Ho v. State Farm Mutual Automobile Insurance

926 F. Supp. 964, 1996 U.S. Dist. LEXIS 7222, 1996 WL 277778
CourtDistrict Court, D. Hawaii
DecidedMay 20, 1996
DocketCivil No. 95-00292 DAE
StatusPublished
Cited by1 cases

This text of 926 F. Supp. 964 (Ho v. State Farm Mutual Automobile Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Hawaii primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Ho v. State Farm Mutual Automobile Insurance, 926 F. Supp. 964, 1996 U.S. Dist. LEXIS 7222, 1996 WL 277778 (D. Haw. 1996).

Opinion

ORDER GRANTING STATE FARM’S MOTION TO DISMISS AND DENYING . PLAINTIFF’S COUNTER MOTION FOR PARTIAL SUMMARY JUDGMENT

DAVID ALAN EZRA, District Judge.

The court heard Plaintiffs and Defendant State Farm’s Motion on April 22, 1996. William Elkner, Esq., and Jacob M. Merrill, Esq., appeared on behalf of Plaintiff; Lennis N. Omuro, Esq., appeared on behalf of Defendant State Farm Mutual Automobile Insurance Co. (“State Farm”). After reviewing the motion and the supporting and opposing memoranda, the court GRANTS State Farm’s Motion to Dismiss, and DENIES Plaintiffs Counter Motion for Partial Summary Judgment.

BACKGROUND

On May 28,1994, while stopped at a traffic light, Plaintiff was rear-ended. This case arises from the alleged injuries Plaintiff sustained from that accident and the ensuing no-fault claims she made to State Farm Mutual Automobile Insurance Company (“State Farm”).

The day after the accident, May 29, 1994, Plaintiff went to the emergency room complaining of lower back pains and of some numbness and tingling. See Plaintiffs Concise Statement of Facts, Exh. G. And on June 2, 1995, Patient consulted a chiropractor, Dr. Gina M. Whest (“Whest”) of Scientific Chiropractic Clinic, for treatment. Id. State Farm appears to have paid the emergency room bills and the June 2, 1994 Scientific Chiropractor bill in an amount reduced to conform with the Workers’ Compensation Fee Schedule.

In mid-September 1994, at State Farm’s request, Comprehensive Medical Review (“CMR”) performed a biomechanical analysis and medical analysis of the incident and of Plaintiffs alleged injuries. CMR concluded in the reports that the accident was extremely minor and incapable of causing serious bodily injury. Based on the results of these Medical and Biomechanical Analysis Reports, State Farm denied Plaintiff payment of benefits by letters dated September 23, 1994 and October 13, 1994. In particular, State Farm refused to pay Pacific Rehab & Sports Medicine bills for service dates September 7, 1994 through December 12, 1994, Scientific Chiropractic Clinic bills for service dates August 5, 1994 through September 6, 1994 and Aloha State Diagnostic bill for service date September 22, 1994. The denial letters stated that, among other things, the claimed benefits were not appropriate, reasonable, necessary, or causally-related to the accident.

Subsequently, Whest submitted a chiropractic treatment plan dated September 8, 1994, for treatments from September 22, 1994 through January 22, 1995. Within five working days from the postmarked date of this treatment plan, State Farm submitted the plan to peer review. Among other things, State Farm challenged whether continued chiropractic treatment was reasonable, appropriate, and necessary.

[967]*967The Peer Review Report dated November 1, 1994, concluded that the September 8, 1994 treatment plan was not reasonable or appropriate. Correspondingly, State Farm informed Plaintiff via letter on December 16, 1994 that it denied the requested treatment plan on the basis of the Peer Review Report and that the Peer Review Report provided additional grounds for the denial of the earlier applications for benefits described above.

Plaintiff then requested a reconsideration of the Peer Review Report.1 The peer reviewer subsequently reconsidered the matter and, contrary to his earlier opinion, determined that the care prescribed by the September 8, 1994 chiropractic treatment plan was reasonable and appropriate. However, the Reconsideration Report dated January 16, 1995, further concluded that “at the termination of this treatment plan, I would strongly consider this patient to be maximally improved.”

Pursuant to the recommendations in the Reconsideration Report, State Farm paid all bills for the services outlined in the treatment plan, rendered from September 22, 1994 through January 20, 1995. State Farm did, however, reduce the November 22, 1994 bill from Scientific Chiropractic Clinic allegedly in compliance with the workers’ compensation fee schedule.

State Farm indicates that it received yet another no-fault treatment plan from Scientific Chiropractic Clinic dated January 10,1995 for treatments from January 24, 1995 to April 18, 1995.2 State Farm denied this treatment plan five days later on January 16, 1995 which State Farm maintains is consistent with recommendation in the January 16, 1995 Reconsideration Report.

STANDARD OF REVIEW

I. Motion to Dismiss

A motion to dismiss will be granted where the plaintiff fails to state a claim upon which relief can be granted. Fed.R.Civ.P. 12(b)(6). For the purposes of a 12(b)(6) motion, “[r]eview is limited to the contents of the complaint.” Clegg v. Cult Awareness Network, 18 F.3d 752, 755 (9th Cir.1994).

A complaint should not be dismissed “unless it appears beyond doubt that plaintiff can prove no set of facts in support of [her] claim which would entitle [her] to relief.” Buckey v. County of Los Angeles, 968 F.2d 791, 794 (9th Cir.1992) (quoting Love v. United States, 915 F.2d 1242, 1245 (9th Cir.1989)) (further citations omitted). All allegations of material fact are taken as true and construed in the light most favorable to the plaintiff. Id. Civil rights complaints are to be liberally construed. Id. (citing Gobel v. Maricopa County, 867 F.2d 1201, 1203 (9th Cir.1989)).

To the extent, however, that “matters outside the pleadings are presented to and not excluded by the court, the motion shall be treated as one for summary judgment.” Fed.R.Civ.P. 12(b); Del Monte Dunes at Monterey, Ltd. v. Monterey, 920 F.2d 1496, 1507 (9th Cir.1990).

II. Summary Judgment

Rule 56(c) provides that summary judgment shall be entered when:

[T]he pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue of material fact and that the moving party is entitled to judgment as a matter of law.

Fed.R.Civ.P. 56(c). The moving party has the initial burden of demonstrating for the court that there is no genuine issue of material fact. Celotex Corp. v. Catrett, 477 U.S. 317, 323, 106 S.Ct. 2548, 2552-53, 91 L.Ed.2d 265 (1986) (citing Adickes v. S.H. Kress & Co., 398 U.S. 144, 90 S.Ct. 1598, 26 L.Ed.2d 142 (1970)).

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926 F. Supp. 964, 1996 U.S. Dist. LEXIS 7222, 1996 WL 277778, Counsel Stack Legal Research, https://law.counselstack.com/opinion/ho-v-state-farm-mutual-automobile-insurance-hid-1996.