VanHaaren v. State Farm

CourtCourt of Appeals for the First Circuit
DecidedMarch 29, 1993
Docket92-1667
StatusPublished

This text of VanHaaren v. State Farm (VanHaaren v. State Farm) is published on Counsel Stack Legal Research, covering Court of Appeals for the First Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
VanHaaren v. State Farm, (1st Cir. 1993).

Opinion

March 5, 1993 UNITED STATES COURT OF APPEALS FOR THE FIRST CIRCUIT

No. 92-1667

DENNIS VANHAAREN,

Plaintiff, Appellant,

v.

STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY,

Defendant, Appellee.

APPEAL FROM THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF MAINE

[Hon. David M. Cohen, U.S. Magistrate Judge]

Before

Selya, Circuit Judge,

Higginbotham,* Senior Circuit Judge,

and Cyr, Circuit Judge.

Francis M. Jackson for appellant.

Michael S. Wilson with whom Louise K. Thomas and Pierce, Atwood,

Scribner, Allen, Smith & Lancaster were on brief for appellee.

March 5, 1993

CYR, Circuit Judge. The district court determined that CYR, Circuit Judge.

plaintiff Dennis VanHaaren had forfeited coverage under the

*Of the Third Circuit, sitting by designation.

uninsured motorist policy issued by defendant State Farm Mutual

Automobile Insurance Company ("State Farm") by not complying with

State Farm's requests that he submit to an independent medical

examination ("IME"). The district court granted summary judgment

in favor of State Farm, and VanHaaren appealed. We affirm.

I

BACKGROUND

VanHaaren was involved in an automobile collision with

an uninsured motorist on July 1, 1989. Alleging permanent back

injury, VanHaaren soon exhausted the $5,000 medical payments

coverage provided under his State Farm automobile insurance

policy, and in March 1991 he submitted a $100,000 claim repre-

senting the full amount of the uninsured motorist coverage under

the State Farm policy. The State Farm policy contained a provi-

sion ("IME clause") which required VanHaaren to submit to an

"examin[ation] by physicians chosen and paid by [State Farm] as

often as [State Farm] reasonably may require."

On April 8, and again on May 2, 1991, State Farm wrote

VanHaaren's counsel requesting confirmation that VanHaaren was

residing in Florida, so that an IME could be conducted in Flori-

da. On May 17, VanHaaren's counsel advised State Farm that

VanHaaren had relocated to North Carolina to take a job at a

summer resort, and suggested that "a realistic approach to the

case would be to allow [State Farm] to obtain an [IME] in the

Ashville, North Carolina area and then to set up an arbitration

or mediation." The State Farm representative responded, noting

that the policy included an arbitration provision. He requested

that VanHaaren's counsel advise State Farm "where [VanHaaren]

will be for a reasonable period of time so I may refer [sic] to

the proper State Farm office to make [IME] arrangements." It is

conceded that VanHaaren's counsel did not respond to the latter

request.

On September 13, VanHaaren brought an action in Maine

Superior Court, which State Farm promptly removed to federal

district court. Counsel to State Farm wrote VanHaaren's counsel

on December 16, requesting confirmation that VanHaaren would

attend an IME scheduled for January 14, 1992, in Portland, Maine.

One week later, VanHaaren's counsel declined to confirm Van-

Haaren's attendance at the IME, noting that he considered the

usual diagnoses of the orthopedist chosen by State Farm too

"conservative," inviting State Farm to propose other orthope-

dists, and inquiring why the IME could not be conducted in

Florida where VanHaaren was again residing. Otherwise, Van-

Haaren's counsel suggested, State Farm "may bring a motion for an

examination in the [district court]." On January 10, 1992, over

VanHaaren's opposition, the presiding magistrate judge granted

State Farm's motion to compel VanHaaren to attend the IME sched-

uled for January 14 in Portland. VanHaaren complied.

In May 1992 the district court granted State Farm's

motion for summary judgment on the ground that VanHaaren's

conduct before and after filing suit constituted a breach of the

IME clause, barring recovery under the uninsured motorist provi-

sion in the State Farm policy.

II

DISCUSSION

A. Applicable State Law

We review a grant of summary judgment de novo, employ-

ing the same criteria incumbent upon the district court. Pedraza

v. Shell Oil Co., 942 F.2d 48, 50 (1st Cir. 1991), cert. denied,

112 S. Ct. 993 (1992). Summary judgment is appropriate where the

record, including the pleadings, depositions, answers to inter-

rogatories, admissions on file, and affidavits, viewed in the

light most favorable to the nonmoving party, reveals no genuine

dispute as to any material fact and the moving party is entitled

to judgment as a matter of law. See Fed. R. Civ. P. 56(c); Canal

Ins. Co. v. Benner, F.2d , (1st Cir. 1992) [No. 92-

1360, 1992 U.S. App. LEXIS 30889, at *5 (1st Cir. Nov. 24,

1992)].

Although the parties agree that Maine law informs the

present determination as to the materiality of any fact in

genuine dispute, see Blanchard v. Peerless Ins. Co., 958 F.2d

483, 485 (1st Cir. 1992), the Maine Supreme Judicial Court has

yet to address the pivotal issue presented by this appeal: what

material facts must an insurer establish beyond genuine dispute

to warrant summary judgment against a policy holder who breaches

an IME clause? Absent controlling state court precedent, a

federal court sitting in diversity may certify a state law issue

to the state's highest court, or undertake its prediction "when

the course [the] state courts would take is reasonably clear."

Porter v. Nutter, 913 F.2d 37, 41 n.4 (1st Cir. 1990) (quoting

Bi-Rite Enters., Inc. v. Bruce Miner Co., 757 F.2d 440, 443 n.3

(1st Cir. 1985)). See also American Waste & Pollution Control

Co. v. Browning-Ferris, Inc., 949 F.2d 1384, 1386 (5th Cir.

1991); S & R Metals, Inc. v. C. Itoh & Co., 859 F.2d 814, 816

(9th Cir. 1988). The prognostic chore is reasonably straightfor-

ward in the instant case.

State Farm argues that Maine law would follow estab-

lished contract law principles, permitting the insurer to avoid

all liability under its insurance contract where the policy

holder commits an anticipatory breach of a condition precedent to

coverage by "refusing" to submit to an IME, irrespective of any

prejudice to the insurer. In our view, its assessment is less

than prescient.

In Ouellette v. Maine Bonding & Cas. Co., 495 A.2d 1232

(Me. 1985), the Maine Supreme Judicial Court, sitting as the Law

Court, explicitly "abandon[ed] the analysis of a negotiated

contract," under which an insurer's performance would be excused

on the bare showing that the insured breached a condition prece-

dent to coverage by inexcusably delaying notification of the

policy claim for four years. Id. at 1235. Rather, the Law Court

held that the insurer must prove "that the notice provision was

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