Fawcett v. The Standard Fire Insurance Company

CourtDistrict Court, W.D. Washington
DecidedOctober 4, 2024
Docket2:23-cv-00248
StatusUnknown

This text of Fawcett v. The Standard Fire Insurance Company (Fawcett v. The Standard Fire Insurance Company) is published on Counsel Stack Legal Research, covering District Court, W.D. Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Fawcett v. The Standard Fire Insurance Company, (W.D. Wash. 2024).

Opinion

1 2 3

4 5 UNITED STATES DISTRICT COURT 6 WESTERN DISTRICT OF WASHINGTON AT SEATTLE 7 ASHLEY S. FAWCETT, CASE NO. C23-0248-KKE 8

Plaintiff(s), ORDER GRANTING IN PART AND 9 v. DENYING IN PART DEFENDANT’S MOTION FOR SUMMARY JUDGMENT 10 THE STANDARD FIRE INSURANCE COMPANY, 11

Defendant(s). 12

13 Plaintiff Ashley Fawcett was in a car accident while she was covered by an insurance policy 14 issued by Defendant Standard Fire Insurance Company (doing business as Travelers Insurance 15 Company (“Travelers”)) that provided coverage for underinsured motorist (“UIM”) bodily injury 16 and personal injury protection (“PIP”). After Fawcett filed a claim with the other driver’s insurer, 17 Fawcett also opened UIM and PIP claims with Travelers, and alleges in this lawsuit that Travelers 18 unreasonably handled her UIM claim. Dkt. No. 1. 19 Travelers moved for summary judgment, arguing that its conduct was reasonable at all 20 relevant times. Dkt. No. 25. Travelers also argues that Fawcett’s claims fail because she has not 21 put forward any evidence quantifying her damages that are attributable to Travelers. Id. 22 Fawcett does not object to dismissal of two of her claims, but the Court will otherwise deny 23 Travelers’ motion because the Court finds a question of fact as to whether Travelers’ conduct was 24 1 reasonable and commensurate with its obligation to act with ordinary care, and likewise finds that 2 the jury should determine whether Fawcett’s damages are attributable to Travelers. 3 I. BACKGROUND

4 In December 2017, Fawcett requested a PIP claim application from Travelers arising from 5 her March 2017 accident and informed Travelers that she would file a UIM claim if the limits of 6 the at-fault driver’s Progressive insurance policy were insufficient to address her injuries. See Dkt. 7 No. 26 ¶ 5. In response to Fawcett’s filing a PIP claim, Travelers agreed to handle the PIP claim 8 under a reservation of rights. Dkt. Nos. 27-4, 27-5. The PIP claim adjuster asked a nurse to 9 perform an initial review of the medical evidence, and to address whether Fawcett’s injuries were 10 caused by her accident and whether the nurse recommended an independent medical exam. Dkt. 11 No. 35-2 at 56–59. The nurse opined that Fawcett’s injuries were not caused by her accident, 12 based on the available information, but the nurse recommended peer review if other information

13 became available or if Fawcett required more treatment. Id. The PIP adjuster requested peer 14 review from a neurosurgeon, Dr. Brad Ward, who opined that Fawcett’s back condition was caused 15 by the car accident, and Travelers thereafter paid Fawcett PIP benefits until they were exhausted 16 in August 2018. Dkt. No. 27-6, Dkt. No. 35-2 at 46–47. 17 In January 2019, Travelers reassigned Kristel Bush to adjust Fawcett’s potential UIM 18 claim.1 Dkt. No. 26 ¶ 13; Dkt. No. 35-2 at 39. Bush determined that a nurse review of the medical 19 evidence was necessary, and asked the same nurse that had initially reviewed the evidence for the 20 PIP claim to review the evidence for the UIM claim. See Dkt. No. 35-2 at 33–34. This time, that 21 nurse was asked only to address causation (not the need for an independent medical exam), and 22 23 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 24 reviewed the PIP file, in contravention of Fawcett’s request to keep the claims files separate. Dkt. No. 33 at 8–9. 1 she provided a similar causation opinion that she had provided with respect to the PIP claim: that 2 based on the reviewed information (which did not include Dr. Ward’s report), Fawcett’s injuries 3 were not caused by the accident. Id. at 32–33.

4 In October 2019, Travelers reassigned James Burnham to adjust Fawcett’s UIM claim. 5 Dkt. No. 35-2 at 31. Fawcett’s attorney contacted Burnham to let him know Fawcett needed 6 another surgery and that the Progressive policy limits were $250,000. Id. at 30. Burnham 7 contacted the Progressive adjuster, who confirmed those policy limits. Id. at 29. 8 Thereafter, after Fawcett continued to seek medical treatment, she made a policy-limits 9 demand to Progressive. See Dkt. No. 35-18. Travelers approved and consented to Fawcett’s 10 policy-limits settlement with Progressive, and allowed her to settle the claim directly with 11 Progressive. Dkt. No. 35-2 at 26–28. Travelers refused to waive its subrogation interest in the 12 PIP benefits it had already paid out, and Fawcett’s counsel held back $10,000 of the Progressive

13 settlement funds in case Travelers eventually pursued that interest. See id. at 12–13, 17–20. 14 Travelers then requested a settlement demand from Fawcett’s counsel, who submitted a 15 demand for $538,183.64. See Dkt. No. 35-2 at 16. Based on his review of the records, which 16 included the opinion of Fawcett’s treating provider that her symptoms were more likely than not 17 caused by her accident, Burnham’s notes indicate that he believed an independent medical exam 18 was needed in order to resolve the causation question. Dkt. No. 35-21 at 75–78. 19 No independent medical exam was obtained, however, before Travelers subsequently 20 offered to resolve the UIM claim for a full waiver of the PIP reimbursement ($10,000). Dkt. No. 21 35-22 at 11. Fawcett’s counsel indicated that he did not find this to be a meaningful offer but 22 reiterated his willingness to negotiate the claim in response to a meaningful offer. Id. Subsequent

23 negotiations continued to be unsuccessful (id. at 7–10), and the parties eventually agreed to 24 mediate in January 2021. Id. at 2–7. Fawcett sought the maximum she could receive in civil 1 arbitration ($100,000), but the most Travelers was willing to pay was $25,000 plus certain fees, 2 and mediation was unsuccessful. Dkt. No. 26 ¶ 34; Dkt. No. 35-2 at 10. Fawcett subsequently 3 filed suit in Pierce County Superior Court and filed a statement of arbitrability. Dkt. No. 26 ¶ 36,

4 Dkt. No. 26-4. 5 The case was arbitrated in June 2021. Dkt. No. 26-6. In anticipation of arbitration, 6 Travelers requested a records review from an orthopedic surgeon, Dr. Alan Brown. Dkt. No. 26 ¶ 7 37. Dr. Brown opined that, after reviewing 2017 and 2018 MRIs, Fawcett’s symptoms were 8 related to pre-existing disease and were not caused, exacerbated, or aggravated by the accident.2 9 Dkt. No. 26-5. The arbitrator awarded Fawcett the maximum of $100,000 (plus $10,000 setoff for 10 PIP benefits paid). Dkt. No. 26-6. 11 Travelers filed an appeal of the arbitration award, requesting a de novo trial, taking the 12 position “that issues regarding the relatedness of the claimed injuries to the subject accident and 13 the amount of damages remained unresolved after the arbitration.” Dkt. No. 26 ¶ 40. After that 14 trial had been requested, but had not yet commenced, Fawcett required a third surgery, which was 15 performed in January 2022. Id. ¶ 41. Travelers requested another independent medical exam with 16 Dr. Brown for the purpose of determining whether the third surgery was caused by the accident. 17 Id. ¶ 42. Dr. Brown reviewed the same records again (including the mistaken-identity 2018 MRI 18 report) and concluded that all of Fawcett’s surgeries were related to radiculopathy that was not 19 caused by the accident. Dkt. No. 26-7. 20 Trial commenced in March 2022, five years after Fawcett’s car accident. Dkt. No. 26 ¶ 44. 21 The jury awarded Fawcett $849,016.44 (which was later reduced to policy limits of $500,000), 22

23 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. 24 No. 35-24.

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Fawcett v. The Standard Fire Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/fawcett-v-the-standard-fire-insurance-company-wawd-2024.