Young v. The Standard Fire Insurance Company

CourtDistrict Court, E.D. Washington
DecidedJune 12, 2020
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. 2020).

Opinion

2 FILED IN THE U.S. DISTRICT COURT EASTERN DISTRICT OF WASHINGTON 3 Jun 12, 2020

4 SEAN F. MCAVOY, CLERK

5 UNITED STATES DISTRICT COURT EASTERN DISTRICT OF WASHINGTON 6

7 DIANE YOUNG, individually NO: 2:18-CV-31-RMP 8 Plaintiff, ORDER RESOLVING MOTION FOR 9 v. PARTIAL SUMMARY JUDGMENT

10 THE STANDARD FIRE INSURANCE COMPANY, a foreign 11 insurance company,

12 Defendant.

13 14 BEFORE THE COURT is a Motion for Partial Summary Judgment by 15 Defendant Standard Fire Insurance Company. ECF No. 121. Having reviewed the 16 briefing, the remaining record, the relevant law, and having heard oral argument, the 17 Court is fully informed. 18 BACKGROUND 19 The Court previously recited much of the relevant background in its prior 20 summary judgment order, but repeats some of the history to the extent necessary to 21 resolve the present motion. See ECF No. 111. Plaintiff has alleged the following 1 claims: (1) violation of Revised Code of Washington (“RCW”) 48.17 et seq. and 2 related Washington Administrative Code (“WAC”) provisions; (2) violation of the

3 Washington Consumer Protection Act (“CPA”), RCW 19.86 et seq.; (3) breach of 4 contract; (4) declaratory relief; (5) insurance bad faith; (6) violations of 5 Washington’s Insurance Fair Conduct Act (“IFCA”), RCW 48.30.010−.015; (7)

6 negligence; (8) injunctive relief; and (9) negligent and intentional infliction of 7 emotional distress. ECF No. 38 (First Amended Complaint). 8 The Court previously dismissed Plaintiff’s class allegations in the Amended 9 Complaint, but denied Defendant’s prior summary judgment motion on the basis that

10 there is a dispute of fact whether Defendant unreasonably delayed requesting an 11 IME or took other actions amounting to bad faith or unfair conduct. ECF No. 111 at 12 13−14. The dispute is material because it will determine whether Defendant’s

13 investigation of Plaintiff’s claim was “reasonable” under WAC § 284-30-330 for 14 purposes of Plaintiff’s breach of contract, CPA, and bad faith claims, which are all 15 based on Plaintiff’s contention that Defendant violated the WAC. See id.; ECF No. 16 38. In this motion, Defendant moves only for summary judgment on Plaintiff’s

17 IFCA, injunctive relief, and intentional infliction of emotional distress, or outrage, 18 claims. ECF No. 129 at 9. 19 Plaintiff’s claims arise out of her central contention that Defendant wrongfully

20 denied personal injury protection (“PIP”) for injuries that Young allegedly sustained 21 in a car accident in May 2017. Plaintiff alleges that Defendant should not have 1 suspended payment pending investigation of Plaintiff’s claims and completion of an 2 independent medical examination (“IME”), when her treating physicians already had

3 determined that the treatment she was receiving was reasonable, necessary, and 4 related to the accident in which she was injured. 5 Several years before the incident upon which this lawsuit is based, Plaintiff

6 was injured in an accident on September 12, 2013. While driving in a wilderness 7 area of Canada, Plaintiff lost control of her vehicle, which rolled seven times, and 8 fractured her neck and back. ECF No. 91 at 58. Plaintiff recovered from her injuries 9 with treatment that included a halo neck brace, massage, acupuncture, physical

10 therapy, chiropractic services, and the care of a physiatrist. See ECF No. 97-1 at 11 153. 12 The parties dispute whether Plaintiff continued to have pain or other

13 symptoms from her 2013 injuries into 2017. Plaintiff maintains that by January 11, 14 2017, she reported to her new primary care provider, Nurse Practitioner Mary 15 Bachko, that she was experiencing nothing more than tension in her upper-mid back 16 as a residual symptom from her 2013 injuries. ECF No. 98 at 4. Defendant

17 emphasizes that the records from the January 11 appointment with Nurse 18 Practitioner Bachko indicate that “chronic back pain” was a problem for Young at 19 the time of her new patient appointment. See ECF No. 89 at 5. However, the

20 deposition testimony of Nurse Practitioner Bachko clarifies that Plaintiff did not tell 21 1 her that she had chronic back pain; rather, Plaintiff only informed Bachko that she 2 had “upper mid-back tenseness on occasion.” ECF No. 97-1 at 153.

3 On May 11, 2017, Plaintiff was involved in an accident in which she was rear- 4 ended at low speed by a pickup truck. ECF Nos. 111 at 3; 91 at 54; and 97-1 at 63. 5 On May 17, 2017, Plaintiff reported the collision to Defendant and conveyed that

6 she was experiencing pain in her neck, back, low back, shoulders, sternum, and a toe 7 on her left foot. ECF No. 91 at 55−56. Plaintiff told Defendant that she had fully 8 recovered from her 2013 accident by May 11, 2017, and that she “had no pain” from 9 her prior accident at the time that she was rear-ended. Id. at 58. At the time of the

10 May 17 phone call, Plaintiff characterized her level of pain due to the May 2017 11 accident as a “7 or 8” on a 10-point scale. Id. at 57. 12 At the time of the May 2017 accident, Plaintiff’s automobile insurance policy

13 with Defendant covered personal injury protection (“PIP”) subject to a $35,000.00 14 limit for medical and hospital expenses. ECF No. 91 at 45−46. The policy provided 15 for benefits to the insured for “bodily injury,” which, by definition, was “caused” by 16 the accident and arose out of “the ownership, maintenance or use of a ‘motor

17 vehicle’ as a ‘motor vehicle.’” ECF No. 91 at 50, 85. The benefits included “[a]ll 18 reasonable and necessary expenses incurred within three years from the date of the 19 accident for . . . [m]edical . . . services.” Id. at 50.

20 Following the accident, Plaintiff incurred $1000 in urgent care expenses and 21 began treatment with chiropractor Jamie Gore, D.C., on May 17, 2017. ECF Nos. 1 97-1 at 42; 88-12 at 8. The claims adjuster initially earmarked PIP medical benefits 2 reserve for the urgent care treatment and up to two chiropractic treatment sessions

3 per week for up to twelve weeks. ECF No. 97-1 at 68. On June 8, 2017, the claims 4 adjuster noted that Plaintiff reported ongoing neck pain that she was treating with 5 acupuncture and massage, in addition to continued chiropractic treatment. Id. at 67.

6 On July 14, 2017, the claims adjuster added up to two acupuncture treatment 7 sessions per week for up to eight weeks to the benefits reserve and made a note that 8 the chiropractic treatment records indicated that “all areas are complicated by prior 9 injury.” Id. at 66−67. Nonetheless, during July and August 2017, Defendant

10 continued to increase the reserve amount based on information it received from 11 Plaintiff and her treatment providers regarding her treatment plan and symptoms. 12 See ECF No. 97-1 at 63−67.

13 However, on September 8, 2017, Defendant’s claims adjuster informed 14 Plaintiff that payment of further PIP benefits would be suspended as of September 15 18, 2017, and requested that Plaintiff submit to an IME. ECF Nos. 111 at 5; 97-1 at 16 63. The letter that Defendant sent to Plaintiff dated September 8, 2017, informed

17 Plaintiff that Defendant was requesting to schedule an IME “to determine if the 18 treatment [Plaintiff was] receiving is reasonable, necessary, and related to [the 19 accident on May 11, 2017].” ECF No. 88-9 at 2. The letter further stated:

20 A medical authorization form is being sent to you at this time with a provider list form.

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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-2020.