State Farm Fire & Casualty Co. v. Winsor

5 F. Supp. 2d 1258, 1998 U.S. Dist. LEXIS 8021, 1998 WL 279172
CourtDistrict Court, D. Wyoming
DecidedMay 11, 1998
Docket2:97-cv-00187
StatusPublished
Cited by2 cases

This text of 5 F. Supp. 2d 1258 (State Farm Fire & Casualty Co. v. Winsor) is published on Counsel Stack Legal Research, covering District Court, D. Wyoming primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State Farm Fire & Casualty Co. v. Winsor, 5 F. Supp. 2d 1258, 1998 U.S. Dist. LEXIS 8021, 1998 WL 279172 (D. Wyo. 1998).

Opinion

ORDER GRANTING DEFENDANT STATE FARM’S MOTION FOR SUMMARY JUDGMENT

ALAN B. JOHNSON, Chief Judge.

This matter is before the court on State Farm’s Motion for Summary Judgment. The court finding that there are no material issues of fact and that State Farm is entitled to judgment as a matter of law, determines as follows:

UNDISPUTED FACTS

1. Plaintiff State Farm and Casualty Company (State Farm), issued automobile liability policy SO97-676-C27-50 to defendant Pat Sherwood. This policy was in full force and effect on September 1, 1993. The policy limits for personal injury are $50,000.

The policy has several clauses relevant to this case:

The insured has the duty to cooperate with State Farm, and when asked, to assist in making settlements, securing and giving evidence, and attending hearings or trials.
The insured shall not make any payment or assume any obligation to others, and shall not incur any expense except for first aid to others.
*1259 State Farm agrees to defend any suit with attorneys “hired and paid by” State Farm.
There is no right of action under - the policy’s liability coverage until the amount of damages an insured is liable to pay has been finally determined by judgment after actual trial, or an agreement between the insured, the claimant, and State Farm.

Pl.’s Ex. A.

2. Defendant Rhonda Winsor is Ms. Sherwood’s daughter. On September 1, 1993, Ms. Winsor was attempting to place an infant ear seat in the back seat of Ms. Sherwood’s vehicle. The vehicle was running. Ms. Sherwood turned to help her daughter and took her foot off the brake. The vehicle moved forward and caused Ms. Winsor to fall to the ground.

8. Ms. Winsor claims that she suffers low back pain and pain in her right leg as a result of her fall on September 1, 1993. Ms. Winsor made a claim against her mother under the State Farm policy based on her alleged injury.

4. Because Ms. Winsor made a bodily injury claim as well as a claim for medical payments under Ms. Sherwood’s policy, State Farm opened two files for the accident and assigned them to separate claims representatives. The purpose of this split was State Farm’s concern that there would-be a conflict of interest if State Farm disputed whether medical payments were reasonable, necessary, or related to the accident. It was concerned that Ms. Winsor might argue that medical payments were withheld or delayed to force settlement of the bodily injury claim. Cetak Depo. at 33-35. State Farm does not permit its claims representative assigned to the bodily injury claim access to the medical records and information submitted to the claims representative assigned to the medical payments claim without a release from the claimant. Id. at 48. State Farm has the right to compel a medical examination under medical payment coverage but not under liability coverage. Policy at 5.

5. State Farm began to investigate the personal injury claim. It asked for medical authorization to see Ms. Winsor’s medical records and received authorization on September 10,1993.

6. In January of 1994, State Farm received an anonymous telephone call from an individual who alleged that Ms. Winsor had a preexisting back condition and then hung up. The claims representative decided to interview Ms. Winsor’s doctor and set up an appointment for March 3,1994.

7. Ms. Winsor hired Mr. Joe Darrah to represent her regarding her claims against State Farm. On March 3, 1994, Mr. Darrah sent a letter to Dr. Stephen Emery revoking Ms. Winsor’s authorization to release medical information. This revocation was sent to Dr. Emery the day he was to be interviewed by a State Farm claims representative and the scheduled interview was canceled.

8. State Farm exercised its rights under the medical payments provision of the policy and asked Ms. Winsor to undergo an independent medical examination. Dr. Donald H. See performed the examination on March 7, 1995. Dr. See’s report dated March 7, 1995, contains the following:

CURRENT SYMPTOMS consist of aches and pains felt broadly across the low lumbar region and intermittent numbness and tingling in the right posterior buttock, thigh and leg down to the ankle.... Her low back symptoms are the most severe and aggravating.... Her right leg symptoms have become gradually more intense over the past several months.
WORK HISTORY ...
The patient denied any trouble with her back or legs prior to September of 1993. Her general health has been good except for morbid obesity.
RADIOLOGIC STUDIES
2. MRI, lumbar spine, dated November 24, 1993 shows an abnormal disc protrusion ....
*1260 * * *
Based on all the medical information made available to me and my examination of Rhonda Winsor, I will now answer your six specific questions to the best of my ability.
1. Clinical diagnosis is trauma to the lumbar spine causing injury to the interverte-bral disc at L4-L5.... The prognosis is that the examinee will, more likely than not, continue to have back pain for an undetermined period of time. Although there are subjective symptoms of numbness and tingling in the leg, objective criteria for nerve root compression, ... are not present at this time.
2. It is my opinion that her current symptoms in regard to the lower spine and lower extremities are directly and solely the result of the accident that occurred on September 1,1993.
* * *
4. In regard to treatment at this time, this should consist of, hopefully, maintaining reasonable mobility and flexibility of the back and legs not requiring a formal therapy program. This examinee desperately needs to lose weight, although the prospect for this seems quite dismal.
5. The examinee’s clinical condition is consistent with “DRE Lumbosacral Category II” which qualifies for a 5% whole person impairment ...
6. It is my opinion that the examinee has reached a point of maximum medical improvement as of the date of this examination ...

Defs.’ Ex. 1 (emphasis added).

9. As part of his examination, Dr. See reviewed Ms. Winsor’s medical records as provided by State Farm. However, State Farm did not have a complete set of medical records and was prevented from obtaining such records by Mr. Darrah’s revocation of Ms. Winsor’s release shortly before the examination.

10. On March 22, 1994, Mr. Darrah sent Dr. Bruce Campbell a request for Ms. Win-sor’s medical records from the time of the accident forward. Because Ms. Winsor revoked her release for medical information, Dr. Campbell’s records were not available to State Farm during this time.

11. On April 18, 1995, Mr.

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Bluebook (online)
5 F. Supp. 2d 1258, 1998 U.S. Dist. LEXIS 8021, 1998 WL 279172, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-farm-fire-casualty-co-v-winsor-wyd-1998.