Lenhart v. Mid-Century Insurance

Filing 33

ORDER granting 15 Defendant's Motion for Partial Summary Judgment. Signed by Judge Benjamin H. Settle. (MGC)

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UNITED STATES DISTRICT COURT
WESTERN DISTRICT OF WASHINGTON
AT TACOMA

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PATRICK LENHART,

CASE NO. C18-5039 BHS
Plaintiff,

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v.
MID-CENTURY INSURANCE,

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ORDER GRANTING
DEFENDANT’S MOTION FOR
PARTIAL SUMMARY
JUDGMENT

Defendant.

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This matter comes before the Court on Defendant Mid-Century Insurance’s (“Mid-

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Century”) motion for partial summary judgment, Dkt. 15. The Court has considered the

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pleadings filed in support of and in opposition to the motion and the remainder of the file

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and hereby grants the motion for the reasons stated herein.

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I.

PROCEDURAL AND FACTUAL BACKGROUND

On December 17, 2004, Plaintiff Patrick Lenhart (“Lenhart”) was injured in an

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automobile collision. Dkt. 1-3, ¶ 1.2. At the time of the accident, Lenhart had a policy of

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insurance with Mid-Century that included Personal Injury Protection (“PIP”). Dkt. 16-1.

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Under this coverage, Mid-Century agreed to pay “reasonable and necessary medical and

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hospital expenses incurred for services furnished within one year from the date of the

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accident which caused the injury.” Id. at 8. Following the accident, Lenhart submitted

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medical bills to Mid-Century for four different types of treatments: (1) chiropractic

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treatment; (2) treatment by an optometrist for vision problems; (3) dental treatment

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related to pain in Lenhart’s temporomandibular joint (“TMJ”); and (4) treatment by a

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physiatrist for an alleged brain injury. Dkt. 1-3, ¶¶ 3.10-3.18. Mid-Century extended PIP

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coverage and paid a total of $5,948.94 for Lenhart’s injuries. Dkt. 1-3, ¶ 3.9; Dkt. 5, ¶

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16.

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As a condition of receiving PIP benefits, the Policy required Lenhart to submit, at

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Mid-Century’s request, to physical examinations by doctors selected by Mid-Century.

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Dkt. 16-1 at 4. Pursuant to this provision, Mid-Century requested that Lenhart undergo

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three independent medical examinations (“IME”) scheduled for June 6, 2005. Dkt. 1-3, ¶

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3.10; Dkt. 5, ¶ 17; Dkt. 16-2. Lenhart attended two of the three examinations.

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After the examinations, the examining doctors issued reports on Lenhart’s injuries.

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Chiropractor Dr. Jeffery Hawkins reported that Lenhart had received maximum benefit

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from the chiropractic treatment he had been receiving and that further treatments were

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not reasonable or necessary. Dkt. 16-3 at 19–20. Finding no evidence of injury to

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Lenhart’s eyes, Dr. William Baer, an ophthalmologist, likewise reported that further eye

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treatments were not reasonable or necessary. Dkt. 16-4 at 6–7. Based on these reports,

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Mid-Century discontinued payments for these treatments in a letter dated July 5, 2005.

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Dkts. 16-5, 16-6.

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On August 11, 2005, Lenhart attended an IME for his TMJ condition. Dkt. 16-8.
In the resulting report, Dr. Scott Anderson, DMD, concluded that the treatment for

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Lenhart’s TMJ condition was reasonable and necessary and causally related to the

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accident. Id. By letter dated September 8, 2005, Mid-Century advised Lenhart that it

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would continue paying for treatment related to his TMJ condition. Dkt. 16-9.

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Regarding his alleged brain injury, Lenhart refused to attend a scheduled IME.
Dkt. 16-11.
On November 1, 2005, Mid-Century wrote Lenhart informing him that the only

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recommended ongoing treatment was for his TMJ condition. Id. Mid-Century thus

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denied all PIP benefits except for the TMJ treatments. Id.

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On December 6, 2007, Washington enacted the Insurance Fair Conduct Act
(“IFCA”).
On May 19, 2011, Lenhart sent Mid-Century a notice that he would pursue a cause

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of action against Mid-Century under IFCA for Mid-Century’s unreasonable denial of

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benefits. Dkt. 16-12. On June 3, 2011, Mid-Century responded upholding its “previous

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position, that no additional wage loss or medical coverage is available or payable on this

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claim.” Dkt. 16-13.

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On December 8, 2017, Lenhart filed a complaint against Mid-Century in Clark

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County Superior Court for the State of Washington. Dkt. 1-3. Lenhart asserts claims for

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failure to act in good faith, violation of the Washington Consumer Protection Act, and

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violation of IFCA. Id., ¶¶ 4.1–6.6.

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On January 17, 2018, Mid-Century removed the matter to this Court. Dkt. 1.

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On September 20, 2018, Mid-Century filed a motion for partial summary

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judgment on Lenhart’s IFCA claim. Dkt. 15. On October 15, 2018, Lenhart responded.

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Dkt. 18. On October 19, 2018, Lenhart replied. Dkt. 20.

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II. DISCUSSION
A.

Summary Judgment Standard
Summary judgment is proper only if the pleadings, the discovery and disclosure

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materials on file, and any affidavits show that there is no genuine issue as to any material

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fact and that the movant is entitled to judgment as a matter of law. Fed. R. Civ. P. 56(c).

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The moving party is entitled to judgment as a matter of law when the nonmoving party

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fails to make a sufficient showing on an essential element of a claim in the case on which

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the nonmoving party has the burden of proof. Celotex Corp. v. Catrett, 477 U.S. 317,

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323 (1986). There is no genuine issue of fact for trial where the record, taken as a whole,

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could not lead a rational trier of fact to find for the nonmoving party. Matsushita Elec.

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Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586 (1986) (nonmoving party must

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present specific, significant probative evidence, not simply “some metaphysical doubt”).

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See also Fed. R. Civ. P. 56(e). Conversely, a genuine dispute over a material fact exists

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if there is sufficient evidence supporting the claimed factual dispute, requiring a judge or

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jury to resolve the differing versions of the truth. Anderson v. Liberty Lobby, Inc., 477

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U.S. 242, 253 (1986); T.W. Elec. Serv., Inc. v. Pac. Elec. Contractors Ass’n, 809 F.2d

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626, 630 (9th Cir. 1987).

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The determination of the existence of a material fact is often a close question. The
Court must consider the substantive evidentiary burden that the nonmoving party must

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meet at trial—e.g., a preponderance of the evidence in most civil cases. Anderson, 477

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U.S. at 254; T.W. Elec. Serv., Inc., 809 F.2d at 630. The Court must resolve any factual

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issues of controversy in favor of the nonmoving party only when the facts specifically

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attested by that party contradict facts specifically attested by the moving party. The

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nonmoving party may not merely state that it will discredit the moving party’s evidence

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at trial, in the hopes that evidence can be developed at trial to support the claim. T.W.

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Elec. Serv., Inc., 809 F.2d at 630 (relying on Anderson, 477 U.S. at 255). Conclusory,

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nonspecific statements in affidavits are not sufficient, and missing facts will not be

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presumed. Lujan v. Nat’l Wildlife Fed’n, 497 U.S. 871, 888–89 (1990).

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B.

IFCA
Mid-Century moves for summary judgment on Lenhart’s IFCA claim arguing that

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Lenhart may not recover under the statute for the denial of a claim that occurred before

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the statute was enacted. Dkt. 15 at 5–9. In response, Lenhart essentially concedes that

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Mid-Century’s motion has merit and argues that his IFCA claim is based on Mid-

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Century’s denial of his claim in 2011. Dkt. 18. The problem with Lenhart’s argument is

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that it finds no support in his current complaint. Lenhart alleges that Mid-Century

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“stopped payment for treatment after August 27, 2005,” and refused “to pay for

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continuing necessary and reasonable medical treatment.” Dkt. 1-3, ¶¶ 3.19, 3.20. Then,

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Lenhart vaguely alleges that Mid-Century “failed to complete its investigation within the

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deadlines set out WAC 284-30-380 or follow the provisions it must follow should it not

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be able to complete its’ investigation within those deadlines.” Id. ¶ 3.22. He fails to

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allege that he resubmitted his claim in May 2011. Instead, he skips forward to the end of

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2014 and alleges that he “engaged in arbitration proceedings on 12-04-2014 and was

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awarded medical bills and income loss.” Id. ¶ 3.23. Therefore, to the extent that

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Lenhart’s current claim as pled relies on a denial in 2005, the Court grants Mid-Century’s

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motion for summary judgment and dismisses Lenhart’s claim with prejudice. This ruling

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does not preclude Lenhart from amending his pleading to assert a claim based on alleged

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violations that occurred after the enactment of IFCA.

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III. ORDER

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Therefore, it is hereby ORDERED that Mid-Century’s motion for partial

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summary judgment, Dkt. 15, is GRANTED.

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Dated this 10th day of January, 2019.

A

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BENJAMIN H. SETTLE
United States District Judge

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ORDER - 6