Phelps v. State Farm Mutual Automobile Insurance

680 F.3d 725, 2012 WL 1889396, 2012 U.S. App. LEXIS 10612
CourtCourt of Appeals for the Sixth Circuit
DecidedMay 25, 2012
Docket10-6085
StatusPublished
Cited by20 cases

This text of 680 F.3d 725 (Phelps v. State Farm Mutual Automobile Insurance) is published on Counsel Stack Legal Research, covering Court of Appeals for the Sixth Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Phelps v. State Farm Mutual Automobile Insurance, 680 F.3d 725, 2012 WL 1889396, 2012 U.S. App. LEXIS 10612 (6th Cir. 2012).

Opinions

GILMAN, J., delivered the opinion of the court in which CLAY, J., joined. BATCHELDER, C.J. (pp. 735-38), delivered a separate dissenting opinion.

OPINION

RONALD LEE GILMAN, Circuit Judge.

Cynthia Phelps alleges that State Farm Mutual Automobile Insurance Company violated Kentucky’s Unfair Claims Settlement Practices Act (UCSPA) in its processing of her third-party insurance claim. The district court granted summary judgment in favor of State Farm on the ground that Phelps had failed to present sufficient evidence to show that the three years taken to settle her claim raised a genuine dispute as to whether State Farm had acted in bad faith. For the reasons set forth below, we REVERSE the judgment of the district court and REMAND the ease for further proceedings consistent with this opinion.

I. BACKGROUND

This case arises out of an automobile accident that occurred on July 18, 2003. As Phelps was pulling into a gas station in Jefferson County, Kentucky, Lindsey Kirby pulled out of the station in front of Phelps without warning. The two cars collided, causing injuries to Phelps’s spine that ultimately required surgery in October 2003. Kirby was insured by State Farm under an automobile insurance policy with a $50,000 limit of liability. State Farm concedes that Kirby was at fault for the accident and that State Farm was obligated to provide the insurance coverage.

Not long after the accident, Phelps filed a third-party liability claim with State Farm for personal injuries and property damage arising out of the accident. Adjuster Denise Ray was assigned to the claim. Ray sent Phelps a medical-authorization form in September 2003, which Phelps signed and returned that same month. On October 2, 2003, State Farm transferred Phelps’s claim to a second adjuster, Bob Nieses. Nieses sent Phelps’s counsel, Thomas Carroll, a letter requesting a list of Phelps’s medical providers. Nieses received a response within two weeks. He then began collecting Phelps’s medical records.

Phelps’s claim file shows minimal activity until February 11, 2004, when State Farm first noted that Phelps had a prior back injury in 1999 in the same part of her body as the present injury. Nieses determined that additional information was needed to evaluate Phelps’s claim and to separate any prior injuries from the current claim. His file note indicates: “Need to gather information on wage loss, medical bills, and prior condition.” But there is no evidence that Phelps was made aware of State Farm’s need for this information at the time.

Carroll submitted a “settlement package” that was received by State Farm on April 2, 2004. The package included documentation regarding Phelps’s surgery and [728]*728related medical and wage-loss costs totaling $22,620.22. The package did not include a demand, but it expressed Phelps’s interest in reaching a settlement and made a request for information about State Farm’s policy limits.

State Farm apparently did little to process Phelps’s claim for several months after receiving her settlement package. Nieses testified in his deposition that he did not complete a claim valuation because he considered it “premature” due to the outstanding information about Phelps’s 1999 back injury. In July 2004, State Farm substituted yet another adjuster, Amy Lirely, to process Phelps’s claim. On September 14, 2004, Lirely requested information from Phelps’s attorney about the 1999 injury. State Farm allegedly “received permission to examine PIP [personal injury protection] records” relating to Phelps six days later, but neither party has explained what these records covered.

By October 24, 2004, State Farm had received the medical records relevant to Phelps’s 1999 injury. But State Farm contends that the records it received covered only Phelps’s immediate treatment following the 1999 injury and did not include documentation about her treatment in the years following that injury. Lirely testified that the missing information was relevant to determine how well Phelps had recovered from the 1999 injury by the time of the present accident. Nonetheless, Lirely proceeded to complete a claim evaluation based on the available records, valuing Phelps’s claim between $24,620 and $49,620. Phelps argues that this range was outrageously low given the documentation that State Farm had before it.

State Farm made an initial settlement offer of $25,000 four days later, on October 28, 2004. According to State Farm, its offer did not include compensation for future wage loss or future impairment of earnings because Phelps failed to include any such information in her settlement package. In addition, medical records from December 2003 indicated to State Farm’s adjusters that Phelps had substantially recovered from her July 2008 injury and probably would not experience any future impairments.

Carroll did not directly respond to State Farm’s offer, but Phelps contends that Carroll made additional requests for State Farm to reveal its policy limits over the course of the fall and that Lirely refused to provide this information. Lirely, however, disputes ever being asked about the policy limits. In any event, having heard nothing from Carroll about her offer, Lirely left a phone message for him in January 2005, but the call was not returned.

On March 29, 2005, Lirely finally heard from Carroll, who rejected State Farm’s $25,000 offer and demanded $150,000 to settle the claim. Although State Farm criticizes Carroll for making a demand that far exceeded the policy limits, there is no evidence that Lirely contemporaneously told Carroll that the demand in fact exceeded the policy limits or that Lirely disclosed any information about the policy limits.

Phelps eventually filed suit against Kirby, the driver insured by State Farm, in Kentucky state court in May 2005. In late May and early June, State Farm’s attorney submitted discovery requests to Carroll. Carroll did not respond to these requests until October 25, 2005. State Farm asserts that the discovery produced pertinent new information, including a comprehensive medical-records release and wage-loss documentation. But Phelps contends that the information obtained through discovery was not necessary to the adjudication of her claim and that State Farm had all of the pertinent information that it needed as of April 2, 2004, [729]*729when it received the settlement package (or, at the very latest, as of October 24, 2004, when it received information about Phelps’s 1999 injury).

On November 3, 2005, State Farm once again replaced Phelps’s claims adjuster, this time assigning the claim to Lillian Jones. Meanwhile, discovery in the pending lawsuit continued through the winter. Phelps was deposed on March 22, 2006. She testified that she had fully recovered from her 1999 injury prior to the 2003 accident. State Farm’s attorney determined that Phelps was a credible witness and recommended that State Farm increase its settlement offer.

Carroll first demanded the policy-limits amount of $50,000 on April 11, 2006. State Farm countered with an offer of $40,000 the following day, which Carroll rejected. Finally, State Farm offered $50,000, the full policy limits, on April 13, 2006. Phelps accepted the offer shortly thereafter, which resolved her pending suit against Kirby.

In May 2007, Phelps filed the present lawsuit, alleging that State Farm had violated Kentucky’s UCSPA through its conduct in processing her claim.

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Cite This Page — Counsel Stack

Bluebook (online)
680 F.3d 725, 2012 WL 1889396, 2012 U.S. App. LEXIS 10612, Counsel Stack Legal Research, https://law.counselstack.com/opinion/phelps-v-state-farm-mutual-automobile-insurance-ca6-2012.