United States District Court, W.D. Pennsylvania
BARBARA A. BAUM, Plaintiff
METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY, t/d/b/a METLIFE AUTO & HOME, Defendant
CHRISTOPHER C. CONNER, CHIEF JUDGE UNITED STATES DISTRICT
Barbara Baum (“Baum”) is a tetraplegic who was
hit by an underinsured motorist while operating her
wheelchair in a parking lot. Baum filed an underinsured
motorist claim (“UIM”) with her insurer,
defendant Metropolitan Property & Casualty Insurance
Company (“MetLife”), for damages she claims she
is “legally entitled” to as a result of the
accident. Baum argues that MetLife reviewed her claim in bad
faith, in violation of 42 Pa. Cons. Stat. § 8371, and
breached her insurance policy. (Doc. 95). MetLife moves for
summary judgment on both counts under Federal Rule of Civil
Procedure 56. (Docs. 89, 91). We will grant in part and deny
in part MetLife’s motion for summary judgment.
Factual Background & Procedural History
Baum is a tetraplegic and a Pennsylvania resident who used a
wheelchair for mobility before the incident underlying this
litigation. (Doc. 9 ¶¶ 1-2; Doc 20 ¶¶
1-2). On January 31, 2014, a car driven by Leanne Diamond
(“Diamond”) struck Baum as she exited a Target
department store and headed toward her own car in the parking
lot. (Doc. 102 ¶ 1). Baum was thrown from her wheelchair
and fractured her fourth and fifth metatarsals in her right
foot and the second and fifth metatarsals in her left foot.
(Id. ¶ 2). Baum claims that, as a result of the
accident, she has suffered from exacerbated episodes of
autonomic dysreflexia (“AD”). (Doc. 95 at 8;
see also Doc. 105-8, Andrzejczyk Dep.
has a long and well-documented history of medical treatment.
(See, e.g., Docs. 103-2, 103-3, 103-4,
103-7, 105-1, 105-2, 105-3, 105-6). Of unique importance here
is Baum’s preexisting diagnosis of AD, which she
received after she suffered a spinal cord injury in an
unrelated automobile accident in 1974. (Doc. 102 ¶ 4;
Doc. 103-4 at 1; see also Doc. 105-6 at
The parties dispute whether Baum’s exacerbated A.D.
symptoms are a product of the January 31, 2014 accident or a
continuation of Baum’s preexisting condition. (Doc. 104
¶¶ 2, 3, 18-20, 25, 26; Doc. 106 ¶¶
29-33). Baum claims she suffered few A.D. episodes before the
accident but has suffered from exponentially more since.
(See, e.g., Doc. 95 at 8). MetLife argues
that Baum’s assertion is not adequately supported by
objective medical evidence. (See, e.g.,
Doc. 106 ¶¶ 27, 29, 30).
filed a claim with Diamond’s insurance company, State
Farm, after the accident. (Doc. 9 ¶ 14; Doc 20 ¶
14). State Farm offered Baum $50, 000-the limit on
Diamond’s policy-for her injuries resulting from the
accident. (Doc. 9 ¶ 15; Doc. 20 ¶ 15). On November
21, 2014, Baum submitted a UIM claim to MetLife for $325,
000. (Doc. 105-11 at 1; Doc. 9 ¶ 18; Doc. 20 ¶ 18).
Baum’s UIM policy provides:
We will pay compensatory damages which an insured is legally
entitled to recover from the owner or operator of an
underinsured motor vehicle for BI:
A. sustained by an insured; and B. caused by an accident
arising out of owning, maintaining, or the use of an
underinsured motor vehicle.
102 ¶ 10). The policy limit is $1, 000, 000. (Doc. 104
¶ 37). On December 11, 2014, MetLife offered Baum $20,
000 for full settlement of her claim. (Doc. 9 ¶ 20; Doc.
20 ¶ 20). Baum declined MetLife’s offer. (Doc.
started its investigation shortly after Baum submitted her
UIM claim, employing senior claims adjuster Ceenelle
Johnson-Sanders (“Johnson-Sanders”) to review
Baum’s case. (See Doc. 105-7, Johnson-Sanders
Dep. 20:10-13, 28:25-29:5). Johnson-Sanders has been a claims
adjuster for several years but does not have a medical
degree. (Id. at 8:9-9:11). MetLife also employed a
claims medical consultant, nurse Ruth Rappaport
(“Rappaport”), to assist Johnson-Sanders with her
review of Baum’s medical condition and to offer
alternative options for investigating medical conditions if
needed. (Id. at 47:24-48:11; Doc. 105-10, Rappaport
Dep. 72:7-78:3). Neither Johnson-Sanders nor Rappaport had
experience evaluating claims involving A.D. before
Baum’s case. (See Johnson-Sanders Dep.
160:9-15; Rappaport Dep. 81:3-7).
of her evaluation, Johnson-Sanders reviewed Baum’s
medical records, (Johnson-Sanders Dep. 101:20-22), used
Rappaport’s expertise in reviewing Baum’s
records, (see Doc. 104 ¶¶ 61-62;
Johnson-Sanders Dep. 157:6-22), and reviewed a narrative
report from Baum’s doctor, Dr. Amanda Harrington
(“Dr. Harrington”), (see Johnson-Sanders
Dep. 155:11-159:2; see also Doc. 102 ¶¶
18-19; Doc. 104 ¶¶ 18-19). Johnson-Sanders
testified that she considered Baum’s medical records
and Dr. Harrington’s narrative report. (Johnson-Sanders
Dep. 157:14-22, 198:9-16). Still, the parties dispute how
much Dr. Harrington’s report influenced MetLife’s
decision to reject Baum’s settlement demand and
challenge her damages figure. (See, e.g.,
Doc. 102 ¶¶ 18-19; Doc. 104 ¶¶ 18-19).
Harrington began treating Baum in February 2014, ten days
after the accident. (Doc. 102 ¶ 6). Dr. Harrington is a
board-certified physiatrist, a professor at the University of
Pittsburgh, and the Director of the Spinal Cord Injury
Services group at the University of Pittsburgh Medical
Center. (Doc. 105-12 at 1). As part of her consultation, Dr.
Harrington drafted a narrative report summarizing
Baum’s previous diagnoses, her understanding of the
January 31, 2014 accident, her recommended treatment, and her
medical opinion on the severity and cause of Baum’s
symptoms. (Doc. 105-12 at 4-10). Dr. Harrington’s
In Ms. Baum’s case, she only had occasional episodes of
autonomic dysreflexia in the years following her initial
spinal cord injury in 1974. However, since the accident
occurring January 31, 2014, she has had increasing
intermittent episodes of autonomic dysreflexia. It is likely
that both the edema, increase in spasticity, and increased
episodes of autonomic dysreflexia are secondary to the foot
fractures. I had initially hoped that as she healed and her
pain was controlled her problems with improve; however, since
it has been 1 year since her accident and these problems are
not resolving, I am concerned that this now may be her new
normal. It is with a reasonable degree of medical certainty
that the foot fractures were the direct cause of the
secondary effects of edema, spasticity, and autonomic
dysreflexia, and I am concerned that she may now have chronic
swelling, increase in her spasticity and increase in
frequency of her episodes of autonomic dysreflexia for the
duration of her life.
(Doc. 105-12 at 9).
of her investigation, Johnson-Sanders never obtained a
statement under oath from Baum. (Doc. 104 ¶ 48).
Johnson-Sanders also did not arrange for an independent
medical review (“IMR”) of Baum’s records or
an independent medical examination (“IME”) of
Baum herself, despite a March 2015 suggestion from Rappaport
that Johnson-Sanders “consider obtaining an IME spinal
cord injury specialist for further comment.” (Doc. 104
¶¶ 51-54; Doc. 105-6 at 46). Johnson-Sanders could
have pursued an IME to obtain additional medical opinions on
Baum’s condition. (See Doc. 104 ¶¶
46, 51-54; see also Andrzejczyk Dep. 67:1-4).
Johnson-Sanders testified that she in fact asked Baum’s
attorney if Baum would undergo an IME. (Johnson-Sanders Dep.
101:3-104:13). Her claim is contradicted by testimony from
Baum’s attorney and Johnson-Sanders’s supervisor,
and her purported IME request is not documented in the
MetLife claims file. (See Doc. 105-9, Glassmith Dep.
38:9-40:11; Andrzejczyk Dep. 83:14-20).
28, 2015, MetLife had obtained the final set of Baum’s
medical records. (See Docs. 105-14, 105-15; see
also Doc. 104 ¶¶ 74-75; Doc. 106 ¶¶
74-75). On July 1, 2015, Baum demanded a “legitimate
offer” from MetLife, threatening to sue if no offer was
made by July 13, 2015. (Doc. 105-17). On July 10, 2015,
MetLife offered Baum $25, 000 for full settlement of her
claim. (Doc. 9 ¶ 30; Doc. 20 ¶ 30). The parties
ceased contact on December 11, 2015, without coming to a
settlement agreement. (Doc. 9 ¶¶ 31-32; Doc. 20
¶¶ 31-32). On April 25, 2016, Baum sued MetLife in
the Allegheny County Court of Common Pleas. (Doc. 1-2).
litigation began, MetLife hired Dr. James Cosgrove
(“Dr. Cosgrove”) to perform an IME. (Doc. 104
¶ 78). Dr. Cosgrove evaluated Baum on July 24, 2017 and
completed a corresponding report on February 21, 2018.
(See Doc. 103-7). Cosgrove found:
Given that the fractures have gone on[ ]to heal uneventfully,
persistent exacerbation of spasticity and dysreflexia is
unlikely. … Furthermore, there has been no significant
change in medication use when comparing pre- to post-injury
medication use. … There is no clear objective
difference noted from a neurologic or musculoskeletal
standpoint when comparing pre- to post-accident status. There
have been no fulminate episodes of autonomic dysreflexia and
no evidence of acute medical management or hospitalization.
(Id. at 10-11). In sum, Dr. Cosgrove concluded that
the January 31, 2014 accident did not cause Baum’s
exacerbated A.D. symptoms. (See id. at 9-11).
sued MetLife in the Allegheny County Court of Common Pleas
alleging breach of contract and bad faith in violation of 42
Pa. Cons. Stat. § 8371. MetLife removed the case to this
court. Baum then filed an amended complaint, which MetLife
moved to dismiss. Judge Conti denied MetLife’s motion
at a September 19, 2016 hearing, and MetLife filed its
answer. MetLife also moved to join three nonparties
affiliated with the Target parking lot where the accident
occurred. Judge Conti denied that motion but requested
supplemental briefing on whether the nonparties are joint
tortfeasors who should be included on the verdict slip. After
the case was reassigned, we denied MetLife’s ...