Joseph v. Hartford Fire Insurance Company
Filing
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ORDER Granting 79 Defendant's Motion for Summary Judgment. IT IS FURTHER ORDERED that 82 Defendant's Motion for Summary Judgment is DENIED as moot. Signed by Judge James C. Mahan on 9/30/2014. (Copies have been distributed pursuant to the NEF - EDS)
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UNITED STATES DISTRICT COURT
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DISTRICT OF NEVADA
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STEPHEN JOSEPH,
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Plaintiff(s),
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Case No. 2:12-CV-798 JCM (CWH)
ORDER
v.
HARTFORD FIRE INSURANCE COMPANY,
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Defendant(s).
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Presently before the court is defendant Hartford Fire Insurance Company’s (hereinafter
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“Hartford”) motion for summary judgment pursuant to Federal Rule of Civil Procedure 56. (Doc.
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#79). Plaintiff Stephen Joseph (hereinafter “plaintiff”) filed a response, (doc. # 122), and
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Hartford filed a reply. (doc. #128).
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Also before the court is a second motion for summary judgment filed by Hartford
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pursuant to Federal Rule of Civil Procedure 56. (Doc. #82). Plaintiff filed a response, (doc.
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#117), and Hartford filed a reply, (doc. #129).
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I.
Background
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On December 14, 2005, plaintiff was involved in a motor vehicle accident with an
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underinsured motorist, Jenna Jabara (“Jabara”). At the time of the accident, plaintiff was insured
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by Hartford and had paid a premium for an umbrella policy. Plaintiff received the policy limit of
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$100,000 from Jabara’s insurance and subsequently sought underinsured motorist benefits from
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Hartford.
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Plaintiff alleges that he has incurred more than $250,000 in medical expenses since the
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accident, including the cost of four surgeries to his lower back and left shoulder. Plaintiff’s
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attorney provided Hartford with an invoice for a surgery performed on March 10, 2008. (Doc.
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James C. Mahan
U.S. District Judge
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122, Ex. 8). However, after a letter on July 1, 2008, plaintiff’s attorney ceased communication
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with Hartford.
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Hartford inquired into whether plaintiff would be subject to additional surgeries
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stemming from the 2005 accident. Hartford also requested prior medical records. When this
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request was not met, Hartford asked for an authorization to gather the medical records on its
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own.
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Hartford attempted to procure this information in a plethora of letters and phone calls
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between July 1, 2008, and October 26, 2011, to which plaintiff’s attorney failed to respond. In an
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October 26, 2011, letter, plaintiff’s attorney acknowledged a delayed response and informed
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Hartford he would forward additional medical records. (Doc. 122, Ex. 13). However, plaintiff’s
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attorney did not provide the requested medical records. Instead, on December 14, 2011, he filed
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the instant action.
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II.
Legal Standard
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The Federal Rules of Civil Procedure provide for summary judgment when the pleadings,
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depositions, answers to interrogatories, and admissions on file, together with the affidavits, if
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any, show that “there is no genuine issue as to any material fact and that the movant is entitled to
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a judgment as a matter of law.” Fed. R. Civ. P. 56(a). A principal purpose of summary judgment
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is “to isolate and dispose of factually unsupported claims.” Celotex Corp. v. Catrett, 477 U.S.
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317, 323–24 (1986).
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In determining summary judgment, a court applies a burden-shifting analysis. “When the
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party moving for summary judgment would bear the burden of proof at trial, it must come
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forward with evidence which would entitle it to a directed verdict if the evidence went
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uncontroverted at trial. In such a case, the moving party has the initial burden of establishing the
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absence of a genuine issue of fact on each issue material to its case.” C.A.R. Transp. Brokerage
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Co. v. Darden Rests., Inc., 213 F.3d 474, 480 (9th Cir. 2000) (citations omitted).
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In contrast, when the nonmoving party bears the burden of proving the claim or defense,
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the moving party can meet its burden in two ways: (1) by presenting evidence to negate an
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essential element of the nonmoving party’s case; or (2) by demonstrating that the nonmoving
James C. Mahan
U.S. District Judge
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party failed to make a showing sufficient to establish an element essential to that party's case on
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which that party will bear the burden of proof at trial. See Celotex Corp., 477 U.S. at 323–24. If
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the moving party fails to meet its initial burden, summary judgment must be denied and the court
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need not consider the nonmoving party's evidence. See Adickes v. S.H. Kress & Co., 398 U.S.
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144, 159–60 (1970).
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If the moving party satisfies its initial burden, the burden then shifts to the opposing party
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to establish that a genuine issue of material fact exists. See Matsushita Elec. Indus. Co. v. Zenith
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Radio Corp., 475 U.S. 574, 586 (1986). To establish the existence of a factual dispute, the
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opposing party need not establish a material issue of fact conclusively in its favor. It is sufficient
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that “the claimed factual dispute be shown to require a jury or judge to resolve the parties’
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differing versions of the truth at trial.” T.W. Elec. Serv., Inc. v. Pac. Elec. Contractors Ass’n, 809
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F.2d 626, 631 (9th Cir. 1987).
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In other words, the nonmoving party cannot avoid summary judgment by relying solely
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on conclusory allegations that are unsupported by factual data. See Taylor v. List, 880 F.2d 1040,
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1045 (9th Cir. 1989). Instead, the opposition must go beyond the assertions and allegations of the
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pleadings and set forth specific facts by producing competent evidence that shows a genuine
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issue for trial. See Celotex Corp., 477 U.S. at 324.
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At summary judgment, a court’s function is not to weigh the evidence and determine the
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truth, but to determine whether there is a genuine issue for trial. See Anderson v. Liberty Lobby,
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Inc., 477 U.S. 242, 249 (1986). The evidence of the nonmovant is “to be believed, and all
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justifiable inferences are to be drawn in his favor.” Id. at 255. But if the evidence of the
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nonmoving party is merely colorable or is not significantly probative, summary judgment may be
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granted. See id. at 249–50.
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III.
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Discussion
a. Condition precedent of insurance policy
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Part E of plaintiff’s insurance policy with Hartford provides that Hartford has no
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obligation to provide coverage under the policy, unless there has been full compliance with a list
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of duties. Under subsection (B)(1), the policy requires cooperation with Hartford in the
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U.S. District Judge
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investigation, settlement or defense of any claim or suit. (Doc. #79, Ex. A). Hartford argues that
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this section of the policy negates the coverage requested by plaintiff because plaintiff failed to
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provide access to his medical records as requested.
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An insurance policy is a contract between a policyholder and an insurer in which the
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policy holder agrees to pay premiums in exchange for “financial protection from foreseeable, yet
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unpreventable, events.” Benchmark Ins. Co. v. Sparks, 254 P.3d 617, 620 (Nev. 2011). As a
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contract, both the insured and insurer are bound by the policy and the terms and conditions
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contained within. Id.
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Nevada law enforces coverage conditions and precludes coverage when a violation of
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such a condition occurs, irrespective of prejudice to the carrier. Schwartz v. State Farm Mut.
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Auto. Ins., No. 2:07-cv-00060-KJDLRL, 2009 WL 2197370, at *7 (D. Nev. July 23, 2009).
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Therefore, the provision of the policy requiring cooperation during the investigation is an
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enforceable condition precedent of the insurance contract. (Doc. #79, Ex. A).
b. Violation of condition precedent of insurance policy
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Part E subsection (B)(1) of the insurance policy sets forth, as a condition precedent, that
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the insured must cooperate with the investigation, defense, or settlement of any claim or suit.
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(Doc. #79, Ex. A). The court must determine whether the actions by plaintiff constitute a
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violation of this condition precedent.
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In Schwartz, a strikingly similar case involving an underinsured motorist claim, the
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plaintiff refused to submit to an independent medical examination (IME) after an auto accident,
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and instead filed a lawsuit against State Farm. 2009 WL 2197370, at *4. The plaintiff’s insurance
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policy contained a condition which obligated him to be “examined by physicians chosen and
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paid by [State Farm] as often as [State Farm] reasonably may require.” Id. Although the plaintiff
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eventually underwent the IME, the court found that the plaintiff’s failure to submit to the IME
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when requested was a violation of the insurance contract. Id. at *7. The court ultimately
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concluded that the plaintiff’s unjustified refusal to submit to an IME, coupled with the filing of
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the lawsuit, precluded the plaintiff from recovering under the policy. Id.
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...
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U.S. District Judge
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In the instant case, plaintiff failed to cooperate with Hartford’s repeated requests for prior
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medical records, causing delay in the settlement of the claim. Plaintiff had an obligation to
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cooperate with Hartford’s reasonable requests, which were made in an attempt to settle the claim.
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Therefore, by failing to provide the records or authorization to Hartford, plaintiff breached the
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contract between the parties.
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In order to defeat a motion for summary judgment, the nonmoving party must go beyond
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the assertions and allegations of the pleadings and set forth facts by producing competent
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evidence that shows a genuine issue of material fact. Celotex Corp., 477 U.S. at 324. Here,
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plaintiff has failed to present any such evidence to show a genuine issue of material fact exists.
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Plaintiff claims a genuine issue of fact exists regarding whether Hartford suffered
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prejudice as a result of plaintiff’s alleged breach of the contractual cooperation clause. (Doc.
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#122). However, because Nevada law does not require prejudice to the carrier, the question of
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whether Hartford suffered prejudice, is insufficient to show the existence of a genuine issue of
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material fact. See Schwartz, 2009 WL 2197370, at *7 (citing State Farm Mut. Auto. Ins. Co. v.
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Casinelli, 216 P.2d 606 (Nev. 1950)).
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c. Legal action provision
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Plaintiff’s insurance policy with Hartford contains a provision entitled “Legal Action
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Against Us.” (Doc. # 79, Ex. A). This provision provides that no legal action may be brought
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against Hartford unless there has been full compliance with all the terms of the policy. Id.
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In Schwartz, plaintiff’s unjustified refusal to submit to State Farm’s request violated the
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requisite cooperation in the “Suit Against Us” provision. 2009 WL 2197370, at *7. Ultimately,
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the court found the breach precluded the plaintiff from recovery.
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Plaintiff failed to comply with the “Duties After an Accident or Loss” provision by
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refusing to cooperate with Hartford. Therefore, plaintiff has violated the “Legal Action Against
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Us” provision by filing this lawsuit, thereby breaching the contract.
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d. Bad faith claim
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Plaintiff alleges Hartford acted unreasonably and in bad faith when handling plaintiff’s
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insurance claim. (Doc. #1-2). The duty to deal fairly and in good faith is implied by common
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U.S. District Judge
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law. Hart v. Prudential Prop. & Cas. Ins. Co., 848 F. Supp 900, 904 (D. Nev. 1994). An insurer
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breaches the duty of good faith when it refuses, without proper cause, to compensate the insured
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for a loss covered by the policy. U.S. Fidelity Guar. Co. v. Peterson, 540 P.2d 1070, 1071 (Nev.
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1975). An insurer refuses without proper cause, when it has an “actual or implied awareness”
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that no reasonable basis exists for the denial of the claim. Id.
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Nevada’s definition of bad faith is (1) an insurer’s denial of (or refusal to pay) an
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insured’s claim, (2) without any reasonable basis, and (3) the insurer’s knowledge or awareness
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of the lack of any reasonable basis to deny coverage or reckless disregard as to the
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unreasonableness of the denial. Pioneer Chlor Alkali Co. v. Nat’l Union Fire Ins. Co. 863 F.
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Supp. 1237, 1247 (D. Nev. 1994).
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In the present case, it is undisputed that Hartford never denied the claim. Hartford
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repeatedly requested medical records or an authorization in order to settle the claim. However,
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plaintiff filed this lawsuit before Hartford was able to collect the requested records and accept or
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deny the claim. Therefore, plaintiff’s bad faith claim fails as a matter of law because Hartford
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never denied the claim, an element required to prove bad faith.
e. Defendant’s second motion for summary judgment
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Defendant filed a second motion for summary judgment asserting a lack of causation
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between the alleged damages and the December 15, 2005, auto accident. (Doc. #82). However,
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the court need not address this motion, as plaintiff’s failure to cooperate warrants granting
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summary judgment on the first motion.
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IV.
Conclusion
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Plaintiff failed to fulfill his obligation to cooperate with Hartford, constituting a violation
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of the condition precedent. Further, plaintiff’s bad faith claim fails as a matter of law because the
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instant lawsuit was filed before Hartford was able to settle the claim.
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Accordingly,
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IT IS HEREBY ORDERED, ADJUDGED, AND DECREED that defendant’s motion for
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summary judgment, (doc. #79), be, and the same hereby is, GRANTED.
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James C. Mahan
U.S. District Judge
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IT IS FURTHER ORDERED that defendant’s motion for summary judgment, (doc. #82),
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be, and the same hereby is, DENIED as moot.
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DATED September 30, 2014.
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UNITED STATES DISTRICT JUDGE
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James C. Mahan
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