Burke v. State Farm Mutual Automobile Insurance Company

CourtDistrict Court, D. Colorado
DecidedJune 30, 2023
Docket1:21-cv-02512
StatusUnknown

This text of Burke v. State Farm Mutual Automobile Insurance Company (Burke v. State Farm Mutual Automobile Insurance Company) is published on Counsel Stack Legal Research, covering District Court, D. Colorado primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Burke v. State Farm Mutual Automobile Insurance Company, (D. Colo. 2023).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLORADO Senior Judge Christine M. Arguello

Civil Action No. 21-cv-02512-CMA-MDB

BETTI BURKE,

Plaintiff,

v.

STATE FARM MUTUAL AUTOMOBILE COMPANY,

Defendant.

ORDER GRANTING DEFENDANT’S MOTION FOR PARTIAL SUMMARY JUDGMENT

This matter is before the Court on Defendant State Farm Mutual Automobile Company’s (“State Farm”) Motion for Partial Summary Judgment (Doc. # 59), wherein State Farm requests that the Court enter summary judgment in its favor on Plaintiff Betti Burke’s claim for unreasonable delay or denial of benefits under Colo. Rev. Stat. §§ 10- 3-1115 and -1116. For the following reasons, the Court grants the Motion. I. BACKGROUND1 On April 29, 2018, Ms. Burke was involved in a motor vehicle accident (“the Accident”). (Doc. # 8 at ¶¶ 6–7; Doc. # 60 at 1.) She was a restrained passenger in a parked vehicle which was struck by another vehicle. (Doc. # 8 at ¶¶ 6–7; Doc. # 60 at 1.) Ms. Burke did not seek medical care until 18 days later when she presented to a

1 Unless otherwise specified, the following facts are undisputed. chiropractor. (Doc. # 60 at 12–13; Doc. # 89-14.) However, Ms. Burke asserts that she suffered injuries as a result of the accident including, but not limited to, jaw pain, ear pain, neck pain, right shoulder pain, chest pain, right breast pain, left flank pain, back pain, hip pain, arm pain, bilateral elbow pain, numbness in the fingers, bilateral wrist pain, numbness and tingling in the upper extremity; tailbone pain, bilateral leg pain, right knee pain, right foot pain, numbness and tingling in the right calf, joint pain, headaches, blurred vision, sonophobia, depression, sleep disturbance, dizziness, and fainting spells, all resulting in mental and physical pain and suffering.

(Doc. # 8 at ¶ 12.) Ms. Burke settled with the at-fault driver, who is not a party to this litigation, for the limits of his $25,000 Safeway Insurance Agency (“Safeway”) liability insurance coverage. (Doc. # 60 at 25–26.) At the time Ms. Burke was the insured under a policy issued by State Farm that provided underinsured motorist (“UIM”) benefits in the amount of $100,000 per person. (Id. at 4.) Nearly three months after the accident Ms. Burke presented to occupational and environmental medicine doctor, Thomas Higginbotham, DO. (Id. at 15.) At that time Dr. Higginbotham diagnosed Ms. Burke with contusion to right upper and lower extremities and flank, lateral hyper-flexion of the neck, contusion to the right hip and knee, and multiple musculotendinous strain patters to the right upper and lower extremity musculature. (Id. at 20.) Dr. Higginbotham examined Ms. Burke’s right shoulder and found “near full” range of motion, as well as multiple “moderate” joint and muscular tenderness and guarding on her right upper extremity. (Id. at 18); see also (Doc. # 89-4 at 7; Doc. # 89-11.) On March 26, 2019, after Ms. Burke had been released from her treating chiropractor for self-care, Dr. Higginbotham also released Ms. Burke from care. (Doc. # 60 at 21.) On this date Dr. Higginbotham noted that Ms. Burke’s shoulder “is much better,” that she was “at maximum therapeutic benefit,” and that “[n]o surgeries are anticipated.” (Id. at 21–22.) In a deposition taken on September 9, 2022, Dr. Higginbotham testified that he missed an appropriate evaluation of Ms. Burke’s right shoulder in 2018 and March of 2019. (Doc. # 89-4 at 7, 15–16, 18.) At that time Dr. Higginbotham also testified that he attributes the rotator cuff tear to the Accident. (Id. at 13.) In November 2019, Ms. Burke was referred to Dr. Devanny, an orthopedic surgeon, who diagnosed Ms. Burke with a rotator cuff tear. (Id. at 1–2.) Dr. Devanny

performed surgery the following month. (Id.) Dr. Devanny’s post-operative diagnoses included “[c]omplete rotator cuff tear or rupture of right shoulder, not specified as traumatic.” (Id. at 24.) During Dr. Devanny’s January 17, 2023 deposition, he testified that he did not personally enter this post-operative diagnosis, but rather it was computer generated or entered by a biller. (Doc. # 89-17 at 9.) On October 16, 2020, Ms. Burke demanded the $100,000 of her UIM coverage from State Farm. (Id. at 27–36.) In her demand letter Ms. Burke claimed $35,399.70 in medical expenses, including the surgery for her right shoulder rotator cuff tear that she attributed to the Accident. (Id.) The following month, State Farm advised Ms. Burke that it had “questions concerning causation,” requested five years of complete prior medical

records, and notified Ms. Burke that it may request an independent medical examination. (Id. at 37.) State Farm also offered Ms. Burke $1,500 to resolve her UIM claim. (Id.) In response, Ms. Burke provided State Farm with six months of redacted prior medical records which Ms. Burke asserts comprise “[a]ll relevant, unprivileged medical records” for the period requested. (Doc. # 89 at 4 citing (Doc. # 89-6 at 29–44; Doc. # 89-7 at 14; Doc. # 89-14 at 3; Doc. # 89-15; Doc. # 89-16.)) On November 24, 2020, noting that it was in receipt of records dating back only to February 2018, some of which were redacted, State Farm again requested five years of complete, unredacted prior medical records. (Doc. # 60 at 40.) Ms. Burke responded on December 17, 2020, rejecting State Farms $1,500 settlement offer and stating, “the records you have requested have nothing to do with the claim.” (Id. at 41.) On January 5, 2021, Ms. Burke provided State Farm with a letter from Dr.

Higginbotham. (Id. at 42–49.) In this letter, Dr. Higginbotham opines that a November 2019 MRI of Ms. Burke’s right shoulder produced results “consistent with a near full thickness tear of the rotator cuff,” attributing this tear to the Accident. (Id. at 44–46.) State Farm’s claims adjuster than requested information from the agency’s medical resources department to better understand Ms. Burke’s shoulder injury and treatment. (Id. at 50.) Based on this information, in early February 2021, State Farm notified Ms. Burke that it intended to move forward with a Utilization Review. (Id. at 55.) Dr. Schwappach, who conducted a records review but did not perform an in- person examination of Ms. Burke (Doc. # 89-8 at 4), provided State Farm with a written report in which he concluded that the Accident did cause Ms. Burke’s right upper

extremity contusion and that all treatment up through March 2019 was reasonable to treat that injury. (Id. at 8–9.) However, Dr. Schwappach asserted that “clearly the shoulder partial thickness tearing and the shoulder tendinosis are not consistent with the [Accident].” (Doc. # 60 at 60.) Dr. Schwappach went on to opine that Ms. Burke’s rotator cuff injury and the need for surgery was not related to the [Accident]. There is no evidence to support this. The [November 2019] MRI scan is not consistent with an acute injury, and her initial examination done by Dr. Higginbotham on July 24, 2018, di [sic] not reveal acute rotator cuff pathology.”

(Id.)2 On March 11, 2021, State Farm notified Ms. Burke that “[b]ased on these findings, we are not considering the right should tear and its related surgery” in its UIM evaluation and reiterated its $1,500 settlement offer. (Id. at 62.) Subtracting the medical treatment for Ms. Burke’s rotator cuff, State Farm calculated Ms. Burke’s accident-related damages as $12,206 in medical treatments and $7,500 to $11,000 in general damages. (Id. at 65, 68.) In a letter dated April 9, 2021, Dr. Higginbotham “respectfully disagree[d] with Dr. Schwappach’s opinion that the motor vehicle collision would not have resulted in rotator cuff pathologies as outlined in the MRI.” (Id. at 72.) State Farm reiterated its settlement offer on May 19, 2021, and August 12, 2021. (Id. at 74–75.) On August 16, 2021, Ms. Burke filed her Complaint in state court. (Doc.

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Burke v. State Farm Mutual Automobile Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/burke-v-state-farm-mutual-automobile-insurance-company-cod-2023.