Roberts v. State Farm Mutual Automobile Insurance ( 2003 )

F I L E D
United States Court of Appeals
Tenth Circuit
UNITED STATES COURT OF APPEALS
MAR 26 2003
TENTH CIRCUIT
PATRICK FISHER
Clerk
RONALD W. ROBERTS,
Plaintiff - Appellant,
vs. No. 02-7052
(D.C. No. 01-CV-499-S)
STATE FARM MUTUAL (E.D. Okla.)
AUTOMOBILE INSURANCE
COMPANY,
Defendant - Appellee.
ORDER AND JUDGMENT *
Before KELLY, ANDERSON, and MURPHY, Circuit Judges. **
Plaintiff-Appellant Ronald W. Roberts appeals the district court’s dismissal
of his action against State Farm Mutual Automobile Insurance Company (“State
Farm”) pursuant to Fed. R. Civ. P. 56. Mr. Roberts filed the instant diversity
action in district court pursuant to 28 U.S.C. § 1332 alleging breach of his
*
This order and judgment is not binding precedent, except under the
doctrines of law of the case, res judicata, and collateral estoppel. This court
generally disfavors the citation of orders and judgments; nevertheless, an order
and judgment may be cited under the terms and conditions of 10th Cir. R. 36.3.
**
After examining the briefs and the appellate record, this three-judge
panel has determined unanimously that oral argument would not be of material
assistance in the determination of this appeal. See Fed. R. App. P. 34(a); 10th
Cir. R. 34.1(G). The case is therefore ordered submitted without oral argument.
insurance contract and breach of the duty of good faith and fair dealing (“bad
faith claim”). His complaint sought compensatory damages on both claims as
well as punitive damages on the bad faith claim. The parties later resolved the
breach of contract claim, leaving only the bad faith claim against State Farm. The
district court thereafter granted State Farm’s motion for partial summary
judgment and dismissed the action in its entirety. On appeal Mr. Roberts argues
that a genuine issue of material fact precluding summary judgment existed as to
whether State Farm committed bad faith in investigating and evaluating his claim.
Our jurisdiction arises under 28 U.S.C. § 1291, and we affirm.
Background
On September 11, 1998 Mr. Roberts was involved in an automobile
accident with an underinsured motorist in Muskogee, Oklahoma. At the time of
the accident Mr. Roberts had $75,000 available in underinsured motorist (“UM”)
coverage through State Farm, and the tortfeasor, who was solely at fault for the
accident, had a liability policy carrying $25,000 in liability coverage. State Farm
first became aware of a potential claim by Mr. Roberts on May 22, 2000 when his
former attorney, Esther Sanders (“Ms. Sanders”) sent a letter to State Farm
seeking information relating to his insurance coverage. The next day a State
Farm Claim Specialist provided the requested information to Ms. Sanders and
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requested that she send State Farm any medical records relating to Mr. Roberts’
injuries. Enclosed in the letter were medical records authorizations to be
completed by Mr. Roberts enabling State Farm to obtain medical information
directly from his health care providers.
Ms. Sanders’ next contact with State Farm did not occur until August of
2000 when she notified State Farm by telephone that she intended to file a state-
court action against the company to prevent expiration of the applicable statute of
limitations. 1 During this conversation Ms. Sanders notified State Farm that Mr.
Roberts had undergone arthroscopic surgery on his knee, at which point State
Farm renewed its request for medical records authorizations and medical
information. On October 11, 2000, nearly five months after State Farm’s first
request for medical information, Ms. Sanders provided State Farm with a
summary of Mr. Roberts’ medical expenses and lost wages together with medical
information she represented as constituting “all medical bills and medical records
related to treatment of injuries [Mr. Roberts] sustained in the wreck.” Aplt. App.
at 82. The letter claimed that Mr. Roberts had incurred $16,286.27 in medical
expenses and $3,024.64 in lost wages. Finally, on October 30, 2000, State Farm
received an executed medical records authorization permitting it to access Mr.
1
Although the suit was in fact filed, Ms. Sanders elected not to serve any
of the named parties in an attempt to facilitate a settlement. The case was later
dismissed without prejudice to being re-filed.
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Roberts’ medical records but disallowing all verbal communication with his
physicians unless Ms. Sanders was present.
The medical records obtained by State Farm revealed that on the day of the
accident Mr. Roberts went to the Muskogee Regional Medical Center complaining
of a headache, pain in his neck, and soreness and pain in his back and abdomen.
Three days after the accident Mr. Roberts visited his family physician, Dr. Chriss
Roberts, complaining of pain in his abdomen, neck and right knee. Dr. Roberts
prescribed pain medication and continued treating him as needed for the next 21
months until referring him to an orthopedist, Dr. R. Douglas Harper, on June 14,
2000. After diagnosing Mr. Roberts with “internal derangement” of the right
knee, Aplt. App. at 90, Dr. Harper performed outpatient arthroscopic surgery on
the knee on June 21, 2000. After a follow-up visit on June 29 Dr. Harper
commented that Mr. Roberts was “doing well” and authorized him to return to
light duty work as soon as July 5. Aplt. App. at 89. Dr. Harper thereafter saw
Mr. Roberts on three more occasions, with the last visit occurring on August 14,
2000. 2
Based on the foregoing information, Valina Enslen, a Claim Specialist at
Despite State Farm’s repeated requests for all pertinent medical records
2
and Ms. Sanders’ statement that the records enclosed in her October 11 letter
constituted “all medical bills and medical records” related to his injuries, State
Farm was never provided with any records of Mr. Roberts’ three visits to Dr.
Harper occurring after June 29, 2000.
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State Farm (“Ms. Enslen”), prepared an Injury Evaluation Form for Mr. Roberts
which listed his past medical expenses and wage loss as totaling $19,310.91,
based on the amounts submitted by Ms. Sanders. Aplt. App. at 81. She further
estimated Mr. Roberts’ future medical expenses as ranging between $1,000 and
$2,000, future wage loss between $100 and $1,000, and non-economic loss,
including future pain and suffering, from $5,000 to $8,000. Id. Accordingly, Ms.
Enslen’s evaluation range for Mr. Roberts’ claim was $25,410.91 to $30,310.91.
Because the tortfeasor’s carrier had already tendered its $25,000 liability policy
limits, State Farm determined the evaluation range for State Farm’s UM payment
to Mr. Roberts to be between $410.91 to $5,310.91.
Pursuant to the above evaluation, and taking into account the $25,000
payment already made, State Farm offered Mr. Roberts $2,000 to settle his UM
claim. Ms. Sanders responded with a $50,000 settlement demand, to which State
Farm responded with a $4,000 counter-offer. After State Farm tendered a $2,000
payment representing the initial settlement offer, Ms. Sanders demanded that
State Farm re-evaluate the claim, and threatened to re-file the previously
dismissed state-court action in federal court if no settlement could be reached by
a certain date. After discussing the claim with a State Farm attorney and a claims
manager, State Farm authorized Ms. Enslen to offer $15,000 beyond the $25,000
tendered by the tortfeasor’s carrier “if it would settle the case.” Aplt. App. at 12.
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After rejecting this latest offer Mr. Roberts filed the instant action in
district court on August 31, 2001 alleging that State Farm committed bad faith by
failing to properly investigate, evaluate and pay his claim. Applying Oklahoma
law, the district court granted State Farm’s motion for partial summary judgment,
holding that: 1) State Farm’s investigation was reasonable under the
circumstances, and 2) State Farm negotiated and handled Mr. Roberts’ claim in
good faith. This appeal followed.
Discussion
We review a grant of summary judgment de novo and apply the same
standard applied by the district court. Ashley Creek Phosphate Co. v. Chevron
USA, Inc., 315 F.3d 1245, 1253 (10th Cir. 2003). Summary judgment is proper
where “there is no genuine issue as to any material fact and . . . the moving party
is entitled to a judgment as a matter of law.” Fed. R. Civ. P. 56 (c). Moreover, a
dispute is “genuine” only “if the evidence is such that a reasonable jury could
return a verdict for the nonmoving party.” Anderson v. Liberty Lobby, Inc., 477
U.S. 242, 248 (1986). On appeal Mr. Roberts alleges that the district court erred
in granting partial summary judgment because 1) reasonable jurors could have
concluded that State Farm failed to discharge its duty of good faith by failing to
conduct an adequate investigation into the value of his claim, and 2) no good faith
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dispute existed as to the value of his claim, and that he therefore presented
sufficient evidence to survive a motion for summary judgment.
Under Oklahoma law, an insurer can be held liable for bad faith “only
where there is a clear showing that the insurer unreasonably, and in bad faith,
withholds payment of the claim of its insured.” Christian v. American Home
Assur. Co., 577 P.2d 899, 905 (Okla. 1977). Moreover, the Supreme Court of
Oklahoma has held that “bad faith cannot exist if an insurer’s conduct was
reasonable under the circumstances.” Barnes v. Okla. Farm Bureau Mut. Ins. Co.,
11 P.3d 162, 170-171 (Okla. 2000). This duty to act reasonably extends to the
manner in which an insurer investigates an insured’s claim. Buzzard v. Farmers
Ins. Co., Inc., 824 P.2d 1105, 1109 (Okla. 1991) (holding that an insurer has a
duty to “conduct an investigation reasonably appropriate under the
circumstances.”). For the following reasons we hold that summary judgment was
proper because no reasonable jury could have concluded that State Farm’s
investigation and evaluation of his claim was unreasonable.
As to his inadequate investigation claim, we note first that Mr. Roberts
does not contend that State Farm conducted no investigation or that the company
has “intentionally disregarded undisputed facts supporting the insured’s claim.”
Oulds v. Principal Mut. Life Ins. Co., 6 F.3d 1431, 1442 (10th Cir. 1993).
Likewise, Mr. Roberts does not dispute that State Farm repeatedly requested all
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relevant medical records, and he admits that none of the records provided by
himself, his attorney, or his doctors in any way indicated a possibility of
permanent impairment, osteoarthritis, or future medical care. Aplt. Br. at 11.
Rather, Mr. Roberts argues that although State Farm promptly requested his
records and based its evaluation on the information contained therein, which Ms.
Sanders represented to be complete, State Farm’s investigation was nonetheless
inadequate because it failed to seek additional information relating to his
damages. Specifically, Mr. Roberts argues that State Farm should have sought
additional information such as a narrative report from Dr. Harper or arranged to
meet with him to discuss the extent of his injuries, and that the failure to do so
amounted to bad faith. We disagree.
Although State Farm’s investigation may have resulted in an undervaluation
of Mr. Roberts’ claim, it was not because State Farm’s investigation was
“unreasonable under the circumstances.” State Farm began investigating the
claim almost as soon as it learned of a potential claim by Mr. Roberts. In fact,
State Farm requested medical records and medical records authorizations the day
after receiving the initial notice. In that letter State Farm specifically requested
Ms. Sanders to “forward any medical information on your clients . . . which
would help in evaluating their claims.” Aplt. App. at 84. When, almost three
months later, Ms. Sanders called to inform State Farm that Mr. Roberts had
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undergone surgery and to inform the company of her intention to file a state-court
action, State Farm renewed its request for medical records and information.
When Ms. Sanders finally provided this information, State Farm did not end its
investigation into the value of Mr. Roberts’ claim even though Ms. Sanders
represented that the records and bills she submitted were complete. Aplt. App. at
82, 235-36. As soon as State Farm received the medical records authorization
from Mr. Roberts, State Farm promptly sent it, along with a request for “all of the
clinical records for [Mr. Roberts] regardless of when they were created” to Dr.
Harper, Dr. Roberts, the hospital where he was initially treated, and the hospital
where his outpatient surgery was performed. Aplt. App. at 87, 88, 91, 95. Upon
receipt of the records, State Farm had no reason to believe that the records and
statements it had obtained from Mr. Roberts’ attorney and health care providers
were anything other than complete.
Moreover, we do not agree with Mr. Roberts that State Farm knew that his
knee was at risk for osteoarthritis and that it would never be as good as before the
injury. Mr. Roberts argues that notwithstanding the medical records’ silence on
this question, because State Farm in fact knew that his knee would never be the
same, it should have investigated further the possible extent of such future harm.
However, none of the portions of the record cited by Mr. Roberts support his
claim that State Farm personnel “knew” Mr. Roberts would suffer future
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complications, and we believe several demonstrate exactly the opposite. See, e.g.
Aplt. App. at 139. Moreover, even if State Farm did know that Mr. Roberts’ knee
would never completely heal, because its evaluation took into account future pain
and suffering, as well as future wage loss and medical expenses, see Aplt. App. at
81, 140, it cannot be said that State Farm wholly disregarded such information.
Of course, State Farm could have scheduled interviews with his doctors,
sought narrative reports, or followed up with his health care providers to ensure
that no relevant information was for whatever reason omitted from the records.
Under Oklahoma law, however, an insurer’s investigation need only be
reasonable, not perfect. Buzzard, 824 P.2d at 1109. In light of the fact that State
Farm requested all relevant information from Mr. Roberts’ attorney and his
doctors, and the fact that nothing in those records suggested they were incomplete
or erroneously omitted discussion of possible future knee problems, we agree with
the district court that no reasonable jury could have concluded that State Farm’s
investigation was unreasonable under the circumstances.
We reach a similar conclusion in regard to Mr. Roberts’ argument that State
Farm’s evaluation of his claim and the settlement offers that followed were
unreasonable, and that the district court therefore erred in granting summary
judgment. In interpreting Oklahoma law in this area, this court has held that “the
insurer does not breach [the duty of good faith] by refusing to pay a claim or by
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litigating a dispute with its insured if there is a ‘legitimate dispute’ as to coverage
or amount of the claim, and the insurer’s position is ‘reasonable and legitimate.’”
Thompson v. Shelter Mut. Ins. Co., 875 F.2d 1460, 1462 (10th Cir. 1989)
(quoting Manis v. Hartford Fire Ins. Co., 681 P.2d 760, 762 (Okla. 1984)). After
carefully reviewing the parties’ briefs, the record, and relevant Oklahoma
authorities, we believe that no reasonable jury could have concluded that State
Farm’s evaluation and settlement offers constituted bad faith under this standard.
First, we note that State Farm’s initial settlement offer was within the range
it assigned to Mr. Roberts’ claim. Thus, we are not presented with the situation
where an insurer has offered to settle a dispute in an amount below the range
assigned to the claim by the insurer’s own investigation. See Newport v. USAA,
11 P.3d 190,196-197 (Okla. 2000) (holding that after a reasonable investigation,
an insurer must promptly settle a claim “for the value or within the range assigned
to the claim as a result of its investigation.”). Moreover, because we have
determined that State Farm’s investigation was reasonable, we reject any
contention that State Farm’s settlement offers or its initial evaluation were
unreasonable by virtue of an inadequate investigation.
Furthermore, as Mr. Roberts concedes, nothing obtained during the course
of State Farm’s investigation in any way suggested or implied that he would likely
require future medical care or suffer permanent impairment or other problems
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stemming from the knee injury. Aplt. Br. at 11. Even so, State Farm nonetheless
figured future non-economic losses, such as pain and suffering, and future
medical expenses and lost wages into its calculation of the amount of damages
likely to be incurred as a result of the accident. 3 As noted above, State Farm
estimated Mr. Roberts’ future medical expenses as ranging between $1,000 and
$2,000, future wage loss between $100 and $1,000, and non-economic loss from
$5,000 to $8,000. Although Mr. Roberts takes issue with these amounts, it cannot
be said, as he repeatedly suggests, that State Farm simply chose to “assume no
impairment, to assume no further treatment, and to assume no osteoarthritis,”
Aplt. Br. at 10, when State Farm in fact assumed just the opposite.
It is true that Mr. Roberts may suffer future economic and non-economic
losses exceeding the amounts listed by State Farm. However, in light of the
information obtained by State Farm through its investigation, Mr. Roberts’ failure
to inform State Farm of any additional information within his possession that
would have assisted State Farm in evaluating his claim, and the complete lack of
evidence suggesting that State Farm knew Mr. Roberts’ injury to be worth more
3
As an additional example of State Farm’s willingness to treat Mr. Roberts
with fairness, we note that following receipt of Ms. Sanders’ summary of Mr.
Roberts’ medical expenses, State Farm calculated the amount to be $14,454.27
instead of $16,286.27 as calculated by Ms. Sanders. Aplt. App. at 113.
Nonetheless, State Farm employed the higher figure in determining the amount of
UM benefits to which Mr. Roberts was likely entitled. Id.- 12 -
than the range assigned to it, we hold that no reasonable jury could have
concluded that State Farm’s conduct in this respect was unreasonable.
Furthermore, our conclusion is not affected by the deposition testimony of
various experts, including Dr. Harper, that future damages for Mr. Roberts’
injuries will likely exceed the amounts estimated by State Farm. Significantly,
this evidence arose only after Mr. Roberts initiated his action in federal court.
We agree that such evidence would be relevant to establishing an entitlement to
damages in excess of that offered by an insurer, or to establishing a bad faith
claim where the insurer was in possession of similar information during its
investigation. We fail to see, however, how such testimony is relevant to the
question of whether State Farm engaged in bad faith here. As Mr. Roberts
concedes, the medical information State Farm obtained gave absolutely no
indication that Mr. Roberts was at risk of developing any of the problems his
experts now claim are likely to occur. It was on the basis of the information in
these records, not the information supplied after settlement negotiations had
ended, that State Farm evaluated and attempted to settle Mr. Roberts’ claim.
Under such circumstances we cannot hold that the district court erred in granting
State Farm’s motion for partial summary judgment.
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AFFIRMED.
Entered for the Court
Paul J. Kelly, Jr.
Circuit Judge
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