Irvin v. State Farm Mutual Automobile Insurance Company

District Court, W.D. Kentucky·Decided December 5, 2023·No. 3:21-cv-00540·Unknown

Opinion

UNITED STATES DISTRICT COURT WESTERN DISTRICT OF KENTUCKY LOUISVILLE DIVISION

CLARA ARREBATO PEDROSO AND ) KATHERINE HERNANDEZ ) ARREBATO, Individually and as Class ) Civil Action No. 3:21-CV-540-CHB Representatives, ) ) Plaintiffs, ) ) MEMORANDUM OPINION v. ) AND ORDER ) STATE FARM MUTUAL ) AUTOMOBILE INSURANCE ) COMPANY, ) ) Defendant. )

*** *** *** *** This matter is before the Court on the Motion to Alter or Amend the Judgment filed by Defendant State Farm Mutual Automobile Insurance Company (“State Farm”), [R. 39], in which State Farm seeks to amend this Court’s March 21, 2023 Judgment. See [R. 37 (Memorandum Opinion and Order)]; [R. 38 (Judgment)]. Plaintiffs Clara Arrebato Pedroso and Katherine Hernandez Arrebato responded, [R. 40], and State Farm replied, [R. 41]. For the reasons set forth below, the Court will deny State Farm’s motion. I. BACKGROUND The Court provided a detailed discussion of the factual and procedural history of this matter in its March 21, 2023 Memorandum Opinion and Order. [R. 37, pp. 1–7]. The Court briefly restates the relevant portions of that history. Clara Arrebato Pedroso, Katherine Hernandez Arrebato, and D’Ella Irvin each suffered injuries in automobile accidents occurring between 2010 and 2015. [R. 22, ¶¶ 10, 20 (Amended Complaint)]; see also Irvin v. State Farm Mutual Auto. Ins. Co., 3:19-CV-690-CHB, 2020 WL 4004808, *1 (W.D. Ky. July 15, 2020) (hereafter, “Irvin I”). To compensate for their injuries, Pedroso, Arrebato, and Irvin each sought Personal Injury Protection (“PIP”) benefits under their policies with State Farm. Irvin I, 2020 WL 4004808, *1. The Kentucky Motor Vehicle Reparations Act (“MVRA”) requires insurance companies to offer such benefits. Id. (citing KRS § 304.39-040).

State Farm initially paid only a portion of Pedroso, Arrebato, and Irvin’s claims for PIP benefits, id. at *4–5, and denied the remainder of their claimed PIP benefits based on a “paper review” of each claim. Id. at *1; see also [R. 22, ¶¶ 13, 23]. In 2018, the Supreme Court of Kentucky held in Government Employees Insurance Company v. Sanders, 569 S.W.3d 923 (Ky. 2018), that insurance companies could not deny PIP benefits based solely on paper reviews. Following that ruling, State Farm voluntarily paid the remainder of Pedroso and Arrebato’s claims, plus twelve percent interest. Irvin I, 2020 WL 4004808, at *4–5. State Farm paid Irvin, who had claimed over $12,000 in medical expenses, [R. 1-2, § 14], up to the statutory maximum of $10,000, plus twelve percent interest. Id. at *4.

In 2019, Pedroso, Arrebato, and Irvin brought suit in Jefferson Circuit Court, seeking damages for all unpaid PIP benefits that had been denied through paper review (capped at $10,000 per plaintiff), eighteen percent statutory interest for past-due medical bills (as opposed to the twelve percent paid by State Farm),1 and attorneys’ fees.2 Irvin I, 2020 WL 4004808, *2. State Farm timely removed the action to this Court and filed a Motion to Dismiss or, Alternatively, for Abstention. Id. On July 15, 2020, the Court issued a Memorandum Opinion

1 The MVRA provides that “[o]verdue payments bear interest at the rate of twelve percent (12%) per annum, except that if delay was without reasonable foundation the rate of interest shall be eighteen percent (18%) per annum.” KRS § 304.39-210(2).

2 The MVRA also allows the Court to award attorneys’ fees for denials or delays caused without a reasonable foundation. KRS § 304.39-220(1). and Order. See generally id. The Court found that each of the three plaintiffs lacked standing to pursue their unpaid benefits claims. Id. at *3–6. The Court explained that, after the Sanders decision, State Farm had issued checks to each of the three plaintiffs to cover the full amount of the claimed PIP benefits, plus statutory interest of twelve percent. Id. at *5. As a result, the Court held, the plaintiffs could not show an injury in fact, nor could they show “how a favorable

judgment from this Court would redress that injury with respect to damages for unpaid PIP benefits.” Id. (citation omitted). However, the Court found that they did possess standing to pursue claims for the additional interest and attorneys’ fees. Id. at *6. Turning to the merits of those claims, the Court concluded that State Farm had a “reasonable foundation” for initially denying the plaintiffs’ claims based on a paper review, as Sanders had not yet been decided at the time of denial (in 2011), and earlier Kentucky precedent plausibly supported the use of paper reviews. Id. at *6–8. Finally, the Court noted that, under the law, it was required to remand the case back to state court. Id. at *8. The Sixth Circuit ultimately affirmed this Court’s decision.3 See Irvin v. State Farm Mut. Auto. Ins. Co., 861 F. App’x 65 (6th Cir. 2021) (hereafter, “Irvin

II”). In the remanded state court action, Pedroso, Arrebato, and Irvin asserted for the first time (in a motion for partial summary judgment) a theory of “unusable benefits” or “preemptively terminated benefits.” See generally [R. 5-4, p. 14]. State Farm then removed the case to this Court for the second time. [R. 1 (Notice of Removal)]. Plaintiffs, in turn, filed a Motion for Remand and Attorney’s Fees, [R. 11]. In that motion, the plaintiffs further attempted to distinguish between “unpaid benefits” and “unusable benefits.” Id. at p. 15. According to the plaintiffs, “unpaid benefits,” or denied benefits, include those for which the plaintiffs submitted

3 The parties appealed only the Court’s Rule 12(b)(6) ruling. See Irvin II, 861 F. App’x at 67. Neither party challenged the Court’s decision to remand the case back to state court. claims (i.e., to cover incurred medical expenses), but which were denied on paper review, then eventually paid by State Farm. Id. These unpaid benefits formed the basis for Pedroso, Arrebato, and Irvin’s initial claims against State Farm. See, e.g., id. “Unusable benefits,” on the other hand, are those PIP benefits that were never requested but would have fallen within the $10,000 statutory cap. Thus, Pedroso’s unusable benefits would be the difference between what she

requested ($4,450.00) and the statutory maximum ($10,000.00), or $5,545.00. At a hearing on Plaintiffs’ motion, the plaintiffs argued that they had always intended to pursue both theories, and when the Court ruled that they lacked standing to pursue the unpaid benefits claims, it had remanded to state court those claims involving unusable benefits. [R. 20, p. 9:3–8]. The Court quickly dispelled Plaintiffs’ argument, explaining that it had reviewed the record in the earlier case, and “there was absolutely no claim for unusable benefits in the previous litigation.” Id. at 14:3–6. Instead, the Court had ruled on Plaintiffs’ unpaid benefits claims and remanded their claim for unpaid PIP benefits to state court as required by law. See, e.g., Irvin I, 2020 WL 4004808, at *8. Nevertheless, the Court allowed Plaintiffs an opportunity

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