Michael Wade Simmons v. Auto-Owners Insurance Company

District Court, D. Arizona·Decided May 15, 2026·No. 4:24-cv-00055·Unknown

Opinion

WO

Michael Wade Simmons, No. CV-24-00055-TUC-AMM

Plaintiff, ORDER

v.

Auto-Owners Insurance Company,

Defendant. Pending before the Court is Defendant Auto-Owners Insurance Company’s Motion for Partial Summary Judgment. (Doc. 50.) The matter is fully briefed. (Docs. 50– 51, 54–55, 56.) The Court held oral argument on May 12, 2026. (Doc. 60.) For the following reasons, the Court will grant the Motion for Partial Summary Judgment. I. Procedural Background Plaintiff Michael Wade Simmons brought this action in Pima County Superior Court on December 21, 2023 against Defendant Auto-Owners Insurance Company. (Doc. 1 at 1.) Defendant removed the case on February 1, 2024 based on diversity. (Id.) Plaintiff brings two claims. (Doc. 1-3 at 5–8.) In Count I, Plaintiff alleges breach of contract because Defendant did not pay out $300,000 from his underinsured motorist (“UIM”) policy after a rear-end collision that he claims resulted in injuries to his neck. (Id. at 5–6.) In Count II, Plaintiff alleges bad faith because Defendant “put their own interests ahead of their insured’s by failing to promptly investigate, evaluate, and pay [Plaintiff’s] claim without a reasonable basis.” (Id. at 7.) Plaintiff seeks compensatory damages, special damages for medical expenses and loss of income, and punitive damages for bad faith. (Id.) II. Relevant Facts On September 24, 2021, Plaintiff Michael Wade Simmons was rear-ended by non- party Daniel Navarro Dominguez. (Doc. 51 at 3; Doc. 55 at 1.) At the scene, Plaintiff told the investigating officer “he was uninjured.” (Doc. 51 at 3; Doc. 55 at 1.) The investigating officers reported the accident as a “non-injury collision.” (Doc. 51 at 3; Doc. 55 at 2.) Both vehicles were operable and driven from the scene by their owners. (Doc. 51 at 3; Doc. 55 at 2.) Defendant insured Plaintiff under a commercial auto policy with UIM coverage limits of $300,000 per person or $300,000 per accident to cover “damages . . . result[ing] from bodily injury sustained by the insured caused by the accident.” (Doc. 51 at 3, 22; Doc. 55 at 2.) The policy required Plaintiff’s cooperation in any claim investigation, including providing authorizations to access medical records, participating in medical examinations, and agreeing to an examination under oath (“EUO”). (Doc. 51 at 3; Doc. 55 at 2.) On September 29, 2021, Plaintiff’s counsel sent Defendant a letter notifying Defendant of the accident. (Doc. 51 at 3; Doc. 55 at 2.) Plaintiff’s counsel called Defendant that same day asking Defendant “not to open up UIM exposure yet.” (Doc. 51 at 3; Doc. 55 at 2.) Plaintiff’s counsel asked for a copy of the policy’s declaration page, and Defendant mailed the copy to Plaintiff’s counsel the following day. (Doc. 51 at 4; Doc. 55 at 2.) On June 13, 2022, Plaintiff’s counsel provided Defendant with a notice of a UIM claim and stated that a demand would soon follow. (Doc. 51 at 4; Doc. 55 at 2.) On June 14, 2022, Plaintiff’s counsel sent a letter to Defendant stating that the at- fault driver’s insurance paid the $25,000 policy limit, and Plaintiff demanded “his UIM policy limit of $300,000.00 to resolve the matter.” (Doc. 51 at 4; Doc. 55 at 2.) The demand letter informed Defendant that Plaintiff is a construction worker and that he incurred expenses after being treated for pain in his neck, right shoulder, and back that he began experiencing after the rear-end collision. (Doc. 51 at 4; Doc. 55 at 2.) The letter listed past medical expenses including more than $66,000 for imaging and steroid injections. (Doc. 51 at 4; Doc. 55 at 2.) It also detailed anticipated future medical expenses of approximately $190,000 for anterior cervical surgery. (Doc. 51 at 4; Doc. 55 at 2.) With the letter, Plaintiff included records of chiropractic visits shortly after the accident at which Plaintiff complained of pain and a record of an MRI taken two weeks after the accident. (Doc. 55 at 3–4.) Defendant’s Auto Claims Branch Manager Chris Khavari reviewed the demand letter and records from Plaintiff’s counsel. (Doc. 51 at 42–43.) On July 6, 2022, Khavari “determined there was insufficient information to pay the claim.” (Id. at 43.) He assigned Auto Claims Adjuster Paul Steffensen to conduct further investigation. (Id. at 43, 55.) On July 7, 2022, Steffensen emailed Plaintiff’s counsel requesting accident photos and Plaintiff’s medical records for the past five years. (Doc. 51 at 4–5; Doc. 55 at 5.) In response, Plaintiff’s counsel provided a property repair estimate showing $6,375 in damage. (Doc. 51 at 5; Doc. 55 at 5.) He did not otherwise respond to Steffensen’s request. On July 13, 2022, Defendant sent another letter to Plaintiff’s counsel to renew its request for photos from the accident and Plaintiff’s medical records for the past five years. (Doc. 51 at 5; Doc. 55 at 5.) Defendant notified Plaintiff that “in the absence of the information we have requested, we cannot make an offer at this time.” (Doc. 51 at 5; Doc. 55 at 5.) On July 14, 2022, Defendant called Plaintiff’s counsel to follow up on its letter. (Doc. 51 at 5; Doc. 55 at 5.) During this call, Defendant also asked Plaintiff’s counsel if Defendant could take a recorded statement of Plaintiff. (Doc. 51 at 5; Doc. 55 at 5.) There is no indication how Plaintiff’s counsel responded on the phone. Later that day, Plaintiff’s counsel sent a letter to Defendant refusing a recorded statement and denying having any accident photos. (Doc. 51 at 5; Doc. 55 at 5.) Plaintiff’s counsel also wrote: “Please note, your insured has no medical records for injuries in the last five (5) year[s] and therefore there is nothing to produce.” (Doc. 51 at 86.) Plaintiff’s counsel did not say whether Plaintiff had non-injury medical records from the past five years, which Defendant believed were nonetheless relevant to investigating the claim. (Doc. 56 at 6.) On July 15, 2022, Steffensen spoke with Plaintiff informally. (Doc. 51 at 5, 51–52, 69–70; Doc. 55 at 5.) Steffensen wrote in his notes that Plaintiff “was very forthright to any questions [he] brought forward.” (Doc. 51 at 51.) According to Steffensen, Plaintiff described himself as a “workaholic” who had not missed any work up to that point. (Id. at 51–52.) He told Steffensen that “[h]e first felt the injuries from the accident the night that they occurred,” and Steffensen recorded that statement in his notes in the claim file. (Id. at 52.) He reported some improvement in symptoms but said that he experienced stiffness and headaches and believed he would need neck surgery. (Id. at 52, 69; Doc. 55 at 5–6.) Later that day, Steffensen emailed Plaintiff’s counsel explaining that Plaintiff had to appear for an independent medical examination (“IME”) and an EUO because there was not enough information to pay for surgery.1 (Doc. 51 at 5, 69–70.) On July 16, 2022, Steffensen made a note in the claim file that said there was not enough information to offer payment, specifically because Steffensen was not sure that surgery was reasonable or necessary. (Doc. 51 at 6, 51.) Steffensen noted that more investigation was needed, including an IME and EUO. (Id. at 51.) On July 19, 2022, Steffensen instructed Chandelle Yi, a registered nurse working for the company, to review Plaintiff’s medical records to determine whether his past and future treatment was reasonable. (Id. at 6, 50.) Nurse Yi opined that the epidural injections Plaintiff received were “an overutilization of healthcare services” and were not necessary “to treat any traumatic injuries to his cervical spine as a result of the [motor vehicle accident] of 9/24/2021.” (Id. at 50.) Nurse Yi further opined that, based on the medical records, Plaintiff had not suffered any traumatic injuries as a result of this accident. (Id.) Nurse Yi recorded her findings in an entry to the claim file. (Id.)

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Michael Wade Simmons v. Auto-Owners Insurance Company, (D. Ariz. 2026).

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