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Torres-Gonzales v. State Farm Fire and Casualty Co.

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

November 3, 2014



JAMES L. ROBART, District Judge.


This matter comes before the court on Defendant State Farm Fire and Casualty Company's ("State Farm") motion for summary judgment. ( See Mot. (Dkt. # 9).) This is an insurance case. State Farm contends that Plaintiff Jesus Torres-Gonzales has forfeited his right to recover under his insurance policy because he did not cooperate with State Farm's investigation into his claim. Having considered the submissions of the parties, the balance of the record, and the relevant law, and no party having requested oral argument, the court DENIES State Farm's motion for summary judgment.


Mr. Torres-Gonzales was involved in a motor vehicle collision in December, 2011. (Dougherty Decl. (Dkt. # 17) ¶ 2.) He claims that the operator of the other motor vehicle was negligent, at fault, and underinsured. (Compl. (Dkt. # 1) ¶ 4.3-4.4.) He claims that he suffered injuries to his back, neck, knees, and shoulder as a result of that collision. (Dougherty Exs. (Dkt. # 17-1) Ex. F ("IME") at 2.) Mr. Torres-Gonzales eventually reached a settlement with the at-fault driver's insurance carrier for an unknown amount. ( See Resp. (Dkt. # 13) at 2; McLellan Decl. (Dkt. # 12) Ex. A[1] ("Denial Letters").)

At the time of the collision, Mr. Torres-Gonzales held an automobile insurance policy from State Farm that included underinsured motorist ("UIM") coverage. (Compl. ¶ 4.1.) Mr. Torres-Gonzales filed a claim under the UIM provision and supported this claim with a "demand package" sent to State Farm in August, 2013. (Resp. at 2.) Although the exact contents of the original demand are not in the record, it appears that Mr. Torres-Gonzales claimed at least $32, 776.35 in medical expenses and $3, 424.00 in past lost wages. ( See Dougherty Decl. ¶ 2; Dougherty Exs. Ex. C ("Wage Calc."); Plf. Damages Stmt. (Dkt. # 3) at 8.) The past lost wages corresponded to a period from December 12, 2011, to June 11, 2012. ( See Wage Calc.) To support his lost wages claim, Mr. Torres-Gonzales provided paystubs from his employment as a construction worker with Mods by Morgan, LLC ("Mods") for September through December, 2011, W2 Wage and Tax Statements from Mods from 2009 through 2011, and his own tax returns from 2009 through 2011. (Dougherty Exs. Ex. A ("Tax Forms").) He also provided two recorded interviews to State Farm. (McLellan Decl. ¶ 3.)

During Mr. Torres-Gonzales' second interview, State Farm's claims representative identified some inconsistencies in his wage documents. (McLellan Decl. Ex. B ("Rec. Stmt.").) First, Mr. Torres-Gonzales' paystubs and W2 forms list a different social security number than his tax returns. ( Id. at 5; see also Tax Forms.) Second, Mr. Torres-Gonzales driver's license apparently states a different address than his W2 statements and tax returns. ( Id. at 3.) Mr. Torres-Gonzales stated that the social security number on his tax returns was his true social security number. (Rec. Stmt. at 5.) He also stated that he had been using his old address because his boss had not updated his information at work to include his new address. ( Id. ) The claims representative indicated that she would "follow up" once she received more information to help her verify the wage claims. ( Id. at 7.) It appears that she requested additional paystubs and tax forms from a third, unidentified party in the room, who was presumably Mr. Torres-Gonzales' lawyer.[2] ( Id. )

After that interview, Mr. Torres-Gonzales provided State Farm with wage loss documentation from the owner of Mods that corroborated his employment and the hours of work he missed during 2012, as well as a a stipulation and authorized release of employment records that permitted Mods to release Mr. Torres-Gonzales' employment records directly to State Farm. ( See Dougherty Exs. Ex. G ("2012 W2"), Ex. B ("Wage Documentation"), Ex. D ("Auth. Release").) Mr. Torres-Gonzales also submitted to an independent medical examination. ( See IME.)

Catherine McLellan, the claims adjuster who handled Mr. Torres-Gonzales' claim, testifies that entries in the claims activity log from October to December 2013 state: "They are currently making a UIM claim and additional documentation has been requested as well as a follow-up statement taken regarding wage loss, etc."[3] (McLellan Decl. ¶ 4.) She further asserts that the entries "indicate" that "tax returns for 2012, paystubs for three months prior to the claimed disability, and follow-up with different information on 2011 tax records and paystubs ha[d] been requested." ( Id. ¶ 6.) She states that the entries continue: "There is no documentation to support the wage loss they are requesting." ( Id. ) She concludes that one entry states: "Based on the documentation provided and the settlement amount from the underlying carrier, it appears that the insured... has been made whole." ( Id. )

Accordingly, in February, 2014, State Farm sent Mr. Torres-Gonzales a letter informing him that State Farm "had no additional money to offer above what the underlying carrier had paid." ( See Denial Letters at 1.) State Farm sent Mr. Torres-Gonzales several more letters to that effect, as well as a letter informing him that his request for arbitration was denied because the policy at issue required disputes to be resolved in litigation. ( See id. at 2-6.)

In response, Mr. Torres-Gonzales filed an action in Washington State court. (Not. of Rem. (Dkt. # 1).) State Farm promptly removed the action to federal court; the case arrived on September 10, 2014. ( See id. ) Less than one month later, State Farm moved for summary judgment. ( See Mot.) As of the date of this order, a discovery schedule has yet to be set, and the deadline for initial discovery disclosures has not passed. ( See 9/18/14 Ord. (Dkt. # 7).) Nonetheless, State Farm argues that it is entitled to judgment as a matter of law that Mr. Torres-Gonzales' suit is barred because he failed to cooperate with State Farm's investigation into his claim. ( See Mot.)

State Farm bases its argument on the following provisions of the insurance policy. First, State Farm's policy requires: "The insured must cooperate with us and, when asked, assist us in: (1) making settlements; (2) securing and giving evidence; and (3) attending... depositions, hearings, and trials." (Policy (Dkt. # 16-1) at 2.) Second, a UIM claimant must "provide written authorization for us to obtain: (a) medical bills, (b) medical records, (c) wage, salary, and employment information; and (d) any other information we deem necessary to substantiate the claim." ( Id. at 3.) "If the holder of the information refuses to provide it to us despite the authorization, then at our request the person making claim or his or her legal representative must obtain the information and promptly provide it to us...." ( Id. ) State Farm's motion for summary judgment is now before the court.


A. Summary Judgment ...

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