AI Case Brief
Generate an AI-powered case brief with:
đKey Facts
âïžLegal Issues
đCourt Holding
đĄReasoning
đŻSignificance
Estimated cost: $0.10â$0.50 per brief, depending on opinion length and retries
Full Opinion
IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF PENNSYLVANIA MATTHEW BORDEN Plaintiff, v. CIVIL ACTION NO. 20-1878 NGM INSURANCE COMPANY Defendant. MEMORANDUM OPINION Rufe, J. March 8, 2023 This is an insurance dispute between Plaintiff Matthew Borden and his insurer Defendant NGM Insurance Company, arising out of NGMâs handling of Plaintiffâs underinsured motorist (âUIMâ) claim. Defendant has moved for summary judgment on the sole remaining claim in this case, for insurance bad faith.1 For the reasons that follow, NGMâs motion will be granted. I. BACKGROUND2 A. The Initial Claim Plaintiff is the owner of Matthew Borden Heating and Cooling, Inc., an air-conditioning and heating business. On August 12, 2017, Plaintiff sustained injuries in a car crash when the tortfeasor, Linda Reilly, struck the rear passenger side of Plaintiffâs company vehicle. Plaintiffâs injuries included spinal cord compression and cervical spinal stenosis. At the time of the accident, Plaintiff was insured under a commercial automobile insurance policy issued by NGM (âthe Policyâ). 1 Plaintiffâs Amended Complaint asserts claims for breach of contract (Count I) and insurance bad faith (Count II). As explained below, both parties agree that Plaintiffâs breach of contract claim was rendered moot on April 30, 2020, when NGM tendered its policy limits. 2 The following facts are largely undisputed; where disputed they are viewed in the light most favorable to Plaintiff as the non-moving party. On October 13, 2017, Plaintiff notified NGM of the accident and his need for ongoing medical treatment. NGM recorded Plaintiffâs claim as âmedical onlyâ and assigned claims adjuster Lynn Cantone to handle the payment of Plaintiffâs first-party medical benefits.3 Plaintiff informed Cantone of the facts of loss and authorized NGM to communicate with his healthcare providers and obtain his medical records. On February 10, 2018, Robert Casson, NGMâs first-party medical benefits manager, reported in Plaintiffâs claim log (âthe Claim Logâ) that âUIM [was] possible, but not needed at this point.â4 Two months later, Plaintiff contacted NGM and spoke with Susan Krull, the NGM claim adjuster who succeeded Cantone, and informed her that he may pursue a legal action for his injuries. At no point did Krull inform Plaintiff that he was entitled to UIM benefits under the Policy. B. The Representation Letter In May 2019, Plaintiff retained counsel to pursue a claim against Reilly. Plaintiffâs counsel sent NGM a representation letter (âthe Representation Letterâ) on May 10, 2019, advising NGM that Plaintiff âmay initiate a cause of action against the tortfeasor and seek to obtain a judgment in excess of the tortfeasorâs policy limits,â and that NGM â[would] be bound by the judgment.â5 The Representation Letter further stated that Plaintiff had received âextensive treatment for cervical injuries, including injectionsâ and that âhis physician [was] recommending a multi-level surgical fusion surgery.â6 3 Def.âs Mot. Partial Summ. J. Ex. 8 [Doc. No. 33-9] at ECF page 37. 4 Def.âs Mot. Partial Summ. J. Ex. 8 [Doc. No. 33-9] at ECF page 34. 5 Def.âs Mot. Partial Summ. J. Ex. 9 [Doc. No. 33-10] at ECF page 2. 6 Def.âs Mot. Partial Summ. J. Ex. 9 [Doc. No. 33-10] at ECF page 2. 2 Upon receipt of the Representation Letter, NGM created a UIM file for Plaintiffâs claim and assigned Denise Domiter to handle the claim. On May 17, 2019, Domiter provided Plaintiffâs counsel with relevant Policy documents and requested information regarding Plaintiffâs injuries and treatment. Plaintiffâs counsel sent a reply email three days later, stating that he had ârequested [Plaintiffâs] medical records and [would] forward them once they [were] received.â7 Domiter sent two follow-up letters to Plaintiffâs counsel in June and July 2019, requesting that counsel âprovide information regarding [Plaintiffâs] injuries and treatment to date.â8 Plaintiffâs counsel did not respond to either correspondence.9 Discovery in this action revealed that, at some point prior to May 2019, NGM had obtained several of Plaintiffâs treatment records in connection with his first-party claim. However, Domiter never reviewed these records, nor did she review the entries in Plaintiffâs Claim Log. In August 2019, NGM reassigned Domiter to a different department, thereby removing her from Plaintiffâs case. While NGM was âin the process of trying to replace [Domiter],â Dana Gucciardi, who had been Domiterâs manager, oversaw Plaintiffâs claim.10 C. The Demand Package On November 14, 2019, Plaintiffâs counsel provided NGM with a demand package outlining Plaintiffâs UIM claim and demanding payment of benefits. The demand package included Plaintiffâs treatment records, a life care plan, the expert report of Dr. Guy Fried, and a coverage letter from Reillyâs insurance company, Erie Insurance Exchange. According to the 7 Def.âs Mot. Partial Summ. J. Ex. 9 [Doc. No. 33-10] at ECF page 6. 8 Def.âs Mot. Partial Summ. J. Ex. 9 [Doc. No. 33-10] at ECF pages 12, 13. 9 Although Plaintiffâs counsel did not receive Plaintiffâs medical records until September 2019, Plaintiffâs counsel failed to update Domiter in the interim as to the status of the records. 10 Def.âs Mot. Partial Summ. J. Ex. 11 [Doc. No. 33-12] at ECF page 4. 3 Erie coverage letter, Reillyâs policy provided policy limits of $100,000 in bodily injury coverage. Plaintiffâs counsel asserted in the demand letter that Plaintiffâs âmedical special damages alone are estimated at just under $500,000â and that âthe available $100,000 in third-party insurance is insufficientâ to compensate Plaintiff for his injuries and damages.11 Plaintiff demanded â$100,000 in UIM benefits coverage, stacked across seven vehicles for a total available UIM coverage . . . of $700,000.â12 Receiving no response from NGM, Plaintiffâs counsel sent another letter on December 10, 2019, cautioning NGM that if it âcontinues to delay paying [Plaintiffâs] UIM benefits, [counsel] will have no choice but to join a UIM breach of contract claim to the already pending third-party litigation.â13 Gucciardi replied on December 12, 2019, stating that he âtried to email [Plaintiffâs counsel] unsuccessfully regarding [Plaintiffâs] claim,â and that he was requesting to schedule an Examination Under Oath (âEUOâ) of Plaintiff regarding the extent of his injuries.14 Gucciardi further provided that, with respect to Plaintiffâs demand of $700,000, NGMâs records showed only â[five] vehicles on the policy [as] opposed to [seven].â15 On December 16, 2019, Plaintiffâs counsel informed Gucciardi that he âchecked [his] email inbox, and [had] not received any messages from [NGM]â and that âno messages were inadvertently filtered to junk mail.â16 Plaintiffâs counsel stated that NGM still had not addressed whether it was âaccepting or denyingâ Plaintiffâs UIM claim, and that NGM had violated the 11 Def.âs Mot. Partial Summ. J. Ex. 9 [Doc. No. 33-10] at ECF page 16. 12 Def.âs Mot. Partial Summ. J. Ex. 9 [Doc. No. 33-10] at ECF page 16. 13 Def.âs Mot. Partial Summ. J. Ex. 9 [Doc. No. 33-10] at ECF page 14. Plaintiff filed a lawsuit against Reilly on August 7, 2019 in the Delaware County Court of Common Pleas. 14 Def.âs Mot. Partial Summ. J. Ex. 9 [Doc. No. 33-10] at ECF pages 93, 94. 15 Def.âs Mot. Partial Summ. J. Ex. 9 [Doc. No. 33-10] at ECF page 94. 16 Def.âs Mot. Partial Summ. J. Ex. 9 [Doc. No. 33-10] at ECF page 92. 4 Pennsylvania Unfair Insurance Practices Act (âUIPAâ) by failing to complete its investigation within 30 days of the November 14, 2019 demand package.17 The email further provided, in relevant part: Concerning your reference to the number of vehicles on the policy, I have attached a copy of the policy in force that was provided by [NGM] when my firm requested a copy of the same. As you will note, the declaration page includes seven (7) vehicles. If vehicles were added or removed before the August 12, 2017 date of incident, kindly provide me with a copy of the policy and the declarations page as it existed on August 12, 2017. ⊠It is unclear . . . why [NGM] believes that an examination under oath performed by an attorney would reveal anything about the extent of [Plaintiffâs] injuries, or for that matter, his current medical condition. This information is already borne out in [Plaintiffâs] medical records following the incident and up through the present as well as in the reports authored by Dr. Fried and Mr. Karrasâall of which has already been provided to [NGM]. The request to examine [Plaintiff] under oath outside the terms of the policy âregarding the extent of his injuriesâ is even more perplexing given that the policy provides that, if requested, [Plaintiff] must submit to be examined by a physician of [NGMâs] choice. If [NGM] genuinely believed it needed more information about the extent of [Plaintiffâs] injuries a physician would actually be able to provide that information as well as information about [Plaintiffâs] current condition.18 NGM did not reply to counselâs email. On February 25, 2020, Plaintiffâs claim was reassigned to NGM claims adjuster Steven Miles. Miles notified Plaintiffâs counsel of the reassignment and requested information and documents, including confirmation of Reillyâs ownership of her vehicle, the declarations page for Reillyâs Erie policy, an update on whether Plaintiff had scheduled surgery, and a copy of the estimates of damages for Plaintiffâs vehicle. Plaintiffâs counsel responded on March 6, 2020, answering each of Milesâ inquiries and providing the materials sought. Plaintiffâs counsel noted that NGM still had not provided 17 Def.âs Mot. Partial Summ. J. Ex. 9 [Doc. No. 33-10] at ECF page 92. 18 Def.âs Mot. Partial Summ. J. Ex. 9 [Doc. No. 33-10] at ECF page 92. 5 Plaintiff with (1) its authority for requesting an EUO of Plaintiff, (2) a confirmation that NGM had provided counsel with a correct copy of the Policy, and (3) written confirmation that NGM was accepting Plaintiffâs UIM claim. Plaintiffâs counsel further stated that neither Gucciardi nor anyone from NGM âha[d] even acknowledged [counselâs] December 16, 2019 correspondence let alone provided the requested, basic confirmations.â19 Accordingly, Plaintiffâs counsel enclosed a copy of Plaintiffâs proposed Complaint against NGM, and advised that it would be filing the Complaint âas early as next weekâ unless NGM were to confirm that it was âacceptingâ Plaintiffâs UIM claim and respond to Plaintiffâs demand for the policy limit of (what Plaintiff believed at the time to be) $700,000.20 Counsel for NGM responded on March 31, 2020 with a detailed letter that included: (1) the factual background of Plaintiffâs UIM claim; (2) NGMâs responses to the issues raised in Plaintiffâs counselâs March 6, 2020 letter; (3) NGMâs acknowledgement that Plaintiff was an âinsuredâ under the Policy for purposes of his UIM claim; (4) an explanation regarding Plaintiffâs counselâs misinterpretation of the number of vehicles covered under the Policy;21 (5) NGMâs continued review of Plaintiffâs claim; (6) NGMâs request for an EUO; (7) NGMâs investigation and Plaintiffâs proposed Complaint; and (8) NGMâs reservation of rights. With 19 Def.âs Mot. Partial Summ. J. Ex. 9 [Doc. No. 33-10] at ECF page 90. 20 Def.âs Mot. Partial Summ. J. Ex. 9 [Doc. No. 33-10] at ECF page 90. 21 Counsel for NGM explained that the Policy uses âSymbol 7â to identify the âcovered motor vehicles under the Policyâs UIM coverage.â Def.âs Mot. Partial Summ. J. Ex. 9 [Doc. No. 33-10] at ECF page 98 (internal quotation marks omitted). NGMâs counsel further stated that âthe number â7â under the heading âCovered Autosâ on the âBusiness Auto Coverage Form Declarationsâ does not represent the number of the vehicles insured under the Policy, but rather indicates which symbolâin this case, Symbol 7âis used to define the term âcovered autosâ as used in the Policy.â Def.âs Mot. Partial Summ. J. Ex. 9 [Doc. No. 33-10] at ECF page 100. 6 respect to Plaintiffâs counselâs demand that NGM âacceptâ Plaintiffâs UIM claim, NGMâs counsel explained that: To the extent that your letterâs use of the term âacceptâ is intended to be a demand that NGM issue immediate payment of the UIM coverage under the Policy, NGM has authorized me to advise you that it is continuing to review and evaluate the materials provided to it, as well as the status of the lawsuit against Ms. Reilly. NGM has further authorized me to advise you that it is not yet in a position to issue paymentâif anyâof the UIM benefits under the Policy, and it reserves its rights under the Policy and Pennsylvania law to continue and complete its investigation of your clientâs claimed injuries and damages.22 D. This Lawsuit On April 13, 2020, Plaintiff filed his Complaint against NGM, asserting claims for breach of contract and insurance bad faith, and alleging that the total available UIM coverage was $700,000â$100,000 stacked by seven vehicles. Plaintiff filed an Amended Complaint on July 6, 2020, conceding that the Policy covered only five vehicles, and that the available stacked coverage was therefore $500,000. On April 30, 2021, following the completion of discovery, NGM agreed to tender the $500,000 UIM policy limits. Plaintiff accepted the tender, which, as both parties agree, rendered Plaintiffâs breach of contract claim moot. Accordingly, Plaintiffâs sole remaining claim is insurance bad faith, as set forth in Count II of the Amended Complaint. II. LEGAL STANDARD Under Federal Rule of Civil Procedure 56(a), summary judgment is warranted if there is âno genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.â23 âOnly disputes over facts that might affect the outcome of the suit under the governing 22 Def.âs Mot. Partial Summ. J. Ex. 9 [Doc. No. 33-10] at ECF page 98. 23 Fed. R. Civ. P. 56(a). 7 law will properly preclude the entry of summary judgment.â24 A âgenuineâ dispute over material facts exists when âthe evidence is such that a reasonable jury could return a verdict for the nonmoving party.â25 To evaluate a motion for summary judgment, the court must âview the facts in the light most favorable to the non-moving partyâ and draw âall reasonable inferences in that partyâs favor.â26 Nonetheless, the non-moving party must support its opposition to the motion by pointing to evidence in the record.27 âIf the evidence is merely colorable, or is not significantly probative, summary judgment may be granted.â28 III. DISCUSSION Under Pennsylvania law, â[i]n an action arising under an insurance policy, if the court finds that the insurer has acted in bad faith toward the insured, the court mayâ award various damages.29 The statute does not define âbad faith,â but the Pennsylvania Supreme Court has defined bad faith to be âany frivolous or unfounded refusal to pay proceeds of a policy[.]â30 To recover on a statutory bad faith claim, the claimant must show by clear and convincing evidence that the insurer (1) lacked a reasonable basis for denying benefits under the policy and (2) knew or recklessly disregarded the lack of reasonable basis for the claim denial.31 Proof of an insurerâs motive of self-interest or ill-will is probative of the second prong, but is not required.32 âBad 24 Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). 25 Id. 26 Hugh v. Butler Cnty. Family YMCA, 418 F.3d 265, 267 (3d Cir. 2005) (citation omitted). 27 Celotex Corp v. Catrett, 477 U.S. 317, 322-23 (1986). 28 Anderson, 477 U.S. at 249-50 (internal citations omitted). 29 42 Pa. Cons. Stat. § 8371. 30 Rancosky v. Washington Nat'l Ins. Co., 170 A.3d 364, 373 (Pa. 2017) (quoting Terletsky v. Prudential Prop. & Cas. Ins. Co., 649 A.2d 680, 688 (Pa. Super. Ct. 1994)). 31 Id. at 376-77 (citations omitted). 32 Id. at 377. 8 faith claims are fact specific and depend on the conduct of the insurer vis Ă vis the insured.â33 Negligence or bad judgment does not equate to bad faith.34 âA reasonable basis is all that is required to defeat a claim of bad faith.â35 Plaintiff argues that NGM lacked a reasonable basis for delaying payment of the UIM claim until April 30, 2021, and that it knew of or recklessly disregarded its lack of a reasonable basis. While delay is relevant in determining whether an insurer acted in bad faith, âa long period of delay between demand and settlement does not, on its own, necessarily constitute bad faith.â36 Courts consider whether âthe delay is attributable to the defendant,â whether âthe defendant had no reasonable basis for the actions it undertook which resulted in the delay,â and whether âthe defendant knew or recklessly disregarded the fact that it had no reasonable basis to deny payment.â37 Courts have also drawn a distinction between an insurer delaying necessary tasks and an insurer delaying settlement when the value of the claim is clear.38 The former, without more, does not constitute not bad faith, while the latter often does.39 Plaintiff first argues that NGM should have initiated Plaintiffâs UIM claim as early as October 13, 2017, when Plaintiff first contacted NGM about his injuries. In turn, NGM contends that Plaintiff âcharacterized the claim as âmedical onlyââ and did not inform NGM of his 33 Condio v. Erie Ins. Exch., 899 A.2d 1136, 1143 (Pa. Super. Ct. 2006) (citing Williams v. Nationwide Mutual Ins. Co., 750 A.2d 881, 887 (Pa. Super. Ct. 2000)). 34 See Northwestern Mut. Life Ins. Co. v. Babayan, 430 F.3d 121, 137 (3d Cir. 2005) (citation omitted). 35 J.C. Penney Life Ins. Co. v. Pilosi, 393 F.3d 356, 367 (3d Cir. 2004) (citing Horowitz v. Fed. Kemper Life Assurance Co., 57 F.3d 300, 307 (3d Cir. 1995)). 36 Seto v. State Farm Ins. Co., 855 F. Supp. 2d 424, 430 (W.D. Pa. 2012) (quoting Kosierowski v. Allstate Ins. Co., 51 F. Supp. 2d 583, 588-89 (E.D. Pa. 1999)). 37 Thomer v. Allstate Ins. Co., 790 F. Supp. 2d 360, 370 (E.D. Pa. 2011) (quoting Wiedinmyer v. Harleysville Mut. Ins. Co., No. 94-19450, 1999 WL 1324202, at *215 (Pa. Com. Pl. Aug. 5, 1999)). 38 See Williams v. Hartford Cas. Ins. Co., 83 F. Supp. 2d 567, 572 (E.D. Pa. 2000), aff'd, 261 F.3d 495 (3d Cir. 2001). 39 See id. 9 intention to pursue a UIM claim until the Representation Letter on May 10, 2019.40 Plaintiff maintains that NGM âunilaterally, and in violation of accepted insurance industry standards,â recorded Plaintiffâs claim as âmedical only,â and impermissibly failed to inform him of his UIM benefits under the Policy.41 In support of this argument, Plaintiff relies on an insurance industry expert, who opines that insurance claim professionals are trained to âexplain to the insured the need for investigation and how the insured can facilitate the investigation,â42 which NGM failed to do. Assuming that NGMâs failure to inform was, as Plaintiff suggests, inconsistent with industry standards, this error was not so unreasonable as to constitute bad faith. As the Pennsylvania Superior Court held in Albert v. Erie Insurance Exchange,43 âabsent evidence of fraud or intentional deception, an insurer has no affirmative duty to advise its insured of every potential claim or benefit that could exist under a policy.â44 In holding that the insurer âhad no duty to inform the insureds of the [applicable] benefit,â the Albert Court noted that the insured âd[id] not allege that Erie persuaded her not to [exercise] her own . . . rights under the policy, or deceived her as to the . . . benefit under her policy.â45 Instead, the insured âsimply allege[d] that Erie failed to advise her of the . . . benefit despite the fact that it [was] set forth unambiguously in the policy.â46 40 Def.âs Mot. Partial Summ. J. Ex. 8 [Doc. No. 33-9] at ECF page 37. 41 Pl.âs Resp. Opp. [Doc. No. 34] at 7. 42 Pl.âs Resp. Opp. Ex. A [Doc. No. 34-3] at ECF page 14 (citation omitted). 43 65 A.3d 923, 929-30 (Pa. Super. Ct. 2013) (citing Miller v. Keystone, 636 A.2d 1109, 1113 (Pa. 1994), cert. denied, 513 U.S. 875 (1994)). 44 Id. 45 Id. at 929-31. 46 Id. at 930. 10 Much like the insured in Albert, Plaintiff does not allege that NGM deceived him or persuaded him not to assert his UIM rights under the Policy. Rather, Plaintiff argues that NGM merely failed to advise him of these rights and that it lacked a reasonable basis for doing so. Nor does Plaintiff argue that the language of the Policy is ambiguous as to whether it provided UIM coverage. The Policy clearly states that, subject to certain conditions, NGM would âpay all sums the âinsuredâ is legally entitled to recover as compensatory damages from the owner or driver of an âunderinsured motor vehicle,ââ and that âthe damages must result from âbodily injuryâ sustained by the âinsuredâ caused by an âaccident.ââ47 The Court recognizes that Plaintiff is not suggesting that NGM has a duty to âexplain every permutation possible from an insuredâs choice of coverage,â48 but rather that NGM should be required to explain any policy benefits that may apply under the circumstances. Nonetheless, the Court must look to Pennsylvania law, which requires that â[o]nce the insurance contract takes effect . . . the insured must take responsibility for his policy.â49 While Plaintiff argues that he was unaware of his UIM benefits, he testified at deposition that at the time he purchased the Policy, âit was [his] understandingâ that the Policy provided âstackedâ UIM coverage.50 Plaintiff was obligated âto question his insurer at the time the insurance contract [was] entered into as to the type of coverage desired and the ramifications desired therefrom.â51 Thus, in the absence of 47 Def.âs Mot. Partial Summ. J. [Doc. No. 33] ¶ 19. 48 See Albert, 65 A.3d at 930 (quoting Kilmore v. Erie Ins. Co., 595 A.2d 623, 626-27 (Pa. Super. Ct. 1991) (âWhile we acknowledge insurance is an area in which the contracting parties stand in somewhat special relationship to each other, the relationship is not so unique as to compel this Court to require an insurer to explain every permutation possible from an insured's choice of coverage.â). 49 Id. (same); see Kilmore, 595 A.2d at 627 (noting that â[e]ach insured has the right and obligation to question his insurer at the time the insurance contract is entered into as to the type of coverage desired and the ramifications arising therefrom.â). 50 See Def.âs Mot. Partial Summ. J. Ex. 3 [Doc. No. 33-4] at ECF page 4. 51 Albert, 65 A.3d at 930 (quoting Kilmore, 595 A.2d at 627). 11 any evidence of a dishonest purpose or ill-will, NGM did not act in bad faith in failing to advise Plaintiff of his UIM benefits. As for NGMâs conduct after receiving the Representation Letter, NGMâs handling of Plaintiffâs UIM claim does not rise to the level of bad faith as a matter of Pennsylvania law. Plaintiff argues that NGM unreasonably failed to (1) independently investigate Plaintiffâs medical records, (2) promptly respond to Plaintiffâs demand package, and (3) tender its policy limits at any point prior to the close of discovery. However, NGM has produced evidence indicating that Plaintiff contributed to NGMâs delays, and that NGMâs conduct was, at worst, negligent. For instance, Plaintiff does not dispute that within one week of receiving the Representation Letter, NGM contacted Plaintiffâs counsel for âinformation regarding [Plaintiffâs] injuries and treatment to date.â52 Plaintiffâs counsel then explicitly assured NGM that he had ârequested [Plaintiffâs] medical records and [would] forward them once they [were] received.â53 However, when NGM attempted to follow up with Plaintiffâs counsel on two separate occasions, Plaintiffâs counsel failed to respond. Although NGM had at least some of the treatment records in connection with the first party claim, it was not reckless for NGM to rely on Plaintiffâs counsel express representation that he would provide NGM with the relevant records. Plaintiff further argues that NGM lacked a reasonable basis for delaying its response to Plaintiffâs November 14, 2019 demand package. In support of this argument, Plaintiffâs expert cites Section 146 of the UIPA, which provides that â[a]n appropriate reply shall be made within 10 working days on . . . pertinent communications from a claimant which reasonably suggest that 52 Def.âs Mot. Partial Summ. J. Ex. 9 [Doc. No. 33-10] at ECF page 4. 53 Def.âs Mot. Partial Summ. J. Ex. 9 [Doc. No. 33-10] at ECF page 6. 12 a response is expected,â and that â[e]very insurer shall complete investigation of a claim within 30 days after notification of claim, unless the investigation cannot reasonably be completed within the time.â54 As a threshold matter, because the Pennsylvania Supreme Court has held that there is no private right of action under the UIPA,55 courts in this Circuit have ârefused to consider UIPA violations as evidence of bad faith.â56 Further, it is undisputed that after Plaintiffâs counselâs follow-up letter on December 10, 2019, Gucciardi promptly responded, stating that he received the demand package and that he was requesting that Plaintiff submit to an EUO regarding the extent of his injuries. Gucciardi also clarified that his records showed only â[five] vehicles on the Policy [as] opposed to [seven].â57 NGM contends that requesting an EUO from Plaintiff was reasonable given: (1) Plaintiffâs preexisting cervical spine condition and his documented history of neck pain; (2) the extent of the property damage resulting from the subject accident; and (3) the fact that more than two years after the subject accident, Plaintiff had not yet had the cervical spine surgery that he claimed was necessary in light of his alleged injuries.58 54 31 Pa. Code §§ 146.5, 146.6; see Pl.âs Resp. Opp. Ex. A [Doc. No. 34-3] at ECF page 19. Section 146.6 further provides that â[i]f the investigation cannot be completed within 30 days, and every 45 days thereafter, the insurer shall provide the claimant with a reasonable written explanation for the delay and state when a decision on the claim may be expected.â 31 Pa. Code § 146.6. 55 See Leach v. Northwestern Mut. Ins. Co., 262 F. Appâx 445, 459 (3d Cir. 2008) (citing D'Ambrosio v. Penn. Nat'l Mut. Cas. Ins. Co., 431 A.2d 966, 970 (Pa. 1981) (finding that the UIPA can be enforced only by the state insurance commissioner)); see also Terletsky, 649 A.2d at 688 (defining âbad faithâ in the context of 42 Pa. Cons. Stat. § 8371). 56 Watson v. Nationwide Mut. Ins. Co., No. 11-1762, 2011 WL 4894073, at *4 (E.D. Pa. Oct. 12, 2011) (citing Leach, 262 F. Appâx at 459 (holding that âthe District Court did not err in finding that, insofar as [Plaintiffâs] claim for bad faith was based upon an alleged violation of the UIPA, it failed as a matter of law.â)); see Dinner v. United Services Auto. Assân Cas. Ins. Co., 29 F. Appâx 823, 827 (3d Cir. 2002) (â[M]uch of the conduct proscribed by the [UIPA] is wholly irrelevant to whether an insurer lacks a reasonable basis for denying benefits and, if so, whether it knew or recklessly disregarded that fact.â). 57 Def.âs Mot. Partial Summ. J. Ex. 9 [Doc. No. 33-10] at ECF page 94. 58 Def.âs Br. Supp. Mot. Partial Summ. J. [Doc. No. 33-1] at 15. 13 Nonetheless, the Court notes that NGM failed to communicate these reasons to Plaintiffâs counsel in response to the December 16, 2019 letter, which explicitly inquired âwhy [NGM] believe[d] that an examination under oath performed by an attorney would reveal anything about the extent of [Plaintiffâs] injuries.â59 NGMâs own expert stated that âthere is no explanation in the file . . . for the further delay which ensued between December 16, 2019 and February 25, 2020, when Mr. Miles wrote to [Plaintiffâs counsel] requesting additional information.â60 The Court agrees that NGM should have provided Plaintiffâs counsel with an explanation as to why it needed the requested information. However, it is undisputed that Plaintiffâs claim had not yet been reassigned to a claims adjuster, and that NGM contacted Plaintiff immediately upon the claimâs reassignment. Plaintiff has not demonstrated that NGMâs oversights amount to more than mere âinadequacies in the investigation,â which, while perhaps ânegligent or indicative of poor judgment,â are âinsufficient to sustain a bad faith claim.â61 As NGMâs counsel explained in his March 31, 2020 letter, it was not unreasonable for NGM to delay consenting to a settlement that had not yet occurred. It is undisputed that Erie did not agree to tender its $100,000 liability insurance policy limits until August 4, 2020. Upon receiving notice of the settlement, NGM promptly reviewed the declarations page for Reillyâs Erie policy, confirmed that Reilly did not have excess coverage, and provided Plaintiff with its consent one week later. Finally, with respect to NGMâs conduct after Plaintiff initiated this lawsuit, Plaintiff argues that NGM âaggressively litigatedâ this action and impermissibly âdelay[ed] paymentâ 59 Def.âs Mot. Partial Summ. J. Ex. 9 [Doc. No. 33-10] at ECF page 92. 60 Pl.âs Resp. Opp. Ex. L. [Doc. No. 34-14] at ECF page 18. 61 See Lehman v. Victoria Fire & Cas. Ins. Co., No. 09-1542, 2011 WL 2457928, at *10 (W.D. Pa. June 16, 2011) (citations omitted). 14 until after its expert had reviewed the relevant discovery documents.62 There is nothing improper about NGM availing itself of the tools of discovery by taking Plaintiffâs deposition, issuing subpoenas based on his testimony, and submitting documents for expert review. Plaintiff fails to demonstrate that NGM acted unreasonably in utilizing the full discovery period as set forth in the Courtâs scheduling order. It is clear from the record that NGM failed to handle Plaintiffâs claim with the upmost diligence and care. However, an insurance companyâs procedures need only be reasonable, not perfect.63 Even considering NGMâs actions as a whole, the evidence reveals that both parties contributed to the delays in this case, and that NGMâs overarching goal was to obtain the necessary information to reasonably evaluate Plaintiffâs claim. Because there is a lack of clear and convincing evidence to support a conclusion that NGM acted in bad faith, NGMâs motion will be granted. IV. CONCLUSION For the reasons stated above, NGMâs Motion for Partial Summary Judgment as to Count II of Plaintiffâs Amended Complaint will be granted. An appropriate order follows. 62 Pl.âs Br. Opp. [Doc. No. 34-2] at 2. 63 See Lincoln Benefit Life Co. v. Bowman, 221 F. Supp. 3d 617, 633 (E.D. Pa. 2016). 15
Case Information
- Court
- E.D. Pa.
- Decision Date
- March 8, 2023
- Status
- Precedential