Fawcett v. The Standard Fire Insurance Company

District Court, W.D. Washington·Decided October 4, 2024·No. 2:23-cv-00248·Unknown

Opinion

UNITED STATES DISTRICT COURT AT SEATTLE ASHLEY S. FAWCETT, CASE NO. C23-0248-KKE

Plaintiff(s), ORDER GRANTING IN PART AND v. DENYING IN PART DEFENDANT’S MOTION FOR SUMMARY JUDGMENT THE STANDARD FIRE INSURANCE COMPANY,

Defendant(s).

Plaintiff Ashley Fawcett was in a car accident while she was covered by an insurance policy issued by Defendant Standard Fire Insurance Company (doing business as Travelers Insurance Company (“Travelers”)) that provided coverage for underinsured motorist (“UIM”) bodily injury and personal injury protection (“PIP”). After Fawcett filed a claim with the other driver’s insurer, Fawcett also opened UIM and PIP claims with Travelers, and alleges in this lawsuit that Travelers unreasonably handled her UIM claim. Dkt. No. 1. Travelers moved for summary judgment, arguing that its conduct was reasonable at all relevant times. Dkt. No. 25. Travelers also argues that Fawcett’s claims fail because she has not put forward any evidence quantifying her damages that are attributable to Travelers. Id. Fawcett does not object to dismissal of two of her claims, but the Court will otherwise deny Travelers’ motion because the Court finds a question of fact as to whether Travelers’ conduct was reasonable and commensurate with its obligation to act with ordinary care, and likewise finds that the jury should determine whether Fawcett’s damages are attributable to Travelers.

In December 2017, Fawcett requested a PIP claim application from Travelers arising from her March 2017 accident and informed Travelers that she would file a UIM claim if the limits of the at-fault driver’s Progressive insurance policy were insufficient to address her injuries. See Dkt. No. 26 ¶ 5. In response to Fawcett’s filing a PIP claim, Travelers agreed to handle the PIP claim under a reservation of rights. Dkt. Nos. 27-4, 27-5. The PIP claim adjuster asked a nurse to perform an initial review of the medical evidence, and to address whether Fawcett’s injuries were caused by her accident and whether the nurse recommended an independent medical exam. Dkt. No. 35-2 at 56–59. The nurse opined that Fawcett’s injuries were not caused by her accident, based on the available information, but the nurse recommended peer review if other information

became available or if Fawcett required more treatment. Id. The PIP adjuster requested peer review from a neurosurgeon, Dr. Brad Ward, who opined that Fawcett’s back condition was caused by the car accident, and Travelers thereafter paid Fawcett PIP benefits until they were exhausted in August 2018. Dkt. No. 27-6, Dkt. No. 35-2 at 46–47. In January 2019, Travelers reassigned Kristel Bush to adjust Fawcett’s potential UIM claim.1 Dkt. No. 26 ¶ 13; Dkt. No. 35-2 at 39. Bush determined that a nurse review of the medical evidence was necessary, and asked the same nurse that had initially reviewed the evidence for the PIP claim to review the evidence for the UIM claim. See Dkt. No. 35-2 at 33–34. This time, that nurse was asked only to address causation (not the need for an independent medical exam), and 1 Fawcett requested that Travelers keep her PIP and UIM claims files separate, without any sharing between the files, and Travelers assigned different people to adjust each claim. See Dkt. No. 35-20 at 4–13. Fawcett alleges that Bush reviewed the PIP file, in contravention of Fawcett’s request to keep the claims files separate. Dkt. No. 33 at 8–9. she provided a similar causation opinion that she had provided with respect to the PIP claim: that based on the reviewed information (which did not include Dr. Ward’s report), Fawcett’s injuries were not caused by the accident. Id. at 32–33.

In October 2019, Travelers reassigned James Burnham to adjust Fawcett’s UIM claim. Dkt. No. 35-2 at 31. Fawcett’s attorney contacted Burnham to let him know Fawcett needed another surgery and that the Progressive policy limits were $250,000. Id. at 30. Burnham contacted the Progressive adjuster, who confirmed those policy limits. Id. at 29. Thereafter, after Fawcett continued to seek medical treatment, she made a policy-limits demand to Progressive. See Dkt. No. 35-18. Travelers approved and consented to Fawcett’s policy-limits settlement with Progressive, and allowed her to settle the claim directly with Progressive. Dkt. No. 35-2 at 26–28. Travelers refused to waive its subrogation interest in the PIP benefits it had already paid out, and Fawcett’s counsel held back $10,000 of the Progressive

settlement funds in case Travelers eventually pursued that interest. See id. at 12–13, 17–20. Travelers then requested a settlement demand from Fawcett’s counsel, who submitted a demand for $538,183.64. See Dkt. No. 35-2 at 16. Based on his review of the records, which included the opinion of Fawcett’s treating provider that her symptoms were more likely than not caused by her accident, Burnham’s notes indicate that he believed an independent medical exam was needed in order to resolve the causation question. Dkt. No. 35-21 at 75–78. No independent medical exam was obtained, however, before Travelers subsequently offered to resolve the UIM claim for a full waiver of the PIP reimbursement ($10,000). Dkt. No. 35-22 at 11. Fawcett’s counsel indicated that he did not find this to be a meaningful offer but reiterated his willingness to negotiate the claim in response to a meaningful offer. Id. Subsequent

negotiations continued to be unsuccessful (id. at 7–10), and the parties eventually agreed to mediate in January 2021. Id. at 2–7. Fawcett sought the maximum she could receive in civil arbitration ($100,000), but the most Travelers was willing to pay was $25,000 plus certain fees, and mediation was unsuccessful. Dkt. No. 26 ¶ 34; Dkt. No. 35-2 at 10. Fawcett subsequently filed suit in Pierce County Superior Court and filed a statement of arbitrability. Dkt. No. 26 ¶ 36,

Dkt. No. 26-4. The case was arbitrated in June 2021. Dkt. No. 26-6. In anticipation of arbitration, Travelers requested a records review from an orthopedic surgeon, Dr. Alan Brown. Dkt. No. 26 ¶ 37. Dr. Brown opined that, after reviewing 2017 and 2018 MRIs, Fawcett’s symptoms were related to pre-existing disease and were not caused, exacerbated, or aggravated by the accident.2 Dkt. No. 26-5. The arbitrator awarded Fawcett the maximum of $100,000 (plus $10,000 setoff for PIP benefits paid). Dkt. No. 26-6. Travelers filed an appeal of the arbitration award, requesting a de novo trial, taking the position “that issues regarding the relatedness of the claimed injuries to the subject accident and the amount of damages remained unresolved after the arbitration.” Dkt. No. 26 ¶ 40. After that trial had been requested, but had not yet commenced, Fawcett required a third surgery, which was performed in January 2022. Id. ¶ 41. Travelers requested another independent medical exam with Dr. Brown for the purpose of determining whether the third surgery was caused by the accident. Id. ¶ 42. Dr. Brown reviewed the same records again (including the mistaken-identity 2018 MRI report) and concluded that all of Fawcett’s surgeries were related to radiculopathy that was not caused by the accident. Dkt. No. 26-7. Trial commenced in March 2022, five years after Fawcett’s car accident. Dkt. No. 26 ¶ 44. The jury awarded Fawcett $849,016.44 (which was later reduced to policy limits of $500,000),

2 According to Fawcett, it was later revealed (when Dr. Brown was on the witness stand at the subsequent trial) that the 2018 MRI that Dr. Brown reviewed was not Fawcett’s but pertained to another person. Dkt. No. 33 at 15–16, Dkt. No. 35-24. It is not clear from the briefing whether this mistake had been discovered by Travelers until that point. and the Pierce County Superior Court awarded her $219,026.08 in attorney’s fees and costs. Id. ¶¶ 44–47, Dkt. No. 26-8. Fawcett later filed this action, alleging claims against Travelers for bad faith, violation of

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