Young v. The Standard Fire Insurance Company

CourtDistrict Court, E.D. Washington
DecidedSeptember 30, 2019
Docket2:18-cv-00031
StatusUnknown

This text of Young v. The Standard Fire Insurance Company (Young v. The Standard Fire Insurance Company) is published on Counsel Stack Legal Research, covering District Court, E.D. Washington primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Young v. The Standard Fire Insurance Company, (E.D. Wash. 2019).

Opinion

1 Sep 30, 2019

2 SEAN F. MCAVOY, CLERK

4 UNITED STATES DISTRICT COURT EASTERN DISTRICT OF WASHINGTON 5

6 DIANE YOUNG, individually NO: 2:18-CV-031-RMP 7 Plaintiff, ORDER DENYING CROSS- 8 v. MOTIONS FOR PARTIAL SUMMARY JUDGMENT, 9 THE STANDARD FIRE GRANTING DEFENDANT’S INSURANCE COMPANY, a foreign MOTION TO DISMISS CLASS 10 insurance company, ALLEGATIONS, AND DENYING AS MOOT PLAINTIFF’S MOTION 11 Defendant. FOR PRE-CERTIFICATION DISCOVERY 12

13 BEFORE THE COURT are cross-Motions for Partial Summary Judgment 14 from Plaintiff Diane Young, ECF No. 90, and Defendant The Standard Fire 15 Insurance Company (“Standard”), ECF No. 86. Also before the Court are 16 Standard’s Motion to Dismiss or Strike Class Action Allegations, ECF No. 54, and 17 18 19 20 21 ORDER DENYING CROSS-MOTIONS FOR PARTIAL SUMMARY 1 Young’s Motion to Compel Class Certification Discovery, ECF No. 66.1 Having 2 reviewed all materials submitted by the parties, including the supplementary filing

3 on August 14, 2019, having heard oral argument from the parties on August 8, 2019, 4 and having researched the relevant law, the Court is fully informed. 5 BACKGROUND

6 Young’s claims arise out of her central contention that Standard, as a 7 subsidiary of Travelers Insurance, wrongfully denied personal injury protection 8 (“PIP”) for injuries that Young allegedly sustained in a car accident in May 2017. 9 Young alleges that Standard should not have suspended payment pending

10 investigation of Young’s claims and completion of an independent medical 11 examination (“IME”), when her treating physicians already had determined that the 12 treatment she was receiving was reasonable, necessary, and related to the accident in

13 which she was injured. 14 Several years before the incident upon which this lawsuit is based, Young was 15 injured in an accident on September 12, 2013. While driving in a wilderness area of 16 Canada, Young lost control of her vehicle, which rolled seven times, and fractured

17 her neck and back. ECF No. 91 at 58. Young recovered from her injuries with 18

19 1 The Court lifts the stay on resolving these pending motions, since the Court is resolving the Motions for Partial Summary Judgment upon which the stay was 20 based. See ECF No. 79. 21 ORDER DENYING CROSS-MOTIONS FOR PARTIAL SUMMARY 1 treatment that included a halo neck brace, massage, acupuncture, physical therapy, 2 chiropractic services, and the care of a physiatrist. See ECF No. 97-1 at 153.

3 The parties dispute whether Young continued to have pain or other symptoms 4 from her 2013 injuries into 2017. Young maintains that by January 11, 2017, she 5 reported to her new primary care provider, Nurse Practitioner Mary Bachko, that she

6 was experiencing nothing more than tension in her upper-mid back as a residual 7 symptom from her 2013 injuries. ECF No. 98 at 4. Standard emphasizes that the 8 records from the January 11 appointment with Nurse Practitioner Bachko indicate 9 that “chronic back pain” was a problem for Young at the time of her new patient

10 appointment. See ECF No. 89 at 5. However, the deposition testimony of Nurse 11 Practitioner Bachko clarifies that Young did not tell her that she had chronic back 12 pain; rather, Young only informed Bachko that she had “upper mid-back tenseness

13 on occasion.” ECF No. 97-1 at 153. 14 On May 11, 2017, Young was involved in an accident in which she was rear- 15 ended at low speed by a pickup truck. ECF Nos. 91 at 54; 97-1 at 63. On May 17, 16 2017, Young reported the collision to Standard and conveyed that she was

17 experiencing pain in her neck, back, low back, shoulders, sternum, and a toe on her 18 left foot. ECF No. 91 at 55−56. Young told Standard that she had fully recovered 19 from her 2013 accident by May 11, 2017, and that she “had no pain” from her prior

20 accident at the time that she was rear-ended. Id. at 58. Young characterized her 21 ORDER DENYING CROSS-MOTIONS FOR PARTIAL SUMMARY 1 level of pain due to the May 2017 accident, at the time of the May 17 phone call, as 2 a “7 or 8” on a 10-point scale. Id. at 57.

3 At the time of Young’s May 2017 accident, her automobile insurance policy 4 with Standard covered personal injury protection (“PIP”) subject to a $35,000.00 5 limit for medical and hospital expenses. ECF No. 91 at 45−46. The policy provided

6 for benefits to the insured for “bodily injury,” which, by definition, was “caused” by 7 the accident and arose out of “the ownership, maintenance or use of a ‘motor 8 vehicle’ as a ‘motor vehicle.’” ECF No. 91 at 50, 85. The benefits included “[a]ll 9 reasonable and necessary expenses incurred within three years from the date of the

10 accident for . . . [m]edical . . . services.” Id. at 50. 11 Following the accident, Young incurred $1000 in urgent care expenses and 12 began treatment with chiropractor Jamie Gore, D.C., on May 17, 2017. ECF Nos.

13 97-1 at 42; 88-12 at 8. The claims adjuster initially earmarked PIP medical benefits 14 reserves for the urgent care treatment and up to two chiropractic treatment sessions 15 per week for up to twelve weeks. ECF No. 97-1 at 68. On June 8, 2017, the claims 16 adjuster noted that Young reported ongoing neck pain that she was treating with

17 acupuncture and massage, in addition to continued chiropractic treatment. Id. at 67. 18 On July 14, 2017, the claims adjuster added up to two acupuncture treatment 19 sessions per week for up to eight weeks to the benefits reserve and made a note that

20 the chiropractic treatment records indicated that “all areas are complicated by prior 21 ORDER DENYING CROSS-MOTIONS FOR PARTIAL SUMMARY 1 injury.” Id. at 66−67. Nonetheless, during July and August 2017, Standard 2 continued to increase the reserve amount based on information it received from

3 Young and her treatment providers regarding her treatment plan and symptoms. See 4 ECF No. 97-1 at 63−67. 5 However, on September 8, 2017, Standard’s claims adjuster informed Young

6 that the insurer was suspending its payment of PIP benefits as of September 18, 7 2017, and requesting that Young submit to an independent medical examination 8 (“IME”). ECF No. 97-1 at 63. The letter that Standard sent to Young dated 9 September 8, 2017, informed Young that Standard was requesting to schedule an

10 IME “to determine if the treatment [Young was] receiving is reasonable, necessary, 11 and related to [the accident on May 11, 2017].” ECF No. 88-9 at 2. The letter 12 further stated:

13 A medical authorization form is being sent to you at this time with a provider list form. Upon receipt of the completed unrestricted and 14 signed medical authorization and the provider form, [Standard] will request your current and prior medical records. Upon receipt of the 15 records, an [IME] will be scheduled.

16 Please be advised until we have an opportunity to determine if your treatment is reasonable, necessary and related to the accident referenced 17 above, [Standard] will handle your [PIP] claim under a reservation of rights. 18 Id. 19 20 21 ORDER DENYING CROSS-MOTIONS FOR PARTIAL SUMMARY 1 The parties dispute the reasons that the IME was not scheduled in fall 2017, 2 with Young asserting that Standard could have scheduled the IME before receiving

3 her prior medical records and Standard attributing the delay to Young’s initially 4 limited medical release and scheduling conflicts involving both Young and the 5 examining practitioners. ECF Nos. 97 at 5; 105 at 15. However, it suffices for

6 purposes of the present motions to acknowledge that the IME did not occur between 7 September 2017 and the end of that year. 8 Young filed a Complaint in Spokane County Superior Court on January 9, 9 2018, contesting the alleged denial of benefits. ECF No. 1. Young alleged

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Young v. The Standard Fire Insurance Company, Counsel Stack Legal Research, https://law.counselstack.com/opinion/young-v-the-standard-fire-insurance-company-waed-2019.