Torres v. American Zurich Insurance Company

CourtDistrict Court, D. Arizona
DecidedFebruary 19, 2025
Docket2:23-cv-02535
StatusUnknown

This text of Torres v. American Zurich Insurance Company (Torres v. American Zurich Insurance Company) is published on Counsel Stack Legal Research, covering District Court, D. Arizona primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Torres v. American Zurich Insurance Company, (D. Ariz. 2025).

Opinion

1 WO 2 3 4 5 6 IN THE UNITED STATES DISTRICT COURT 7 FOR THE DISTRICT OF ARIZONA

9 Lorena Torres, No. CV-23-02535-PHX-JJT

10 Plaintiff, ORDER

11 v.

12 Zurich American Insurance Company, et al.,

13 Defendants.

14 15 At issue is Defendant Zurich American Insurance Company’s Motion for Partial 16 Summary Judgment (Doc. 37, Motion),1 to which Plaintiff Lorena Torres filed a Response 17 (Doc. 39, Response) and Defendant filed a Reply (Doc. 41, Reply). Both parties have filed 18 Statements of Facts in support of their legal memoranda (Doc. 38, DSOF; Doc. 40, PSOF). 19 The Court finds these matters appropriate for resolution without oral argument. See 20 LRCiv 7.2(f). For the reasons that follow, the Court grants Defendant’s Motion. 21 I. Background 22 This case involves a dispute regarding the manner by which Defendant processed 23 Plaintiff’s claim for workers’ compensation insurance coverage following the unfortunate 24 occurrence of a workplace injury. Although Plaintiff originally brought suit against both 25 Defendant and an individual insurance adjuster named Terena Payton, (see Doc. 1), 26 Plaintiff later voluntarily dismissed Ms. Payton as a party, (see Doc. 7). The only remaining 27 1 This is Defendant’s second motion for summary judgment, the first having been 28 an unsuccessful pre-discovery motion that concerned threshold issues of claim preclusion and issue preclusion. (See Doc. 18; Doc. 34.) 1 claim in this case is Plaintiff’s claim against Defendant for insurance bad faith. (See Doc. 1 2 at 8–9.) Defendant’s Motion does not relate to the viability of Plaintiff’s cause of action. 3 Indeed, Defendant concedes that there exist triable issues related to Plaintiff’s bad faith 4 claim. (See Reply at 1, 3.) The Motion asserts that, irrespective of the merits or lack thereof 5 of Plaintiff’s underlying tort claim, punitive damages are not available. Accordingly, the 6 Court does not herein consider whether there exist genuine disputes of material fact relating 7 to Plaintiff’s assertion that Defendant breached the duty of good faith and fair dealing. 8 Rather, the Court directs its attention only to the question of whether there exist disputed 9 facts that are materially relevant to the propriety of punitive damages. The facts, most of 10 which are undisputed, are as follows. 11 Plaintiff sustained a workplace injury in August of 2022. (Response at 3.) In 12 September of the same year, Plaintiff filed a claim for workers’ compensation with 13 Defendant, who designated Ms. Payton as the adjuster for Plaintiff’s claim. (Response 14 at 1.) Plaintiff’s claim was immediately accepted, and she began to receive benefits. 15 (DSOF ¶ 5; PSOF at 8.) However, Plaintiff’s condition continued to worsen into October, 16 at which time Defendant assigned a registered nurse named Amber Zadina to assist 17 Ms. Payton with the coordination of Plaintiff’s medical care. (Response at 3.) Plaintiff 18 received an adverse spinal diagnosis in December, and in January of 2023 Plaintiff received 19 a recommendation from one of her medical providers, Dr. Ladin, that she needed to consult 20 with a surgeon as soon as possible to determine whether surgery was required. (Response 21 at 3–4.) Plaintiff then attended a consultation with orthopedic surgeon Dr. Paul Gause, who 22 determined that surgery was indeed necessary. (Response at 4.) On January 17, Dr. Gause 23 faxed a “surgery auth request” to Ms. Zadina. (Response at 4.) Although the parties dispute 24 the extent to which it may be assumed that Ms. Zadina apprised Ms. Payton of the contents 25 of the fax, it is undisputed that the fax was sent only to Ms. Zadina. (DSOF ¶¶ 10–11; 26 PSOF at 8.) 27 On February 6, Ms. Zadina transmitted a voicemail and an email to Ms. Payton, 28 both of which pertained to the surgical request from Dr. Gause and inquired as to whether 1 Ms. Payton needed any additional information in order to act upon the request. (Response 2 at 5.) Ms. Payton did not respond to either the voicemail or the email. (Response at 5.) On 3 February 23, Ms. Zadina composed another email to Ms. Payton informing her of 4 Dr. Gause’s reiteration that surgery was urgently needed. (Response at 5–6.) Ms. Payton 5 again did not respond. (Response at 6.) Ms. Zadina sent another similar email on March 1, 6 to which Ms. Payton responded that she would check Plaintiff’s file. (Response at 6.) Two 7 weeks later, Ms. Zadina followed up again, this time indicating that Plaintiff was still 8 waiting to see a shoulder specialist. (Response at 6.) The next day, Ms. Zadina transmitted 9 two additional follow-up communications to Ms. Payton regarding the need for surgery 10 and shoulder consultation, to which the latter responded that she would “get [Plaintiff] 11 scheduled.” (Response at 6–7.) Ms. Payton then began the process of procuring funding 12 for Plaintiff’s surgery, pending the results of the consultation with the shoulder specialist. 13 (Response at 7.) On March 23, Plaintiff was again examined by Dr. Gause, who again 14 determined that surgery was urgently needed. On March 27, Ms. Zadina sent an email to 15 Ms. Payton seeking action on Dr. Gause’s recommendation, and on March 29 Ms. Zadina 16 followed up again. (Response at 7–8.) On March 30, Plaintiff directly contacted Ms. Payton 17 regarding the surgical authorization, at which point Ms. Payton stated that she had never 18 received the surgery authorization request form. (Response at 8.) That same day, 19 Ms. Payton requested that Dr. Gause’s office send both her and Defendant’s Utilization 20 Review department the surgery authorization request, which Dr. Gause’s office promptly 21 did. (Response at 8.) 22 On April 1, Defendant’s “peer review physician,” Dr. Kopacz, requested a 23 peer-to-peer meeting with Dr. Gause for the purpose of assessing the propriety of the 24 latter’s surgery recommendation. (Motion at 3–4.) Dr. Gause did not respond to 25 Dr. Kopacz’s request. (Motion at 4.) Dr. Kopacz then declined to certify Plaintiff’s need 26 for surgery based on the written record alone. (Motion at 4.) Defendant’s Utilization 27 Review department therefore denied authorization of the requested surgery. (Motion at 4.) 28 In the notice of denial was a description of a process by which Plaintiff could appeal the 1 disposition, including an invitation to Plaintiff’s doctors to participate in the peer-to-peer 2 discussion that Dr. Kopacz had attempted to initiate. (Motion at 4.) Rather than avail herself 3 of these procedures, Plaintiff retained counsel and commenced an administrative action 4 before the Industrial Commission of Arizona (ICA) on April 21. (Motion at 4; Response 5 at 9; PSOF ¶ 36 & Ex. 19.) On May 1, Dr. Kopacz again attempted to establish 6 communication with Dr. Gause, this time successfully. (Motion at 4.) On May 19, 7 Dr. Gause transmitted a written record of his medical opinions regarding the surgery. 8 (Motion at 4.) Finally, on June 9, Defendant authorized Plaintiff’s surgery. (Response at 9 10.) 10 Although the parties diverge markedly in their respective assessments of where 11 primary responsibility for the communicative breakdown lies, both parties agree that 12 Ms. Payton erred in her handling of Plaintiff’s claim. Indeed, Ms. Payton herself fully 13 acknowledges as much. She has said that “[t]he delay was [her] error” and that “the issue 14 [was] with [her].” (Response at 11.) She has acknowledged that her conduct was “wrong” 15 and that she failed in her professional obligation to Plaintiff. (Response at 11–12.) While 16 discussing the subject of her handling of Plaintiff’s claim, Ms. Payton broke down in tears. 17 (Reply at 5.) Nevertheless, Defendant did not discipline Ms. Payton, and Ms. Payton still 18 received annual bonus pay at the end of 2023.

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Torres v. American Zurich Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/torres-v-american-zurich-insurance-company-azd-2025.