Morrison v. Esurance Insurance Co

District Court, W.D. Washington·Decided February 6, 2020·No. 2:18-cv-01316·Unknown

Opinion

WESTERN DISTRICT OF WASHINGTON MIKESHIA MORRISON, on behalf of herself and all others similarly situated, Plaintiff, C18-1316 TSZ v. ORDER ESURANCE INSURANCE CO., a foreign automobile insurance company, Defendant. THIS MATTER comes before the Court on Plaintiff’s Motion for Class Certification and Appointment of Class Counsel and Class Representatives, docket no. 57. The Court held oral argument on January 24, 2020. Having reviewed all papers filed in support of and in opposition to the motion and considered the arguments of counsel, the Court DENIES class certification. Background Plaintiff Mikeshia Morrison (“Morrison” or “Plaintiff”) was injured in an automobile collision on March 6, 2018. Morrison Decl., docket no. 62, ¶ 3. As a result of the collision, Morrison sustained injuries to her neck, spine, and back. Id. ¶ 4. Morrison submitted a Personal Injury Protection (“PIP”) claim with her insurer, Esurance Insurance Company (“Esurance” or “Defendant”) seeking wage loss and medical

benefits. Gribble Decl., docket no. 64, ¶ 4. Esurance paid more than $16,000 in connection with Plaintiff’s claim. Id. Esurance requested Morrison undergo an independent medical exam to determine whether Morrison had reached Maximum Medical Improvement (“MMI”). Morrison Decl., docket no. 62, ¶ 7. After Morrison’s June 6, 2018 examination, the examiner issued a report, finding in pertinent part that “Ms. Morrison is at maximum medical

improvement. There [are] no positive objective findings observed during this examination that physiologically will identify her symptoms.” Rogers Decl., docket no. 59-1 at 10, Ex. A. On June 7, 2018, the Washington Supreme Court issued its decision in Durant v. State Farm Mut. Auto. Ins. Co., 191 Wn. 2d 1 (2018). In Durant, the Washington

Supreme Court answered two certified questions1 concerning (1) whether an insurer violates the Washington Administrative Code (hereinafter “WAC”) Section 284-30- 395(1)2 if that insurer “denies, limits, or terminates an insured’s medical or hospital

1 The district court certified the two questions after granting class certification in Durant v. State Farm Mut. Auto. Ins. Co., 2017 WL 950588 (W.D. Wash. Mar. 9, 2017). In Durant, Plaintiff sought class certification against State Farm based on its use of the MMI standard to deny coverage for personal injury claims. Id. at 2. State Farm used reason codes to deny and limit insured benefits. Id. at 4. 2 The WAC provides in pertinent part that “the insurer may deny, limit, or terminate benefits if the insurer determines that the medical and hospital services: (a) Are not reasonable; (b) Are not necessary; (c) Are not related to the accident; or (d) Are not incurred within three years of the automobile accident. These are the only grounds for denial, limitation, or termination of medical and hospital services permitted.” WAC 284-30-395(1). benefits claim based on a finding of MMI,” and (2) whether the term MMI is consistent with the terms “reasonable” and “necessary” as they appear in WAC 284-30-395(1). Id.

at 7. The court held that “an insurer violates WAC 284-30-395(1)(a) or (b) if that insurer denies, limits, or terminates an insured’s medical or hospital benefits claim based on a finding of ‘MMI.’” 3 Id. at 18-19. The court further held that the only bases upon which insurance companies can deny, limit, or terminate PIP benefits are when treatment is not (1) reasonable, (2) necessary, (3) related to the accident, or (4) incurred within three years of the accident. Id. at 14.

On June 14, 2018, an Esurance claims representative emailed Morrison’s attorney stating that “[b]ased on the [medical examiner’s] report, it does not appear further wage loss benefits would be owed under this loss, as your client is deemed at MMI for her motor vehicle injury.” Rogers Decl., docket no. 59-2, Ex. B. On June 15, 2018, the Esurance claims representative “drafted” a discontinuation of benefits letter, which she

sent to her supervisor. Gribble Decl., docket no. 64, ¶ 7. The draft letter stated that “[b]ased on the findings in the [medical examiner’s] report, Manipulative Therapy, Massage Therapy, and Chiropractic Treatment were found not to be medically necessary and related to the motor vehicle accident in question. Esurance Insurance Company has determined that further benefits under your First Party Medical coverage [are] no longer

3 At oral argument, counsel disagreed regarding whether the Durant court held that insurers violate WAC 284-30-395(1) when they terminate benefits based on a finding of MMI or whether Durant prohibits the use of MMI as one of the many bases for terminating medical benefits. Although the Court believes the former reading is the clear conclusion of the Washington Supreme Court, the Court reaches the same result regardless of the reach of Durant. reasonable, necessary or related . . . .” Gribble Decl., docket no. 64-3, Ex. C. The draft letter did not include the use of the term “MMI.” In response to the draft letter, the

Esurance supervisor stated, “[w]ill hold until after WA new case discussion on Mon...fyi...thanks.” Rogers Decl., docket no. 59-3, Ex. C. On June 20, 2018, the Esurance claims representative emailed her supervisor stating, “Circling back on this one. In my discontinuation letter, I didn’t use the term ‘MMI.’ Dr[.] states no further treatment is necessary or related.” Id. In response, the supervisor stated, “Yes good to go…good job w/wording and not using MMI…ok to

discontinue.” Rogers Decl., docket no. 59-4, Ex. D. That same day, Esurance sent Morrison a letter discontinuing further benefits. Morrison Decl., docket no. 62-2, Ex. B. Morrison contends that she continues to suffer from pain in her pelvis, hip, stomach, neck, and back. Morrison Decl., docket no. 62, ¶ 9. On August 6, 2018, Plaintiff filed a class action against Esurance in King County

Superior Court based on Esurance’s use of the MMI standard to deny and limit her coverage. Docket no. 1. Esurance removed the action to this Court on September 6, 2018. Id. Plaintiff amended her complaint to include six causes of action for declaratory relief, breach of contract, Insurance Fair Conduct Act (“IFCA”) violations/bad faith, Washington Consumer Protection Act (“CPA”) violations, common law bad faith, and

breach of the implied covenant of good faith and fair dealing. Docket no. 8. Plaintiff now seeks to appoint class counsel and to certify a class comprised of: All first party insureds and all third-party beneficiaries of any automobile insurance policies issued by Esurance in the State of Washington, who made a claim for PIP benefits and Esurance terminated their PIP benefits, limited their benefits, utilized MMI in the adjustment of PIP benefits, or denied coverage for future treatment of injuries based on Esurance’s contention that the insured/beneficiary had reached MMI, or that such treatment or benefits were not essential in achieving MMI for the injuries arising out of the automobile accident.4 Motion for Class Certification, docket no. 57 at 10. By Minute Order dated April 17, 2019, the Court granted Plaintiff discovery related to class certification. Docket no. 35. As a result, the parties were able to provide the Court with Defendant’s records relating to their decisions to limit or terminate the benefits of possible class members. Discussion A. Standard for Class Certification Rule 23 operates as “an exception to the usual rule that litigation is conducted by and on behalf of the individual named parties only.” Comcast Corp. v. Behrend, 569 U.S. 27, 33 (2013) (quoting Califano v. Yamasaki, 442 U.S. 682, 700-01 (1979)). To maintain a class action, a plaintiff must “affirmatively demonstrate” compliance with

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