Jones v. State Farm Mutual Automobile Insurance Company

CourtDistrict Court, S.D. Mississippi
DecidedJuly 14, 2025
Docket1:23-cv-00326
StatusUnknown

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

Bluebook
Jones v. State Farm Mutual Automobile Insurance Company, (S.D. Miss. 2025).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF MISSISSIPPI SOUTHERN DIVISION

WALTER JONES § PLAINTIFF § § v. § Civil No. 1:23-cv-326-HSO-RPM § § STATE FARM MUTUAL § AUTOMOBILE INSURANCE § DEFENDANT COMPANY

MEMORANDUM OPINION AND ORDER DENYING PLAINTIFF WALTER JONES’S AND DEFENDANT STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY’S MOTIONS [50], [55] FOR PARTIAL SUMMARY JUDGMENT

Following a motor vehicle accident, Plaintiff Walter Jones (“Jones” or “Plaintiff”) filed suit against his uninsured motorist insurance carrier, Defendant State Farm Mutual Insurance Company (“State Farm” or “Defendant”), for breach of contractual obligations and bad faith. See Compl. [1] at 2. Both parties have filed Motions [50], [55] seeking partial summary judgment, see Mot. [50], [55], but the Court finds that there remain genuine disputes of material fact requiring resolution at trial. Both Motions [50], [55] should be denied. I. BACKGROUND A. Factual Background In July 2023 Plaintiff Walter Jones was involved in a motor vehicle accident in Gulfport, Mississippi, when he was struck by an unknown motorist who fled the scene. See Compl. [1] at 2. Jones allegedly “suffered serious injuries and incurred substantial medical expenses arising from his medical treatment.” Id. At the time of the accident Jones was insured by State Farm under three separate insurance policies, which together provided a total of $75,000.00 in Uninsured/Underinsured Motorist (“UM”) coverage. See id. at 2; Mem. [56] at 1; Mem. [52] at 2. The

“Uninsured Motor Vehicle Coverages” provision of Jones’s car insurance policy (the “Policy”) with State Farm states, in pertinent part, the following: Insuring Agreements

1. Under Uninsured Motor Vehicle Coverage (Bodily Injury), we will pay compensatory damages for bodily injury an insured is legally entitled to collect from the owner or driver of an uninsured motor vehicle. The bodily injury must be

a. sustained by an insured; and b. caused by an accident that involved the operation, maintenance, or use of an uninsured motor vehicle as a motor vehicle.

2. Under Uninsured Motor Vehicle coverage (Bodily Injury and Property Damage), we will pay compensatory damages for bodily injury and property damage an insured is legally entitled to collect from the owner or driver of an uninsured motor vehicle. The bodily injury or property damage must be caused by an accident that involves the operation, maintenance, or use of an uninsured motor vehicle as a motor vehicle. The bodily injury must be sustained by an insured.

* * *

Deciding Fault and Amount

1. a. The insured and we must agree to the answers to the following two questions

(1) Is the insured legally entitled to collect compensatory damages from the owner or driver of the uninsured motor vehicle?

(2) If the answer to 1.a.(1) above is yes, then what is the amount of the compensatory damages that the insured is legally entitled to collect from the owner or driver of the uninsured motor vehicle? b. If there is no agreement on the answer to either question in 1.a. above, then the insured shall

(1) file a lawsuit, in a state or federal court that has jurisdiction, against

(a) us; (b) the owner and driver of the uninsured motor vehicle unless we have consented to a settlement offer proposed by or on behalf of such owner or driver; and (c) any other party or parties who may be legally liable for the insured’s damages

(2) consent to a jury trial if requested by us;

(3) agree that we may contest the issues of liability and the amount of damages . . . .

Ex. [55-2] at 18 (emphasis in original).

Jones filed a claim for damages with State Farm on July 29, 2023. See Mem. [56] at 2; Ex. [55-1] at 10 (Claim Notes). Two days later State Farm determined that UM property damage coverage would apply to the accident and informed Jones of that determination. See Mem. [56] at 2; Ex. [55-5] at 1. On August 10, 2023, State Farm made a payment of $1,772.44 to the automotive shop for repairs to Plaintiff’s vehicle, and on October 12, 2023, it issued $1,000.00 to Jones in medical payments coverage, which was a separate payment provided for in the Medical Payments Coverage provision of the Policy. See Mem. [56] at 3; Ex. [55-7] at 2. On November 7, 2023, Plaintiff’s counsel sent State Farm a demand letter advising that Jones’s medical bills totaled $16,950.30 and demanding all available policy limits. See Ex. [55-12]. Following its determination that UM coverage would apply to Plaintiff’s accident, State Farm assigned a “UM/UIM claims specialist” named Jessica Fricke (“Fricke”) to handle Plaintiff’s claim. See Mem. [56] at 3. After reviewing Jones’s claim, Fricke made an offer to Jones’s counsel in the amount of $15,680.00, see Ex. [55-15], a value Jones claims she determined by inputting the bills into the

“Mitchell program,” which reduced the reimbursement amount to 200% of the Medicare reimbursement rate, see Mem. [52] at 4. In response to that settlement offer, Plaintiff’s counsel stated that “State Farm is in bad faith,” see Ex. [55-16], and filed this lawsuit. After this suit was filed, “State Farm offered $19,000 on March 19, 2024,” which was over five months after Jones’s medical treatments ended. Mem. [63] at 2-3. According to Plaintiff, “[a]s of February 12, 2025, . . . State Farm

has paid [him] $0.00 under [his] UM coverage.” Mem. [64] at 2. B. Procedural History Plaintiff filed suit on November 21, 2023, alleging that “[d]espite having been presented with a valid claim for UM benefits, State Farm has breached its contractual obligations in bad faith and refused to pay sums legally owed to Plaintiff under the terms of the policies.” Compl. [1] at 2. And “State Farm acted with no arguable or legitimate basis and has committed malice and/or gross

negligence with regard to Plaintiff’s rights under the policies.” Id. Plaintiff seeks compensatory, punitive, and extra-contractual damages, including attorney’s fees. See id. at 3. In his Motion [50] for Partial Summary Judgment,1 Plaintiff first argues that State Farm denied his claim in bad faith because “the Mitchell program uses a

1 Although it is not entirely clear, it appears that Plaintiff is seeking partial summary judgment solely on the issue of bad faith breach, not on the underlying issue of breach of contract. See Mem. ‘pricing module’ of 200% the Medicare reimbursement rate when evaluating medical expenses submitted by its insureds,” Mem. [52] at 10, which was “in place prior to the accident,” id. In other words, Plaintiff claims that State Farm used an

“arbitrary ‘pricing module’” which was not authorized under the Policy—and which he claims violates the collateral source rule—to reduce Jones’s medical reimbursement to 200% of the Medicare reimbursement rate. Id. Second, Plaintiff asserts that State Farm has engaged in bad faith delay in payment because it had “no reasonable or arguable basis for failing to pay at least some undisputed amount to Mr. Jones.” Id. at 12-13. And finally, Plaintiff contends that State Farm has

unfairly attempted to “shoe-horn terms and conditions of the Medical Payments coverage into Mr. Jones’s [UM] policy.” Id. at 13. State Farm responds that its “consideration of two-times the Medicare reimbursement rate when evaluating the fair and reasonable value of Jones’s medical expenses was reasonable and not contrary to any controlling Mississippi authority.” Mem. [63] at 1. According to State Farm, “utilizing the Medicare reimbursement rate—which is a reasonable standard—does not run afoul of

Mississippi’s collateral source rule as State Farm is not considering payment from other sources to reduce the amounts owed.” Id. at 2. For that reason, State Farm

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Jones v. State Farm Mutual Automobile Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/jones-v-state-farm-mutual-automobile-insurance-company-mssd-2025.