Wahlert v. American Standard Insurance

173 F. Supp. 3d 1187, 2016 WL 1222944, 2016 U.S. Dist. LEXIS 41295
CourtDistrict Court, D. Colorado
DecidedMarch 29, 2016
DocketCivil Action No 14-cv-02744-RBJ
StatusPublished
Cited by7 cases

This text of 173 F. Supp. 3d 1187 (Wahlert v. American Standard Insurance) is published on Counsel Stack Legal Research, covering District Court, D. Colorado primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Wahlert v. American Standard Insurance, 173 F. Supp. 3d 1187, 2016 WL 1222944, 2016 U.S. Dist. LEXIS 41295 (D. Colo. 2016).

Opinion

ORDER

R. Brooke Jackson, United States District Judge

This is an insurance coverage case. Pending before the Court is defendant American Standard Insurance Company of Wisconsin’s motion for a partial summary judgment dismissing plaintiffs common law and statutory bad faith claims. For the reasons discussed in this order, the motion is granted as to the common law claim but denied, in part, as to the statutory claim.

BACKGROUND

Joyce Wahlert was injured in an automobile accident on May 17, 2011. The accident was caused by one Zachary Brunette who negligently collided with a car in which Ms. Wahlert was a passenger. On April 3, 2012 Ms. Wahlert through counsel sent a letter to Brunette’s liability insurer, GEICO, claiming $14,708.15 in medical expenses; between $5,000 and $15,000 in future medical expenses; $100,000 in non-economic loss; and $100,000 in physical impairment. ECF No. 35-2 at 6-7. Despite the total of $226,164.15 to $236,164.15 in claimed damages, counsel stated that he was authorized to settle for $135,000. Id. GEICO’s policy limit was $25,000, which GEICO paid.

On June 13, 2014 Ms. Wahlert, through counsel, sent the demand letter it had served on GEICO and other materials to American Standard, the liability insurer for the driver of the car in which Ms. Wahlert was a passenger. In addition to up to $400,000 of underinsurance motorist coverage for the driver, the policy provided up to $100,000 in such coverage to the passenger. Ms. Wahlert’s counsel demanded that American Standard pay the $100,000 limits to her.

American Standard requested and received copies of Ms. Wahlert’s medical records for the five years prior to the accident and her wage loss records. American Standard’s evaluation of the records was that Ms. Wahlert had suffered rib contusions and neck, arm and wrist pain. She had attended several physical therapy sessions but had discontinued those and obtained an evaluation from a hand specialist concerning the arm and wrist pain. As a result she underwent a carpal tunnel release which apparently was effective in reducing her arm and wrist pain. She did not return to physical therapy or seek further treatment concerning neck pain.

On by September 20, 2012 American Family’s adjuster, Christina Osborn, evaluated the claim as follows:

Medical expenses $13,300

Wage loss 4,566

<less medical expenses paid ... 5,000>

Non-economic damages $15.000-$2Q,Q00

TOTAL $27,866-$32,866

[1191]*1191Accordingly, after deducting the $25,000 paid to Ms. Wahlert by GEICO, these numbers resulted in a valuation range of $2,866 to $7,866. Ms. Osborn assigned a “final value” of $7,866 to the claim. EOF No. 35-1 at 46. She made an offer of settlement to Ms. Wahlert of $2,866 on October 23,2012. Id. at 44.

The offer was not accepted. On December 6,2012 Ms. Wahlert’s counsel provided records indicating that in August 2012 Ms. Wahlert had complained of left leg and knee pain beginning in June 2012 and had been diagnosed with osteoarthritis: a total knee arthroplasty (replacement) had been recommended. Id. at 42. In light of this new information Ms. Osborn requested that American Standard’s Medical Services Department set up a review of Ms. Wah-lert’s medical records by an independent doctor. American Standard contacted a vendor, Corvel, which selected an orthopedic surgeon, John Douthit, M.D. to review the records. Dr. Douthit provided a report on March 20, 2013. Among other things he concluded that the leg and knee issues were unrelated to the auto accident.

In April 2013 Ms. Wahlert’s claim was reassigned to another American Standard adjuster, Dennis Feliciano, who conducted his own evaluation. The key points in his evaluation were:

• Ms. Wahlert’s injuries from the accident were cervical strain, rib contusion, chest contusion, carpal tunnel syndrome (right hand), limited range of motion, and radiating pain (right arm & hand numbness).
• X-rays of Ms. Wahlert’s ribs, chest and cervical spine taken in the Emergency Room where she was taken following the accident were normal (no fractures).
• After three doctor visits and 16 physical therapy visits the right hand and arm pain was not resolved. However, on September 30, 2011 a neurologist diagnosed carpal tunnel syndrome of .the right wrist, and her symptoms resolved after a carpal tunnel release was performed on October 21, 2011. Because prior medical records did not reveal any symptoms regarding her right hand or arm, Dr. Douthit concluded- that the right wrist injury was attributable to the accident.
• Ms. Wahlert.had a prior worker’s compensation claim for a back injury resulting from a fall off a ladder on October 7, 2010. This resulted in a 22% permanency rating. Treatment for back injury continued to November 3, 2011, i.e., for several months after the motor vehicle accident. The back issues did not appear to relate to the motor vehicle accident.
• Ms. Wahlert reported leg pain during a doctor visit on August 14, 2012 and was diagnosed with osteoarthritis of both knees. She had made no mention of pain in her lower extremities prior to that time. The leg and knee issues-, did not appear to be accident related.1 .
• Ms. Wahlert’s counsel had provided verification ■ of one and one-half [1192]*1192weeks of missed work due to injuries sustained in the accident.

EOF No. 35-1 at 34.

Mr. Feliciano’s evaluation of Ms. Wah-lert’s claim was $15,901.65 for medical expenses (with an indication that the only medical bills submitted were for neck pain, rib/chest contusions, and right arm/hand/ wrist issues), $1,656.00 wage loss, and $12,000 to $15,000 “general damages,” for a total of $29,557.65 to $32,557.65. He deducted the $5,000 medical expenses previously paid by American Standard and the $25,000 paid by GEICO, leaving a difference between an overpayment of $442.35 and an additional amount owed of $2,557.65. Id.. He requested and obtained $2,600 in settlement authority. Id. at 31, 34. He extended a settlement offer to Ms. Wahlert’s counsel of $1,000 on May 13, 2013 and re-extended the same offer on June 13,'2013; July 17, 2013; and August 4, 2013. Id. at 29-30.

On August 21, 2013 Ms. Wahlert’s counsel apparently expressed concerns about the- offers. Mr. Feliciano noted that the consultative review (on- which his evaluation was based) was by a peer of Ms. Wahlert’s treating providers, not' an American Standard nurse, but indicated that he would. review and respond. Id. at 27. On November 14, 2013 Mr. Feliciano noted internally that American Standard’s current reserve on the Wahlert claim was $8,000. Id. at 21. Meanwhile, the records indicate that Ms. Wahlert’s counsel, who also represented the driver in her underin-sured claim, continued to dispute American Standard’s evaluation of the claims of both women. Id. at 18-20,

On (or before, it’s not entirely clear) January 15,. 2014 Mr. Feliciano increased his settlement offer to $2,866 (the amount that Ms. Osborn had previously offered). Id. at 16-17. After receiving an inquiry from Ms. Wahlert’s counsel as to whether that was the full value of American Family’s evaluation, Mr.

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173 F. Supp. 3d 1187, 2016 WL 1222944, 2016 U.S. Dist. LEXIS 41295, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wahlert-v-american-standard-insurance-cod-2016.