Thursday, January 31, 2019

First Party Benefits/UIM Carrier's Reliance on IME Report in Evaluation Not Bad Faith

In the case of Phillips v. State Farm Mut. Auto. Ins. Co., No. 4:18-cv-01672 (M.D. Pa. Dec. 17, 2018 Brann, J.), the court dismissed a Plaintiff’s bad faith claim which was based upon an allegation that it was bad faith for the carrier to rely upon its own medical expert’s opinion rather than the insured’s medical expert.   The court found that such allegations alone did not make out a bad faith case.  

This case involved disputes between an insured and her own auto carrier over a first party benefits claim and a UIM claim.

Judge Matthew W. Brann
In his Opinion, Judge Brann stated that it “is well-settled that, when making a claim determination, an insurer may reasonably rely on the findings of an independent medical examination - - even in the face of contrary medical opinion.”  

When reviewing the allegation that the carrier “improperly favored” its own expert’s conclusions, the court noted that “an insurer is not required to give greater credence to opinions of treating medical providers.” 

Judge Brann additional stated that, even if the carrier’s reliance upon its own medical expert amounted to alleged negligence or bad judgment, this did not rise to the level of statutory bad faith under Pennsylvania law.  

Accordingly, the bad faith count in the Plaintiff’s Complaint was dismissed but the Plaintiff was given the right to file an Amended Complaint if the deficiencies could be cured.

Anyone wishing to review this Opinion may click this LINK.

I send thanks to Attorney Lee Applebaum of the Philadelphia office of Fineman, Krekstein & Harris for bringing this case to my attention.   Check out Attorney Applebaum’s excellent blog, the Pennsylvania New Jersey Insurance Bad Faith Case Law blog HERE.   

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