Smith v. Fireman's Fund Insurance

575 F. Supp. 69, 1983 U.S. Dist. LEXIS 13054
CourtDistrict Court, E.D. Pennsylvania
DecidedOctober 5, 1983
DocketCiv. No. 81-3989
StatusPublished
Cited by2 cases

This text of 575 F. Supp. 69 (Smith v. Fireman's Fund Insurance) is published on Counsel Stack Legal Research, covering District Court, E.D. Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Smith v. Fireman's Fund Insurance, 575 F. Supp. 69, 1983 U.S. Dist. LEXIS 13054 (E.D. Pa. 1983).

Opinion

MEMORANDUM

LOUIS H. POLLAK, District Judge.

Defendant Fireman’s Fund Insurance Company’s motion for summary judgment poses the question of whether California, New York or Pennsylvania law determines the viability of plaintiff Robert Smith’s claim. Mr. Smith, a citizen of New York, presses a claim for wrongful termination of Pennsylvania workers’ compensation benefits against Fireman’s Fund, a California corporation.

The choice-of-law question arises in the following context: Fireman’s Fund carried Mr. Smith’s employer’s workers’ compensation insurance at the time of Smith’s work-related back injury in 1976. Fireman’s Fund paid Mr. Smith’s benefits from the time of the injury until 1980. During this period Mr. Smith moved from Pennsylvania to Florida, and then to New York. From time to time, Fireman’s Fund required plaintiff to undergo a physical examination to determine whether plaintiff had recovered his health enough to return to work. These examinations disclosed no such improvement until, in 1980, Fireman’s Fund insisted that Mr. Smith travel from Brooklyn to Pennsylvania and submit to an examination by Dr. Blaker. Dr. Blaker executed an affidavit reciting that' Smith could return to work. Fireman’s Fund filed the affidavit with the Pennsylvania Worker’s Compensation Bureau and, pursuant to that filing, automatically terminated Mr. Smith’s benefits. In 1981 the Bureau determined that Dr. Blaker had erred [70]*70and the Bureau reinstated Mr. Smith’s benefits. Thereafter, Mr. Smith brought this action for compensatory and punitive damages against Fireman’s Fund in the Northern District of California. Smith alleges bad faith termination of benefits, intentional infliction of emotional distress, and fraud. Upon defendant’s motion, the California district court transferred this action to this court pursuant to 28 U.S.C. § 1404(a). Fireman’s Fund has now moved for summary judgment.

Choice of the proper substantive law governing this action disposes of this motion for summary judgment. Three states have some arguable relation to this law suit: (1) California is the state of defendant’s incorporation; moreover, since suit was commenced there, it remains, in point of federal judicial practice, constructively the forum (as more fully explained below). (2) New York was plaintiff’s state of residence when benefits were terminated, and New York is where plaintiff continues to reside. (3) Pennsylvania was plaintiff’s state of residence and employment when he was injured, and the Pennsylvania Worker’s Compensation statute has governed the initiation, termination and reinstatement of plaintiff’s benefits.

California allows a plaintiff to recover for bad faith failure to pay his claim. See Gruenberg v. Aetna Insurance Co., 9 Cal.3d 566, 510 P.2d 1032,108 Cal.Rptr. 480 (1973). On the other hand, Pennsylvania does not permit a private right of action for bad faith failure to pay. D ’Ambrosio v. Pennsylvania National Mutual Casualty Insurance Co., 494 Pa. 501, 431 A.2d 966 (1981); Layton v. Liberty Mutual Fire Insurance Co., 511 F.Supp. 1 (E.D.Pa.1983). If the Pennsylvania courts will not permit plaintiff to bring an allegation of bad faith termination on an insurance contract, a fortiori they will disallow claims for intentional infliction of emotional distress and for “fraud” which essentially rest on the same facts. In particular, although plaintiff here strongly asserts that his complaint makes out a claim in fraud, plaintiff does not allege that Fireman’s Fund or Dr. Blaker defrauded plaintiff. At most, Fireman’s Fund and Dr. Blaker unsuccessfully attempted to defraud the Pennsylvania Workers’ Compensation Bureau.

New York presents a more difficult problem. N.Y.Ins.Law § 40-d (McKinney Supp.1982) prohibits certain unfair claim settlement practices on the part of insurers. The Appellate Division initially held that this section provided no private right of action against insurers. Cohen v. New York Property Insurance Underwriting Association, 65 A.D.2d 71, 410 N.Y.S.2d 597 (1978). However, the Court of Appeals has since intimated that a private cause of action might lie under this section, although the Court of Appeals has never affirmed an award of damages under such a private claim. See Dano v. Royal Globe Insurance Co., 59 N.Y.2d 827, 451 N.E.2d 488, 489, 464 N.Y.S.2d 741, 742 (1983) (“[ajssuming that section 40-d of the Insurance Law can be read to create a private cause of action[,]” plaintiffs evidence still insufficient); Hubbell v. Trans World Life Insurance Co., 50 N.Y.2d 899, 901, 408 N.E.2d 918, 919, 430 N.Y.S.2d 589, 590 (1980) (“assuming section 40-d of the Insurance Law can be read to create a private cause of action, the allegations of the complaint were insufficient to bring the case within that statute, which proscribes only unfair business practices”); Halpin v. Prudential Insurance Co., 48 N.Y.2d 906, 908, 401 N.E.2d 171, 172, 425 N.Y.S.2d 48, 49 (1979) (“Assuming, without deciding, that a private damage action lies under [section 40-d], the one instance of unfair settlement practice pleaded would not constitute a general business practice within the meaning of the statute.”) The Appellate Division has recognized that these cases limit Cohen. Royal Globe Insurance Co. v. Chock Full O’ Nuts Corp., 86 A.D.2d 315, 318, 449 N.Y.S.2d 740, 742 (1982).

In Halpin, defendant had terminated plaintiff’s disability benefits under a group accident and sickness insurance policy. Plaintiff demanded compensatory and punitive damages and also asserted a mal[71]*71practice claim against defendant’s physician who had examined plaintiff and provided the basis for the termination. The Court of Appeals held that, in an action on the insurance contract, plaintiff could recover no more than the policy limit. Plaintiff could not recover additional compensatory damages or punitive damages under section 40-d because plaintiff had not shown a pattern of conduct on the part of defendant; plaintiff had alleged only one incident.

Halpin therefore suggests that a New York court could entertain plaintiff Smith’s action only under section 40-d. Smith has recovered under his policy. In this action he claims a right to recover for further damages incurred as a result of his benefits interruption. However, Smith might recover under 40-d if he can show a pattern of bad business practice on the part of Fireman’s Fund. Smith has alleged two patterns. Smith alleges that Fireman’s Fund repeatedly had him examined in an effort to establish grounds for terminating his benefits. Smith also suggests that Dr. Blaker often gives questionable diagnoses.

Thus, if New York or California law applies, plaintiff can survive this motion for summary judgment. If Pennsylvania law applies, defendant will prevail on this motion.

As a transferee court under 28 U.S.C. § 1404

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Bluebook (online)
575 F. Supp. 69, 1983 U.S. Dist. LEXIS 13054, Counsel Stack Legal Research, https://law.counselstack.com/opinion/smith-v-firemans-fund-insurance-paed-1983.