GEBRETSADIKE v. TRAVELERS HOME AND MARINE INSURANCE COMPANY

Filing 48

MEMORANDUM OPINION re 44 Defendant's Motion for Summary Judgment. Signed by Judge Christopher R. Cooper on 9/22/2016. (lccrc2)

UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLUMBIA
AWOKE GEBRETSADIKE,
Plaintiff,
Case No. 1: 14-cv-02059 (CRC)

v.
THE TRAVELERS HOME AND MARINE
INSURANCE COMPANY,
Defendant.

MEMORANDUM OPINION
Pro se plaintiff Awoke Gebretsadike sued his auto insurer—Traveler Home and Marine
Insurance Company (“Travelers”)—for allegedly failing to honor the terms of his automobile
insurance policy after a hit-and-run driver struck his car on New Year’s Eve 2011. At the motionto-dismiss stage of the suit, the Court permitted two of Gebretsadike’s claims to proceed to
discovery: first, his contention that Travelers violated the District of Columbia Consumer
Protection Procedures Act (“DCCPPA”) by not providing him with a full copy of his insurance
policy, and second, his claim that Travelers breached the policy by not reimbursing him under its
personal-injury-protection or uninsured-motorist coverage provisions. Gebretsadike v. Travelers
Home & Marine Ins. Co., 103 F. Supp. 3d 78, 84–86 (D.D.C. 2015). With discovery now
complete, Travelers moves for summary judgment on these remaining claims. For the reasons
explained more fully below, the Court will grant Travelers’ motion on the DCCPPA claim because
the company has established that it did in fact provide Plaintiff with a copy of the policy. It will
also grant Travelers’ motion on Plaintiff’s allegation that he was entitled to personal injury
protection under the policy, as Gebretsadike failed to properly elect that coverage within the
required time period. Because Gebretsadike further failed to cooperate in the claim settlement
process, the Court will likewise grant Travelers’ motion with respect to his uninsured-motorist

coverage, but with one caveat: Through the course of litigation, Gebretsadike has established—and
Travelers has acknowledged—that he is entitled to $5,421.50 in medical expenses. The Court will
therefore direct Travelers to reimburse Gebretsadike for that amount.
I.

Background

On New Year’s Eve of 2011, Mr. Gebretsadike was driving to a restaurant in D.C. when
another car crashed into him. Compl. ¶ 1–2. As a result of the accident, Gebretsadike briefly lost
consciousness and suffered injuries to his head and leg. Id. The other driver fled the scene and
Gebretsadike reported what details he could remember to the police. See Def.’s Mem. Supp. Mot.
Summ. J. (“MSJ”), Ex. 1. Gebretsadike had acquired automobile insurance from an authorized
Travelers agent six months earlier. Def.’s MSJ, Ex. 2. Decl. of Dorothy Kennard (“Kennard
Decl.”) ¶ 4. The initial policy was effective from June 15, 2011 through December 15, 2011, but it
automatically renewed to cover an additional term of December 15, 2011 to June 15, 2012. Id.
¶¶ 6–9. Under the terms of the policy, Gebretsadike was potentially entitled to personal-injuryprotection (“PIP”) or uninsured-motorist coverage as a result of his accident. See Kennard Decl.,
Ex. C. The uninsured-motorist coverage provision required Travelers to pay medical and property
damages resulting from an accident with an uninsured driver. Id. at 89. The D.C.’s Compulsory
No-Fault Motor Vehicle Insurance Act of 1982, D.C. Code § 31-2405, governed Travelers’
obligations to pay PIP benefits. Id. at 85.
A few days after the accident, Gebretsadike contacted Travelers to report the incident and
discuss these coverage options. Kennard Decl. ¶¶ 11, 14. Travelers followed up by sending him a
letter explaining how he could invoke PIP coverage and warning him that he must do so before
March 2, 2012 or the option would expire. Kennard Decl., Ex F. The letter further clarified that
Gebretsadike could either elect to use his PIP benefits, which had a $50,000 limit, or file a liability
claim against the driver who had hit him, but that he could not pursue both types of claims except in
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certain, statutorily circumscribed situations. Id. Gebretsadike then received a series of forms—
including a PIP election form and a medical authorization form—to complete and return. Kennard
Decl., Ex. E at 125. He signed and returned all of the forms to Travelers. Id. at 125–29. On the
election form, however, he indicated that he wanted to invoke his PIP coverage as well as pursue a
liability claim against the unknown driver. Id. at 129.
Travelers promptly informed Gebretsadike that he could pursue only one of these options,
id. at 145, and reminded him that his ability to elect PIP coverage would expire at the start of
March. Gebretsadike did not remit another PIP election form, and on March 5, 2012, Travelers
closed his PIP claim. Id. at 174. While he was no longer eligible for PIP, Travelers told
Gebretsadike that he was still entitled to his uninsured-motorist coverage because the police report
indicated that he was hit by an unknown driver. Def.’s Statement of Material Facts ¶ 31; see also
Kennard Decl. ¶ 20; Kennard Decl., Ex. E at 165, 174. During this exchange, Gebretsadike
struggled to obtain medical treatment for his injuries because he lacked health insurance. Kennard
Decl., Ex. E at 148. He requested help from Travelers, which sent him a list of medical providers
but told him that they could not pre-authorize his treatment—only settle his claims after reviewing
the medical bills he submitted. Id. at 145, 148. A long chain of correspondence ensued, spanning
almost three years, between Gebretsadike and a series of Travelers claim representatives. See
Kennard Decl., Ex. E.
Gebretsadike went back and forth with Travelers on the uninsured motorist coverage
requirements and the documentation he needed to provide to settle his claim. He dealt
simultaneously with another Travelers claim representative regarding the property damage to his

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car.1 For a time, Gebretsadike stopped communicating with Travelers agents, but he re-initiated
contact in the fall of 2013—after the police officially closed its investigation of his accident—to
enlist Travelers’ assistance in locating the hit-and-run driver. Id. at 255, 259. When Gebretsadike
also inquired about his uninsured-motorist coverage, Travelers told him that they would need a
medical release authorization, a list of his healthcare providers, and a wage verification form in
order to process his claim. Id. at 267–69. In response, Gebretsadike submitted a letter from his
former employer claiming that Gebretsadike had been earning $789 a week before the accident but
had been unable to work since then. Kennard Decl., Ex. G at 482. Gebretsadike expressed
discomfort though with providing the names of his doctors and asked Travelers if he could submit
the medical bills instead. Kennard Decl., Ex. E at 272–73. Travelers agreed. Id. at 273, 277. Yet
Gebretsadike still wavered on sending his medical expenses. Id. at 284–85. Travelers stated that
they could not proceed with his claim adjustment without them, but offered him $500 in lieu of an
official settlement. Id. at 350–51. Around this time, Gebretsadike also began to pursue legal
remedies by seeking the assistance of pro bono counsel, and he requested that Travelers send him a
complete copy of his policy along with any other records they had on file regarding his claims. Id.
at 287. On March 18, 2014, a dissatisfied Gebretsadike “respectfully request[ed] [Travelers] not to
send [him] any more email.” Id. at 474. And on November 6, 2014, he filed this lawsuit. Compl.
During the course of litigation, Travelers finally obtained medical records totaling $5,421.50
from Gebretsadike. Kennard Decl. ¶ 26. They also received an affidavit from Gebretsadike’s
allegedly former employer, who stated that he did not recall ever seeing or signing a letter on
Gebretsadike’s behalf. Kennard Decl., Ex. G ¶ 5. Despite this wrinkle, Travelers twice offered

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After reviewing the damages to Gebretsadike’s car, Travelers declared it a total loss and
Gebretsadike chose to have it salvaged. Kennard Decl., Ex. E at 213. Travelers released a
settlement check for the salvage value of the car to Gebretsadike in May 2012. Id.
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during mediation to settle Mr. Gebretsadike’s claim for $5,421.50. Kennard Decl. ¶ 26.
Gebretsadike rejected both offers. Id.
II.

Standard of Review

Summary judgment shall be granted “if the movant shows that there is no genuine dispute as
to any material fact and the movant is entitled to judgment as a matter of law.” Fed. R. Civ. P.
56(a). The movant bears the burden to demonstrate an “absence of a genuine issue of material fact”
in dispute. Celotex Corp. v. Catrett, 477 U.S. 317, 323 (1986). For a factual dispute to be material,
it must “be capable of affecting the substantive outcome of the litigation; to be genuine, [it] must be
supported by sufficient admissible evidence that a reasonable trier-of-fact could find for the
nonmoving party.” Laningham v. U.S. Navy, 813 F.2d 1236, 1242–43 (D.C. Cir. 1987). In
considering if there are genuine factual disputes, the Court will consider “pleadings, depositions,
answers to interrogatories, admissions on file, [and affidavits]” presented by both parties. Celotex
Corp., 477 U.S. at 323.
In ruling on a motion for summary judgment, a court accepts as true the nonmovant’s
evidence and draws all reasonable inferences in favor of the nonmoving party. Anderson v. Liberty
Lobby, Inc., 477 U.S. 242, 255 (1986). But “while the movant bears the initial responsibility of
identifying those portions of the record that demonstrate the absence of a genuine issue of material
fact, the burden shifts to the non-movant to come forward with ‘specific facts showing that there is
a genuine issue for trial.’” Klayman v. Judicial Watch, Inc., 628 F. Supp. 2d 112, 123–24 (D.D.C.
2009) (quoting Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 587 (1986)). In
doing so, the nonmovant may not rely simply on allegations or conclusory statements. Veitch v.
England, 471 F.3d 124, 134 (D.C. Cir. 2006). Thus, “[i]f the evidence is merely colorable, or is not
sufficiently probative, summary judgment may be granted.” Anderson, 477 U.S. at 249–50
(internal citations omitted). “[M]ere allegations or denials in the adverse party's pleadings,” for
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example, “are insufficient to defeat an otherwise proper motion for summary judgment.” Williams
v. Callaghan, 938 F. Supp. 46, 49 (D.D.C.1996).
III.

Analysis
A.

District of Columbia Consumer Protection Procedures Act Claim

This Court previously noted that, under the DCCPPA, it is “the insurer’s duty to spell out in
plainest terms—terms understandable to the man in the street—any exclusionary or delimiting
policy provisions,” and that “this duty logically encompasses an obligation to provide a
policyholder with a complete copy of the policy.” Gebretsadike, 103 F. Supp. 3d at 84 (quoting
Whiting v. AARP, 637 F.3d 355, 360 (D.C. Cir. 2011)) (internal quotations omitted). Travelers has
since established—through a declaration and a copy of its mailed policy—that it sent Gebretsadike
a copy of his entire policy within days of purchase. On June 15, 2011, Gebretsadike provided an
Ace Insurance Services agent a signed copy of his application for Travelers’ automobile insurance.
Def.’s MSJ, Ex. 3, Decl. of Emebet Bekele ¶ 6. Travelers, that same day, mailed a copy of the
purchased policy to the address Gebretsadike had provided on his application. Kennard Decl. ¶ 7;
see also Kennard Decl., Ex. C. On November 17, 2011, Travelers also mailed Gebretsadike a
summary of his renewed policy to that same address along with his updated insurance identification
cards, which Gebretsadike acknowledged he received. Kennard Decl. ¶ 10; see also Kennard Decl.,
Ex. D.
A properly addressed letter creates a “presumption . . . that it was received by the
addressee,” Toomey v. D.C., 315 A.2d 565, 567 (D.C. 1974) (quoting Columbia Finance Co. v.
Worthy, 141 A.2d 185, 186 (D.C. Mun. Ct. 1958)), a presumption that Gebretsadike has failed to
rebut. Rather than explaining why he did not receive the mailed policy, Gebretsadike responds by
insisting that the Ace Insurance agent did not personally provide him a copy of the policy nor did he
receive a full copy in November 2011 when his policy was renewed. Pl’s Mem. Opp’n Def.’s MSJ
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2–3, 6. These arguments, however, are beside the point because they do not negate that Travelers
had already sent a copy of the entire policy to Gebretsadike in June.
As to Gebretsadike’s further claims that Travelers violated the DCCPPA by misleading him
about the terms of his policy, the overwhelming weight of the record says otherwise. The parties’
voluminous correspondence over the course of three years shows that Travelers attempted—via
telephone, letters, and email—to explain the terms and provisions of its insurance policy to
Gebretsadike. Travelers repeatedly clarified the extent of his coverage, the types of coverage he
was entitled to, and the documentation it needed in order to settle his claim. See generally Kennard
Decl., Ex. E. And when Gebretsadike, after consulting with his pro bono attorneys, requested an
additional copy of his policy, Travelers promptly provided him with one. Kennard Decl. ¶ 12. The
Court thus concludes that no reasonable juror could find that Travelers violated the DCCPPA and
will, accordingly, award summary judgment in its favor.
B.

Breach of Contract Claims

To prevail on a breach of contract claim in the District of Columbia, “a party must establish
(1) a valid contract between the parties; (2) an obligation or duty arising out of the contract; (3) a
breach of that duty; and (4) damages caused by breach. Tsintolas Realty Co. v. Mendez, 984 A.2d
181, 187 (D.C. 2009) (citing San Carlos Irrigation & Drainage District v. United States, 877 F.2d
957, 959 (Fed. Cir. 1989)); see also Jia Di Feng v. See-Lee Lim, 786 F. Supp. 2d 96, 104 (D.D.C.
2011) (citations omitted). The parties agree that a valid contract existed between the parties—
Gebretsadike’s insurance policy—and that Travelers had a duty to honor it. Gebretsadike alleges,
however, that Travelers breached this contract by failing to provide him with coverage under the
personal-injury-protection and uninsured-motorist provisions of his policy.

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1.

Personal Injury Protection Coverage

Travelers’ insurance policy and D.C.’s No-Fault Statute require insured individuals to elect
PIP coverage within 60 days of a qualifying accident. D.C. Code § 31-2405(a); Kennard Decl., Ex.
A. Yet even if properly elected, an individual cannot pursue PIP coverage along with liability
claims—like uninsured-motorist coverage—unless the injury results in:
[a] substantial permanent scarring or disfigurement,
[b] substantial and medically demonstrable permanent impairment which has
significantly affected the ability of the victim to perform his or her professional activities
or usual and customary daily activities,
[c] a medically demonstrable impairment that prevents the victim from performing all or
substantially all of the material acts and duties that constitute his or her usual and
customary daily activities for more than 180 continuous days; or
[d] [t]he medical and rehabilitation expenses of a victim or work loss of a victim exceeds
the amount of personal injury protection benefits available.
D.C. Code § 31-2405. Travelers agrees that Gebretsadike’s policy entitled him to PIP as a result of
his accident. But the defense Travelers raises is that Gebretsadike failed to properly elect PIP
within the statutory and contractual time frame, thus forfeiting his right to invoke that coverage
now.
Travelers reinforces its position by pointing to a series of communications it had with
Gebretsadike explaining these requirements. First, within a week of the accident, Travelers sent
Gebretsadike a package with a letter explaining the election process, the PIP election form, and a
reminder of the 60-day window for electing it. Kennard Decl., Ex. F. Second, when Gebretsadike
returned the form—indicating that he wanted to pursue both a PIP and liability claim—Travelers
contacted him again to explain why he needed to choose between the two. Travelers continued to
follow up with Gebretsadike for the next two months, seeking to obtain a corrected election form
from him before the March 2 deadline. Kennard Decl., Ex. E at 160, 165 (“I also do need the
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election form completed and return[ed] to me by March 2, 2012 if you are going to use the personal
injury protection coverage on your policy. As stated in prior emails, the first election form you sent
was not valid as you elected both personal injury protection and bodily injury. Unfortunately,
you[r] coverage only allows you to use one of the elected coverage’s not both.”). Gebretsadike
never provided another election form to Travelers. His statements, on the contrary, indicated that
he was willing to forego PIP if it meant preserving his legal remedies against the hit-and-run driver.
Id. at 165 (“There’s no way I choose something that stops me from taking the other driver to legal
procedures. I guess choosing PIP alone does that.”). And finally, on March 5, 2012, Travelers
informed Gebretsadike that the PIP election period had passed. This left Gebretsadike with the
option to file a claim either against the hit-and-run driver or with Travelers under the uninsuredmotorist provision in his policy. Id. at 174. The evidence establishes that Gebretsadike knew he
needed to properly elect PIP before March 2, 2012 in order to receive its benefits. Despite this
knowledge, Gebretsadike failed to act, relieving Travelers of any obligation to provide PIP
coverage.
As noted above, however, there are exceptions to the bar against simultaneously pursuing
PIP and liability claims. While Travelers summarily presented the text of the statutory exceptions
to Gebretsadike in its first letter to him after the accident, Kennard Decl., Ex. F, it glossed over
these exceptions in all further communications and in its briefing to this Court. The Court will not
be so glib in its assessment of whether any of the exceptions could have applied.
For Gebretsadike to survive summary judgment on this issue, he must “make a prima facie
showing that the injury falls within one of the categories of the No-Fault statute.” State Farm Mut.
Auto. Ins. Co. v. Hoang, 682 A.2d 202, 207 (D.C. 1996) (citing Smith v. Washington Metro. Area
Transit Auth., 631 A.2d 387, 392 (D.C. 1993)). And if a reasonable juror could infer from the
record that an exception applies, then a genuine factual issue would remain, requiring a trial.
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Hoang, 682 A.2d at 207–08. Of the four exceptions, the only potentially applicable one here is the
third—“a medically demonstrable impairment that prevents the victim from performing . . .
customary daily activities for more than 180 continuous days.”2 D.C. Code § 31-2405. The D.C.
Court of Appeals has required objective, credible evidence when assessing a plaintiff’s claim under
§ 31-2405(b). See id. (citing Oswing v. Shaw, 609 A.2d 415, 429 (N.J. 1992)); see also Smith, 631
A.2d at 391–92. In ruling on a summary judgment motion, the Smith court held that “without
sworn medical affidavits as to the extent of [the plaintiff’s] impairment for 180 continuous days,”
the plaintiff’s “conclusory answers [to interrogatories were] inadequate to meet the . . . exception to
the No-Fault statute.” Id. at 392. Gebretsadike, like the plaintiff in Smith, has not presented sworn
medical affidavits—or even a single medical record—to show that he suffered from a debilitating
impairment for more than 180 days. And the only “objective” evidence that he presented to
Travelers on the extent of his injury was a letter from the owner of a cell phone store stating that
Gebretsadike had worked there but was unable to work from January 2012 to July 2012 due to his
injuries. However, the purported author of the letter has disavowed any knowledge of it.3 Def.’s
MSJ, Ex. 4. Without any objective, credible evidence to rely on, this Court concludes that

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Gebretsadike did not present any medical records to the Court. Consequently, there is no
evidence that he suffered “permanent scarring,” “disfigurement,” or a “permanent impairment”
from the accident. Nor do his medical expenses, acknowledged to be approximately $5,421.50 in
total, exceed the $50,000 limit of his PIP coverage.
3

The store’s owner, Pushpinder Chadha, stated in a sworn declaration that while
Gebretsadike “provided some services as an independent contractor,” he was never an employee.
Def.’s MSJ, Ex 4, Decl. of Pushpinder Chadha ¶ 4. Chadha also averred that he did not recall ever
seeing or signing the letter provided by Gebretsadike to Travelers during the claim adjustment
process. Id. ¶ 5. Although Gebretsadike presented counter-declarations from customers of the cell
phone store confirming that he worked there, they do not create a genuine dispute of material fact
because they do not speak to the extent of his injury or the amount of time he was unable to work.
Pl.’s Mem. Opp’n Def.’s MSJ, Ex. 6–8.
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Gebretsadike’s medical injuries do not fall within one of the No-Fault statute’s listed exceptions
and, therefore, Travelers did not breach his policy by failing to provide PIP coverage.
2.

Uninsured Motorists Coverage

Travelers next maintains that its policy “imposes a duty on the insured to cooperate in the
investigation and settlement of any claims.” Def.’s MSJ 22. If an insured fails to comply with this
duty, the insurance company is unable to carry out its end of the bargain because it does not have
the information necessary to settle the claim. The “Duties After an Accident or Loss” section of
Gebretsadike’s policy requires insured individuals to “[c]ooperate with us in the investigation,
settlement or defense of any claim or suit” and “[a]uthorize us to obtain [] medical reports; and []
other pertinent records.” Kennard Decl., Ex. C at 77.
Courts have recognized this duty to cooperate, akin to a condition precedent, and have
voided contracts when they have found an insured did not comply with it. See, e.g., Akers v.
Liberty Mut. Grp., 847 F. Supp. 2d 21, 26–27 (D.D.C. 2012) (“An insured party’s compliance with
insurance policy provisions is viewed as a condition precedent to indemnification.” (citing Claflin
v. Commonwealth Ins. Co., 110 U.S. 81, 91 (1884))). The Akers court went on to provide
examples of how an insured could fail to adequately cooperate: by refusing to produce relevant
documents, misrepresenting or intentionally concealing material facts, or giving vague, nonresponsive answers to key questions about the nature of the loss. See 847 F. Supp. 2d at 25–26.
The court there awarded summary judgment to the insurer because the insured did not corroborate
her employment, made misleading and contradictory statements, and refused to produce requested
documents during the claim adjustment process.
The central question here is whether Gebretsadike likewise failed in his duty to cooperate.
Travelers points to three examples to establish that he did. First, he never provided Travelers a
medical authorization form. Second, he did not provide Travelers with a list of medical providers.
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And third, he did not provide Travelers with the medical bills that resulted from the treatment he
received for injuries sustained in the accident. Def.’s MSJ 24–25. The Court will address each of
these in turn. When Gebretsadike first contacted Travelers after his accident, they sent him a
medical authorization release form. On January 16, 2012, he emailed the signed release form back
to the Travelers agent.4 Kennard Decl., Ex. E at 125–27. Gebretsadike’s later communications
with Travelers were plagued by a continuing misunderstanding regarding this form because
Gebretsadike (understandably) asked why another authorization was needed while as the agents he
spoke to maintained that he had never signed one. On October 31, 2013, for instance, Gebretsadike
wrote, “[w]hat type of my medical or any kind of information you or Travelers
collected/learnt/accessed/tried to get using the release form I signed for you last time or otherwise?”
Id. at 283–84. And on November 14, 2013, a claims representative emailed, “[y]ou never signed
the medical authorization.” Id. at 322. At bottom, despite the confusion, the record is clear:
Travelers received a signed medical authorization from Gebretsadike in January 2012, so he did not
fail in his duty to provide one.
This same evidence—emails between Gebretsadike and Travelers spanning three years—
also establishes that Gebretsadike refused to send Travelers a list of his medical providers because
he decided that he would collect the medical bills and send them to Travelers himself. Unlike in
Akers, then, this was not an outright refusal to produce documents. Gebretsadike, however, did not
provide Travelers with the promised bills before initiating this lawsuit. During the course of
litigation, Travelers did obtain medical records from Gebretsadike totaling $5,421.50 and offered to
settle his claim for that amount. Kennard Decl. ¶ 26; see also Def.’s MSJ 15. In short, Travelers, at

4

The release form included a statement indicating that it was valid for the duration of the
associated claims. Kennard Decl., Ex. E at 127.
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this time, has all of the information necessary to settle Gebretsadike’s claim regarding his medical
expenses, and none of the information necessary to reimburse him for any other type of expense.
The Court, therefore, concludes that no factual dispute remains as to the $5,421.50 in
medical bills accrued by Gebretsadike after his accident, and it will direct Travelers to reimburse
him accordingly. As to any other bodily injury or lost wage claim, however, the Court finds that
Gebretsadike failed in his duty to cooperate by not providing Travelers with the necessary and
requested documentation, thus absolving Travelers of further obligations under the policy.
Consequently, the Court will award summary judgment to Travelers on Gebretsadike’s breach of
contract claims with the exception of the $5,421.50 in medical bills previously mentioned.
IV.

Conclusion

For the foregoing reasons, the Court will grant Defendant Travelers Home and Marine
Insurance Company’s Motion for Summary Judgment. An Order will accompany this
Memorandum Opinion.

CHRISTOPHER R. COOPER
United States District Judge
Date:

September 22, 2016

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