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Neal v. State Farm Mutual Automobile Insurance Co.

United States District Court, M.D. Pennsylvania

May 12, 2015

SHARON NEAL, Plaintiff
v.
STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant

MEMORANDUM

Kane, Judge.

Before the Court is Defendant State Farm Mutual Automobile Insurance Company’s motion for partial summary judgment, and its motion to bifurcate the trial. (Doc. No. 22.) For the reasons that follow, the Court will grant the motion for summary judgment, and deny as moot the motion to bifurcate the trial.

I. BACKGROUND[1]

On or about January 27, 2011, Plaintiff Sharon Neal was a passenger in a car when it was rear-ended at a stop light. (Doc. No. 21 ¶ 3.) At the time of the accident, Plaintiff had automobile insurance provided by Defendant that included, among other provisions, $25, 000 in medical payments coverage. (Id. ¶ 4.) On February 28, 2011, Plaintiff reported the claim to Defendant and communicated with Defendant’s claim representative Donna Samarya. (Id. ¶ 5.) Plaintiff informed Ms. Samarya that her neck and back areas were injured in the accident. (Id.) Plaintiff also informed Ms. Samarya that she previously had neck and back injuries following a 2005 accident, [2] that she had a left knee replacement in 2009, and that she was on disability due to her medical history. (Id.) Plaintiff further informed Ms. Samarya that she was nevertheless “doing fine” until the January 27, 2011 accident.[3] (Id.)

On June 23, 2011, Defendant was informed that Penn Rehabilitation Associates had been treating Plaintiff since her 2005 accident and had seen her as recently as January 3, 2011. (Doc. No. 21 ¶ 6.) Ms. Samarya thereafter wrote and called Penn Rehabilitation Associates for copies of Plaintiff’s pre-accident records. (Id. ¶¶ 7-10.) After Ms. Samarya received the records, she communicated with Plaintiff and requested that an independent medical examination (“IME”) be performed on Plaintiff to address if her ongoing complaints were still accident related and whether she had reached pre-injury status from the accident. (Id. ¶¶ 10-12.)

Accordingly, on February 7, 2012, Defendant contacted a vendor, The Prime Network, requesting that it arrange an IME by an orthopedic surgeon. (Doc. No. 21 ¶ 14.) The Prime Network initially scheduled another physician to perform the IME; however, Plaintiff requested an examination closer to Harrisburg, her residence, so The Prime Network arranged for Dr. Walter C. Peppelman to perform the IME. (Id. ¶¶ 15-16.) Prior to going to the IME, Plaintiff briefly discussed Dr. Peppelman with her current physician, Dr. Zeliger; the two doctors formerly had a practice together. (Id. ¶ 19.)

Dr. Peppelman conducted the IME on May 10, 2012. Among his many conclusions were the observations that: (1) he was “unable to detect any specific injury which occurred from the most recent motor vehicle accident;” (2) “[Plaintiff] at the time of the event, may have had a cervical or lumbar strain and sprain, but this has reached maximal medical improvement and full recovery;” (3) “[Plaintiff’s] physical examination shows significant finding of symptom magnification and inappropriate illness behavior;” and that (4) “[Plaintiff] has reached her pre-injury status . . . . [Plaintiff] has reached full recovery from the accident on January 27, 2011, and from any alleged injury which may have occurred during the accident.” (Doc. Nos. 21 ¶ 24; 19-2 at 65-70.)

Claim representative Michele Depola received the report of Dr. Peppelman on May 17, 2012, and Defendant decided that all bills after the date of the IME would be denied. (Doc. No. 21 ¶ 38.) That same day, Ms. Depola wrote to Plaintiff, specifically noting Dr. Peppelman’s conclusion that Plaintiff had reached “pre-injury” status – that is, her status prior to the January 27, 2011 accident. (Id. ¶ 19.) Plaintiff has continued to receive treatment (Doc. No. 23 ¶ 47); however, the parties dispute whether Dr. Peppelman’s assessment was correct and whether the injuries are in fact attributable to the January 27, 2011 accident.[4]

On September 10, 2012, Plaintiff’s former attorney contacted and informed Defendant that Dr. Peppelman and Plaintiff’s treating physician, Dr. Zeliger, were formerly involved in a partnership with each other, and represented to Defendant that Dr. Peppelman had been involved with voting Dr. Zeliger out of the practice. (Doc. Nos. 23 ¶¶ 64-65; 23-1 at 7.) Defendant, however, did not reject the IME results or schedule a new examination.

On July 23, 2013, Plaintiff filed a complaint in the Court of Common Pleas of Dauphin County, Pennsylvania, arising out of Defendant’s refusal to pay benefits. (Id.) The five-count complaint brought claims that: (1) Defendant violated the Pennsylvania Motor Vehicle Financial Responsibility Law, 75 Pa. Stat. § 1716 et seq. (“MVFRL”); (2) Defendant breached its contract; (3) Defendant refused in bad faith to pay benefits in violation of 42 Pa. Stat. § 8371, (4) Defendant violated the Pennsylvania Unfair Trade Practices and Consumer Protection Law (“UTPCPL”), 73 Pa. Stat. § 201.1 et seq.; and (5) Defendant is liable for deceit. (Id.) On September 4, 2013 Defendant removed the action to this Court. Defendant thereafter filed a motion to dismiss, which the Court granted in part, dismissing Count Five (Deceit) and the claim for attorney’s fees for the breach of contract claim. (Doc. No. 11.)

Following discovery, on January 9, 2015, Defendant filed the present motion for partial summary judgment. (Doc. No. 19.) Defendant moves the Court to award judgment in its favor on Counts One, Three, and Four; Defendant has not moved for summary judgment on Count Two, breach of contract. (Id.) The motion is fully briefed and ripe for disposition.

II. LEGAL STANDARD

Rule 56(a) of the Federal Rules of Civil Procedure provides that summary judgment is warranted “if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(a). A factual dispute is material if it might affect the outcome of the suit under the applicable law, and it is genuine only if there is a sufficient evidentiary basis that would allow a reasonable fact finder to return a verdict for the non-moving party. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248-49 (1986). At summary judgment, the inquiry is whether the evidence presents a sufficient disagreement to require submission to the jury or whether it is so one-sided that one party must prevail as a matter of law. Id. at 251-52. In making this determination, the Court must “consider all evidence in the light most favorable to the party opposing the motion.” A.W. v. Jersey City Pub. Schs., 486 F.3d 791, 794 (3d Cir. 2007).

The moving party has the initial burden of identifying evidence that it believes shows an absence of a genuine issue of material fact. Conoshenti v. Pub. Serv. Elec. & Gas Co., 364 F.3d 135, 145-46 (3d Cir. 2004). Once the moving party has shown that there is an absence of evidence to support the non-moving party’s claims, “the non-moving party must rebut the motion with facts in the record and cannot rest solely on assertions made in the pleadings, legal memoranda, or oral argument.” Berckeley Inv. Grp. Ltd. v. Colkitt, 455 F.3d 195, 201 (3d Cir. 2006); accord Celotex Corp. v. Catrett, 477 U.S. 317, 324 (1986). If the non-moving party “fails to make a showing sufficient to establish the existence of an element essential to that party’s case, and on which that party will bear the burden at trial, ” summary judgment is warranted. Celotex, 477 U.S. at 322. With respect to the sufficiency of the evidence that the non-moving party must provide, a court should grant summary judgment when the non-movant’s evidence is merely colorable, conclusory, or speculative. Anderson, 477 U.S. at 249-50. There must be more than a scintilla of evidence supporting the non-moving party and more than some metaphysical doubt ...


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