Wiggins v. Allstate Property & Casualty Insurance

94 F. Supp. 3d 1276, 2015 U.S. Dist. LEXIS 43858, 2015 WL 1401967
CourtDistrict Court, S.D. Florida
DecidedMarch 2, 2015
DocketCase No. 13-CV-23354
StatusPublished
Cited by1 cases

This text of 94 F. Supp. 3d 1276 (Wiggins v. Allstate Property & Casualty Insurance) is published on Counsel Stack Legal Research, covering District Court, S.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Wiggins v. Allstate Property & Casualty Insurance, 94 F. Supp. 3d 1276, 2015 U.S. Dist. LEXIS 43858, 2015 WL 1401967 (S.D. Fla. 2015).

Opinion

ORDER

KATHLEEN M. WILLIAMS, District Judge.

THIS MATTER is before the Court on Defendant Allstate’s Motion for Summary Judgment [D.E. 70] and Plaintiff Said Wiggins’ Motion for Summary Judgment [D.E. 66]. For the reasons stated below, Defendant’s Motion is DENIED and Plaintiffs Motion is DENIED.

I. Background

This bad faith action arises from an automobile accident involving Plaintiff Said Wiggins on June 1, 2008. At the time of the accident, Wiggins was driving an automobile owned by his girlfriend’s mother, Phyllis Albury, an insured under Allstate policy number 94171159109/20 [D.E. 71 ¶ 1]. Wiggins was insured under the Allstate policy as a permissive driver [D.E. 67 ¶ 1; D.E. 71 ¶ 4]. The insurance policy on the vehicle contained uninsured motorist coverage with limits of $10,000.00 per person and $20,000.00 per accident [D.E. 15-1 at 7]. According to Wiggins, the driver that struck him, Jose Sierra, was an underin-sured motorist [D.E. 67 ¶ 3].

After the accident, Wiggins was examined at South Miami Hospital, where he complained of injuries to his neck, lower back and right knee [D.E. 67-4 at 2-4]. Wiggins reported a “popping sensation” when he extended his right- knee, and a physician noted “mild tenderness” of the knee. Id. at 3-6. Wiggins alerted Allstate about the collision on June 1, 2008, and he informed the insurer of his complaint about right knee pain on June 4, 2008 [D.E. 67-3 at 3].

Wiggins subsequently visited multiple times with Dr. Joel Shapiro, to whom he repeated his complaints about pain in his right knee [D.E. 67-5]. On November 3, 2008, Dr. Shapiro noted a “probable medial meniscus tear,” and recommended an MRI exam. Id. at 5. Shapiro’s office called Allstate on that date to inform the insurer that Wiggins will need an MRI [I)ÍE. 67-3 at 19]. The MRI was performed on November 13, 2008, by Dr. Grazie Christie, who concluded that Wiggins suffered from [1278]*1278a medial meniscus tear in his right knee [D.E. 67-6],

Wiggins again visited Dr. Shapiro complaining of knee pain'on February 23, 2009 [D.E. 67-8]. Dr. Shapiro then recommended an arthroscopy procedure. Id. By that time, however, Wiggins had exhausted his PIP limits under the Allstate policy [D.E. 67-3 at 21].

On March 6, 2009, Wiggins’ attorney, Donna B. Michelson, sent a letter on his behalf to Allstate “with regard to Mr. Wiggins’ underinsured motorist claim” [D.E. 71-6 at 1]. Enclosed with the letter was a copy of a demand letter Michelson had sent to State Farm, the insurance carrier for Jose Sierra, seeking the $15,000 limits of that policy. Id. at 2-3. Also enclosed were medical records Michelson sent to State Farm, including records of Wiggins’ visits with Dr. Shapiro, and Dr. Christie’s evaluation of the MRI and diagnosis of medial meniscal tear in Wiggins’ right knee. Id. at 56-63. The medical bills at the time totaled $14,455, $10,000 of which was covered by Allstate’s PIP coverage. Id. at 79.

Though Michelson’s March 6, 2009, letter to Allstate did not explicitly demand the $10,000 of available underinsured motorist coverage, Allstate treated this letter as a demand for same [D.E. 71 ¶ 12; D.E. 71-3 at 4-5]. Following receipt of the letter, Wiggins’ claim was taken up by Allstate adjuster Marizena Falcon [D.E. 71-3 at 5]. Falcon then completed a “Casualty Worksheet” based on her evaluation of the medical records provided by Michelson [D.E. 71-8]. The worksheet noted that Wiggins’ “primary treating physician did not award a permanency.” Id. The data from the\ Casualty Worksheet was then entered into Colossus, Allstate’s claims adjustment software program [D.E. 68-3 at 10]. In addition, the medical records were examined by an Allstate evaluation consultant, Michael Porter. Id. at 11.

On March 24, 2009, Colossus produced an evaluation of Wiggins’ claim which stated: “The right knee injury was under care for 3 to 6 months with a prognosis of complaint, no more treatment” [D.E. 71-9]. The Colossus evaluation makes no mention of Dr. Christie’s diagnosis of a meniscal tear, or of Dr. Shapiro’s recommendation of arthroscopic surgery. Colossus recommended a gross settlement range of Wiggins’ claim of $6,215 to $6,655. Id.

On that same date, Porter produced a separate evaluation in which he noted that Wiggins had an MRI indicating a right knee tear, but added that neither Dr. Shapiro nor Dr. Christie indicated a “permanency” of injury [D.E. 71-10]. He recommended an evaluation of the MRI and a record indicating a permanency after State Farm tendered its policy limit. Id.

Consistent with Porter’s evaluation, Falcon sent a letter to Michelson informing her that Allstate had concluded that the value of Wiggins’ claim fell within the limits of Sierra’s State Farm policy [D.E. 71-11]. In the event that State Farm tendered its policy limit, Michelson was advised to provide Allstate with (1) copies of the settlement documents, (2) knee MRI films, and (3) “final discharge summary from the treating physician indicating the current condition, prognosis and permanency resulting from the accident.” Id. On March 27, 2009, Michelson informed Allstate that State Farm had tendered the policy limits on the claim and sought permission to settle with State Farm, which Allstate granted [D.E. 71-12; D.E. 71-13].

On April 2, 2009, Wiggins was evaluated by an orthopedic surgeon, Dr. Arturo Corees, who identified an “internal derangement of the knee” and a medial men-[1279]*1279iscal tear and recommended arthroscopic surgery [D.E. 71-14 at 4-6].

On April 16, 2009, Wiggins’ counsel notified Allstate of the settlement with State Farm and explicitly demanded Allstate’s underinsured policy limit of $10,000. Id. at 1-2. At that time, Allstate also received a copy of the MRI on Wiggins’ knee, and a report from Dr. Corees. Id. The letter highlighted Wiggins’ torn meniscus and the recommendation for surgery, and informed Allstate that Wiggins could not pursue the surgery at that time because he did not have health insurance and his PIP insurance had been exhausted. Id.

Less than three weeks later, on May 5, 2009, Wiggins filed a Civil Remedy Notice of Violation with the Florida Department of Financial Services, as required by Fla. Stat. § 624.155(3)(a), in which he alleged that Allstate failed to attempt to settle his claim in good faith [D.E. 71-15 at 2-4], Wiggins’ counsel forwarded the Notice to Allstate and informed the insurer that it had 60 days from the date of receipt to correct the alleged violation. Id. at 1.

Allstate then had the MRI film independently reviewed by a radiologist, Dr. Paul Koenigsberg, who found “no definitive evidence for a meniscal tear” [D.E. 71-17]. In his report, Koenigsberg described the MRI as “somewhat limited given the low strength of field of the magnet.” Id. Though Koenigsberg’s report is dated May 14, 2009, it was not received by Falcon, the Allstate claims adjuster, until June 4, 2009 [D.E. 71-3 at 6].1

On June 12, 2009, Falcon informed Mi-ehelson, Wiggins’ counsel, that Allstate’s review found no evidence of a meniscal tear; in addition, Falcon discounted the report of Dr. Corees because “it did not appear that Dr. Corees had the benefit of the MRI films for his review and recommendation” [D.E. 71-18].

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Bluebook (online)
94 F. Supp. 3d 1276, 2015 U.S. Dist. LEXIS 43858, 2015 WL 1401967, Counsel Stack Legal Research, https://law.counselstack.com/opinion/wiggins-v-allstate-property-casualty-insurance-flsd-2015.