this information, Bridgeman determined that Plaintiff obviously suffered from a pre-existing condition that affected her lower back. (Injury Evaluation, ECF No. 21-2, Ex. K). Accordingly, before State Farm could make any payments under the UM/UIM coverage, it needed to determine what medical costs were attributable to the Plaintiff's alleged injury from the Accident and which expenses arose from Plaintiff's pre-existing condition.

On June 1, 2013, Bridgeman completed a partial evaluation of Plaintiff's UM/UMI claim but sent Plaintiff's counsel a letter requiring the additional information necessary to finalize the evaluation. Bridgeman stated that it appeared "that Ms. [Valentine] [had] chronic back problems and was treating just prior to this loss." (June 1, 2013 Letter, ECF No. 21-2, Ex. L). Bridgeman then requested Plaintiff's five-year medical history and an opinion of apportionment pertaining to Plaintiff's lumbar and cervical areas from Plaintiff's treating physician, Dr. Jeremy Lipshutz. (Id. ). Bridgeman noted that, alternatively, Plaintiff could sign an enclosed medical authorization form and State Farm would obtain the requested information from her doctors. (Id. ).

When State Farm heard nothing from Plaintiff or her counsel, Bridgeman sent a letter on July 8, 2013 to reiterate the need for the information requested in the June 1st letter and stating that State Farm could not complete the UM/UIM evaluation without it. (July 8, 2013 Letter, ECF No. 21-2, Ex. M). On July 19, 2013, Plaintiff's counsel provided denial letters from the adverse insurance companies, including Allstate, and counsel indicated that Plaintiff's prior medical records had been requested. (July 19, 2013 Response, ECF No. 21-2, ECF No. N). On August 6, 2013, Bridgeman wrote to Plaintiff's counsel, thanking him for the denial letters and again requesting that Plaintiff's medical history and that Dr. Lipshutz's apportionment opinion be sent to State Farm so the UM/UIM claim evaluation could be completed. (Aug. 6, 2013 Letter, ECF No. 21-2, Ex. O).

On October 2, 2013, Bridgeman once again sent a letter to Plaintiff's counsel with enclosed copies of the June 1st letter, the July 8th letter, and the August 6th letter, requesting that Plaintiff's five-year medical history be provided. (Oct. 2, 2013 Letter, ECF No. 21-2, Ex. O). Alternatively, Bridgeman asked that Plaintiff sign a medical authorization form and identify a list of medical providers so that State Farm could pursue the information on its own. (Id. ). In response, Plaintiff's counsel sent State Farm prior medical records from Plaintiff's primary care provider, Dr. Jennifer Leepard. (Hooker Decl. ¶ 20). The records revealed that Plaintiff had sought treatment for serious lumbar spine conditions during the five years prior to the Accident. (Id.; Medical Records, ECF No. 21-2, Ex. Q).

With this additional information, Bridgeman attempted to complete her evaluation of Plaintiff's UM/UMI claim, but she still needed to know how the various medical bills should be apportioned between Plaintiff's pre-existing condition and the injuries allegedly suffered in the Accident. Since Plaintiff still had not provided an apportionment opinion, State Farm contacted Dr. Joseph Schifini and requested that he provide an objective opinion regarding the apportionment of Plaintiff's injuries and treatment expenses. (Nov. 19, 2013 Letter, ECF No. 21-2, Ex. T). Dr. Schifini conducted an evaluation based on the medical records provided; however, he requested a number of missing records from "Dr. Lipshutz, Dr. Jason Garber, and Dr. Harb" as well as lumbar MRIs that were performed on Plaintiff during the five years preceding the Accident but that were not included in the information sent to State Farm. Bridgeman then made this same request to Plaintiff's counsel on January 15, 2014 and indicated that State Farm would secure the information if Plaintiff was inclined to sign the medical authorization form. (Jan. 15, 2014 Letter, ECF No. 21-3, Ex. U). Bridgeman also invited Plaintiff's treating physician to respond to Dr. Schifini's report if Plaintiff so wished. (Id. ).

On February 11, 2014, Bridgeman sent yet another letter to Plaintiff's counsel to follow up the January 15th letter and again request the missing medical information and lumbar MRIs so that apportionment could be determined and evaluation of Plaintiff's UM/UIM claim completed. (Feb. 11, 2014 Letter, ECF No. 21-3, Ex. V). The next day, Plaintiff's counsel returned the signed authorization form for the release of Plaintiff's medical information, though a list of medical providers was not included. (Feb. 12, 2014 Letter, ECF No. 21-3, Ex. W). Plaintiff's counsel also advised that he would contact State Farm in thirty days for a status update on the UM/UIM claim evaluation.

However, on February 26, 2014, less than two weeks after sending the medical authorization form, Plaintiff filed the present lawsuit against State Farm in state court claiming breach of contract, bad faith, and unjust enrichment. (Compl. ¶¶ 20, 25, 29). State Farm removed the action to this Court. (Pet. for Removal, ECF No. 1). After engaging in discovery, State Farm filed the present Motion for Summary Judgment on Plaintiff's claims.


A principal purpose of the summary judgment rule is to "isolate and dispose of factually unsupported claims or defenses." Celotex Corp. v. Catrett, 477 U.S. 317, 323-24 (1986). A court grants summary judgment only if "the movant shows that there is no genuine issue as to any material fact and the movant is entitled to judgment as a matter of law." Fed.R.Civ.P. 56(a). In making this determination, the court "must draw all reasonable inferences supported by the evidence in favor of the non-moving party." Villiarimo v. Aloha Island Air, Inc., 281 F.3d 1054, 1061 (9th Cir. 2002). "[T]his standard provides that the mere existence of some alleged factual dispute between the parties will not defeat an otherwise properly supported motion for summary judgment." Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 247-48 (1986). Rather, only genuine issues of material facts are relevant to the summary judgment analysis. A fact is material if it "might affect the outcome of the suit under the governing law." Id. at 248. "The moving party bears the initial burden of establishing the absence of a genuine issue of material fact." Fairbank v. Wunderman Cato Johnson, 212 F.3d 528, 531 (9th Cir. 2000). The burden is met by demonstrating to the court "that there is an absence of evidence to support the nonmoving party's case." Celotex Corp., 477 U.S. at 325. This is done by citing to depositions, documents, electronically stored information, affidavits or declarations, stipulations, admissions, interrogatory answers, or other materials. Fed.R.Civ.P. 56(c)(1)(A). Once the initial burden is met, however, "Rule 56(e) requires the nonmoving party to go beyond the pleadings and identify facts which show a genuine issue for trial." Fairbank, 212 F.3d at 531.

Furthermore, summary judgment is mandated "against a party who fails to make a showing sufficient to establish the existence of an element essential to that party's case, and on which that party will bear the burden of proof at trial." Celotex Corp., 477 U.S. at 322. "In such a situation, there can be no genuine issue as to any material fact, since a complete failure of proof concerning an essential element of the nonmoving party's case necessarily renders all other facts immaterial." Id. at 322-23. Conversely, where reasonable minds could differ on the facts proffered in support of a claim, summary judgment should not be granted. Petzak v. Nevada ex rel. Dep't of Corr., 579 F.Supp.2d 1330, 1333 (D. Nev. 2008). ...

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