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Schreib v. American Family Mutual Insurance Co.

United States District Court, W.D. Washington, Seattle

August 25, 2014

THERESA L. SCHREIB, Plaintiff,
v.
AMERICAN FAMILY MUTUAL INSURANCE CO., Defendant.

ORDER DENYING PARTIAL SUMMARY JUDGMENT

JAMES L. ROBART, District Judge.

I. INTRODUCTION

This matter comes before the court on Plaintiff Theresa Schreib's motion for partial summary judgment. (Mot. (Dkt. #13).) This case arises from a dispute over the value of Ms. Schreib's claim for underinsured motorist ("UIM") benefits against Defendant American Family Mutual Insurance Co. ("American Family"). Having considered the submissions of the parties, the balance of the record, and the relevant law, and deeming oral argument unnecessary, [1] the court DENIES Ms. Schreib's motion for partial summary judgment.

II. BACKGROUND

Ms. Schreib was involved in an uncontested liability automobile collision in April, 2009. (Compl. (Dkt #3) ¶ 2.1.) Ms. Schreib alleges that, as a result of the collision, she incurred injuries to her neck, back, and hip, as well as a mild traumatic brain injury. ( Id. ¶ 2.5.) American Family disputes the extent to which Ms. Schreib's alleged injuries were caused by the collision. ( See generally Resp. (Dkt. #18).)

At the time of the collision, Ms. Schreib held an automobile insurance policy from American Family that included, among other things, UIM coverage with a policy limit of $500, 000.00. (Policy (Dkt. #20-19).) Ms. Schreib settled her claim against the tortfeasor who caused the collision and his insurer for $75, 000.00, the tortfeasor's policy limit. (Davis Decl. (Dkt. #14) ¶ 4.)[2] Ms. Schreib also received $56, 300.00 in personal injury protection ("PIP") medical and income loss benefits from her policy with American Family. ( Id. ¶ 5.)

In addition to recovering those amounts, Ms. Schreib submitted a claim to American Family for UIM benefits in spring of 2011. ( See Am. Fam. 5/3/11 Letter (Dkt. #20-1).) Ms. Schreib's attorney testifies that her initial request for UIM benefits was supported by "copies of Ms. Schreib's medical and billing records to date, employment records and/or wage loss documentation, and copies of the settlement demand packages sent to the tortfeasor's auto insurers." (Davis Decl. ¶ 8.) The record before the court, however, does not include either Ms. Schreib's initial request for UIM benefits or the documentation that allegedly accompanied it. ( See generally Davis Decl. Exs. 1-17; Dkt.)

Over the next several months, Ms. Schreib and American Family corresponded numerous times regarding her claim for UIM benefits. Initially, American Family "pended" Ms. Schreib's UIM demand and requested more information. (Am. Fam. 5/3/11 Letter.) Shortly thereafter, in June, 2011, American Family agreed to voluntarily waive its $56, 300.00 PIP subrogation claim against Ms. Schreib's settlement with the tortfeasor's insurer. (Am. Fam. 6/2/11 Letter (Dkt. #20-6).) In September, 2011, Ms. Schreib provided American Family with a medical report created in connection with her application for Social Security benefits. (Davis Decl. ¶ 10.) This report concluded that Ms. Schreib was medically disabled due to a traumatic brain injury. ( See SS Rep. (Dkt. #3).) In addition, Ms. Schreib's lawyer testifies that over the course of several months, his office provided American Family with "medical records, medical bills, witness statements, tax returns, and expert reports" supporting the value of her UIM claim. (2d Davis Decl. (Dkt. #23) ¶ 3.)

In November, 2011, American Family informed Ms. Schreib that it had determined that the combination of her settlement and the PIP waiver, which results in a total recovery $131, 300.00, was sufficient to fully compensate her for the injuries sustained in the collision. (Am. Fam. 11/1/11 Letter (Dkt. #20-7); Am. Fam. 11/9/11 Letter (Dkt. #20-8).) American Family based this decision on an independent medical review completed in September, 2009, by a neurosurgeon and a chiropractor. ( See 11/9/11 Letter.) This review, which evaluated Ms. Schreib's neck, back, and hip injuries, as well as the mental difficulties she was allegedly experiencing, concluded that further treatment was no longer necessary or likely to be effective and that Ms. Schreib was capable of performing her functional job activities going forward. ( See IME Rep. (Dkt. #19-1).)

In February, 2012, Ms. Schreib submitted a "settlement demand package" to American Family that included additional medical documentation regarding her injuries and formally requested payment of the $500, 000.00 UIM policy limit. (Davis Decl. ¶ 15; Davis 2/9/12 Letter (Dkt. #14-8); Am. Fam. 2/10/12 Letter (Dkt. #20-9); Am. Fam. 2/14/12 Letter (Dkt. #20-10).) This additional documentation, which is not contained in the record currently before the court, apparently consisted of medical records, reports, and billings concerning the various evaluations, procedures, and physical therapy that Ms. Schreib had undergone, including, for example, one doctor's diagnosis that she was suffering from a mild traumatic brain injury. ( See Davis 2/9/12 Letter; 2d Davis Decl. ¶ 4.) The formal demand for payment identified past medical expenses of over $90, 000.00 and estimated Ms. Schreib's damages as of that date date, including pain and suffering, to be over $900, 000.00. ( Id. )

American Family agreed to consider the new medical evidence and submitted Ms. Schreib's file to two consultants-an orthopedic surgeon and a neuropsychologist-for review. (Am. Fam. 2/14/12 Letter.) The orthopedic surgeon concluded that Ms. Schreib's hip injury was unrelated to the vehicular collision and instead stemmed from certain preexisting conditions. (Ortho Review (Dkt. #19-6) at 14-16.) The neuropsychologist concluded that Ms. Schreib did not sustain a traumatic brain injury from the collision. (Neuro Review (Dkt. #19-4) at 15, 18.)

In April, 2012, Ms. Schreib provided American Family with a report from an expert in vocational assessment and rehabilitation who concluded that Ms. Schreib was unemployable due to cognitive impairment caused by her mild traumatic brain injury. (Davis 4/2/09 Letter (Dkt. #14-11); Job Rep. (Dkt. #14-10).) Ms. Schreib also provided American Family with a report from an economist that estimated Ms. Schreib's past and future lost earnings capacity to be over $2 million. (Davis Decl. ¶ 19; Earnings Rep. (Dkt. #14-12).)

In June, 2012, American Family formally informed Ms. Schreib that it had determined that she was fully compensated by her recovery to date of $131, 300.00, and that American Family therefore would not offer her any more compensation. (Am. Fam. 6/9/12 Letter (Dkt. #20-12).) American Family based this decision on the reviews provided by the orthopedic surgeon and neuropsychologist concluding that Ms. Schreib's hip and brain injuries were not causally connected to the collision. ( Id. )

Dissatisfied with this response, in December, 2012, Ms. Schreib requested that her claim be submitted to binding arbitration pursuant to the terms of the American Family policy. (Davis 12/14/12 Letter (Dkt. 14-16).) In preparation for the arbitration, the parties engaged in more medical fact-finding and evaluation. Specifically, Ms. Schreib supported her claim for benefits with, among other materials, (1) a report from her counselor, (2) a report by a neurological consultant, and (3) an independent medical examination by a medical doctor. (Jaeger Decl. ¶ 6; Dkt. ##19-19 through 19-21.) American Family, for its part, supported its position that Ms. Schreib had been fully compensated with (1) a report from a neuropsychological ...


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