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Baum v. Metropolitan Property and Casualty Insurance Co.

United States District Court, W.D. Pennsylvania

September 26, 2019

BARBARA A. BAUM, Plaintiff



         Plaintiff 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.

         I. Factual Background & Procedural History [1]

         A. Factual Background

         Barbara 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. 78:7-79:2).[2]

         Baum 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 4).[3] 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).

         Baum 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.

         (Doc. 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. 105-17).

         MetLife 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).

         As part 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).

         Dr. 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 report concluded:

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).

         As part 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).

         By May 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).

         After 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).

         B. Procedural History

         Baum 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 ...

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