Cousin v. Geico General Insurance

166 F. Supp. 3d 1290, 2015 U.S. Dist. LEXIS 181678, 2015 WL 10791911
CourtDistrict Court, M.D. Florida
DecidedDecember 15, 2015
DocketCase No. 3:14-cv-397-J-39JRK
StatusPublished

This text of 166 F. Supp. 3d 1290 (Cousin v. Geico General Insurance) is published on Counsel Stack Legal Research, covering District Court, M.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cousin v. Geico General Insurance, 166 F. Supp. 3d 1290, 2015 U.S. Dist. LEXIS 181678, 2015 WL 10791911 (M.D. Fla. 2015).

Opinion

[1293]*1293 ORDER

BRIAN J. DAVIS, United States District Judge.

THIS CAUSE is before the Court on Defendant GEICO General Insurance Company’s (“GEICO”) Motion for Summary Judgment and Incorporated Memorandum of Law (Doc. 53) and Plaintiff Ethel Cousin’s response in opposition (Doc. 66).

I. BACKGROUND1

On June 12, 2009, Ms. Cousin and her husband were involved in a traffic accident (the “accident”) when Helen Bratcher made a left turn in front of the Cousins’ vehicle.2 (Doc. 58.1). Ms. Bratcher was found to be at fault for the accident and she was cited for careless driving. (Id.). It is undisputed that both drivers were insured by GEICO. On the same day of the accident GEICO was notified that Ms. Cousin sustained a fractured leg, as well as injuries to her knee, neck, and shoulder, and that an ambulance transported Ms. Cousin to the hospital. (Doc. 58.7 at 19). By June 15, 2009, GEICO conducted interviews with the Cousins verifying that both had sustained injuries. (Id. at 17-18). The interview of Ms. Cousin revealed that she was suffering from neck, back, chest, knee, feet, wrist, and arm pain, and that she was losing wages from her job as a certified nursing assistant. (Id. at 18).

On June 29, 2009, attorney Michael Mar-rese began representing Ms. Cousin in her efforts to recover for injuries she sustained in the accident. (Doc. 58.8). On July 27, 2009, GEICO notified Ms. Cousin that it assigned Kimberly Stephens to handle Ms. Cousin’s UM claim and asked for an update regarding the “injury and treatment status” of Ms. Cousin. (Doc. 58.10).3 On August 3, 2009, the adjuster assigned to Ms. Cousin’s bodily injury (“BI”) claim against Ms. Bratcher notified Ms. Stephens that GEICO tendered the full $10,000.00 available under Ms. Bratcher’s policy to Ms. Cousin because of Ms. Cousin’s “Displaced Spiral Fx [fracture] Of The Tibia.”4 (Doc. 58.6 at 26). On August 10, 2009, Ms. Cousin also notified Ms. Stephens that she received a check for $10,000.00 from Ms. Bratcher’s insurance and demanded payment of the full $100,000.00 available under Ms. Cousin’s UM policy. (Doc. 58.11).

Ms. Cousin attached copies of various medical records with her demand. (Docs.58.11-58.18). Among the records was a Patient Assessment form completed by Medwell Medical Center (“Medwell”) on June 25, 2009, which described Ms. Cousin as experiencing pain in her neck, hand, and foot with levels of pain high enough that it interfered with her ability to work and sleep.5 (Doc. 58.14 at 5). After completing its evaluation, Medwell [1294]*1294diagnosed Ms. Cousin with a neck sprain and spiral fracture of the right tibia. (Id. at 6). Medwell then recommended that (1) Ms. Cousin undergo two to three weeks of, among other things, physical therapy and electrical stimulation therapy and (2) referred Ms. Cousin to see an orthopedic specialist (Doc. 58.13 at 5). Between July 8 and July 10, 2009, Ms. Cousin underwent a series of x-rays on her hip, wrist elbow, and lumbar and thoracic spine, which only showed scoliosis and mild degenerative disc disease of her thoracic spine. (Doc. 58.18).

Also among the medical records Ms. Cousin provided GEICO was a July 20, 2009 follow-up evaluation by Medwell, which reported that Ms. Cousin was experiencing cervical, lumbar, hip, elbow, and ankle pain. (Doc. 58.15 at 4). Ms. Cousin rated the severity of her cervical and lumbar pain at a 6 and 7, respectively. (Id.). The evaluation recommended another three to four weeks of physical therapy in hopes of improving Ms. Cousin’s pain, posture, strength, and range of motion. (Id. at 5).

Simultaneous to Ms. Cousin’s demand letter to GEICO for the full amount available under the UM policy, Ms. Cousin filed her first Civil Remedy Notice of Insurer Violations (Doc. 58.19; 8/10/09 “First CRN”). The First CRN accused GEICO of violating Florida Statute section 524.155(l)(b)(l), which provides a cause of action where an insurer fails “in good faith to settle claims when, under all the circumstances, it could and should have done so, had it acted fairly and honestly toward its insured and with due regard for her or his interests!/]” Ms. Stephens responded to Ms. Cousin’s initial demand letter by confirming receipt of the initial demand letter and that GEICO would contact Ms. Cousin after evaluation of the claim. (Doc. 58.20; 8/17/09 Response). Two days later, Ms. Cousin sent additional medical records which included some medical records predating the accident. (Doe. 58.21). Of note, the additional medical records showed that Ms. Cousin had testing on her lumbar on February 9, 2007, which showed mild broad lumbar dextroscoliosis. (Id. at 7). The additional medical records also showed that she underwent further testing on her lumbar following the accident, which showed degenerative disc and joint disease, but no acute findings. (Id. at 4).

On August 26, 2009, GEICO completed review of Ms. Cousin’s UM claim, and GEICO decided that the information available to them at the time was “[l]imited” and that it needed personal injury protection (“pip”) logs and all billing information. (Doc. 58.6 at 8). The following day, Ms. Stephens informed Ms. Cousin that GEI-CO was considering Ms. Cousin’s UM claim and that GEICO needed pips logs and documentation of any lost wages to complete its evaluation. (Id. at 7). Again, on September 9, 2009, Ms. Stephens advised Ms. Cousin that her claim remained under consideration and that GEICO was in need of pip logs and lost wage information. (Doc. 58.22). On September 29, 2009, GEICO again requested all of Ms. Cousin’s medical records and bills related to the accident so it could make a determination on her UM claim. (Doc. 58.23 at 2). During a phone conversation on the same day, GEICO again asked for all of Ms. Cousin’s medical records and bills. (Doc. 58.5 at 33-34). Ms. Cousin advised that she was undergoing treatment and would update GEICO as to her status in a week or so. (Id. at 34).

Ms. Cousin followed-up with GEICO on October 5, 2009, by sending a letter that informed GEICO that her fractured tibia received a positive prognosis and was healing well. (Doc. 58.24; 10/5/2009 Letter). That same letter also informed GEICO that Ms. Cousin was still experiencing “tremendous” back pain for which she un[1295]*1295derwent two epidural injections to her lumbar spine with a third scheduled in the immediate future. (Id.). Attached to the letter was the report from an August 10, 2009 MRI of Ms. Cousin’s lumbar, which showed a mild annular disc bulge, eccentric disc bulge, mild central canal stenosis, and small central disc protrusion. (Doc. 58.24 at 64).

The letter also advised GEICO that Ms. Cousin informally met with her husband’s neurosurgeon Dr. Gomes at one of her husband’s appointments. Ms. Cousin claimed that as a courtesy, Dr. Gomes reviewed her MRI films, which she happened to have with her at the time. After review of her MRI films, Dr. Gomes asked that Ms. Cousin make an appointment with him because he thought that Ms. Cousin could very likely be a good candidate for a lumbar fusion procedure, given that the epidural injections were not providing the desired relief. (Id. at 1). Ms. Cousin did not provide any notes from Dr. Gomes regarding his opinion on Ms. Cousin’s lumbar.

Ms.

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Bluebook (online)
166 F. Supp. 3d 1290, 2015 U.S. Dist. LEXIS 181678, 2015 WL 10791911, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cousin-v-geico-general-insurance-flmd-2015.