Results
Summary Judgment for Large Insurance Carrier in a Breach of Contract Case
The parties had filed cross-motions for summary judgment. The issue for the court was whether the carrier had breached the terms of the policy when it denied the plaintiff’s first-party benefits claim relating to medical bills for PTSD allegedly caused by the underlying accident. The policy defined “bodily injury” as “accidental bodily harm to a person, and that person’s resulting illness, disease or death.” The plaintiff argued that, because she had sustained both physical and mental injuries as a result of the accident, the treatment related to both types of injuries and should be covered. The defense argued that, per the policy and controlling case law, mental injuries are only covered if they “result from” the physical injury. Because the PTSD stemmed from the plaintiff’s fear of driving following the accident—as opposed to mental injuries that resulted directly from the physical injuries—the defense asserted that they are not covered. The court agreed with the defense and found that the language of the policy was clear and unambiguous. It found that the Superior Court’s holding in Zerr v. Erie Ins. Exchange controlled and that the plaintiff had failed to provide evidence that her mental injuries resulted from her bodily injuries. Absent that connection, there was no coverage for the PTSD, regardless of any collateral physical injuries sustained in the accident.
Defense Prevails in Automobile Liability Case.
We secured the dismissal of a declaratory judgment action filed in federal court against a large insurer. This case arose from a motor vehicle accident that occurred in 2015. The plaintiff averred that she had sustained injuries in excess of the tortfeasor’s bodily injury liability limits and sought stacked underinsured motorist (UIM) benefits. While the plaintiff had admittedly signed a rejection of UIM coverage form and a rejection of UIM coverage stacked limits form, she argued that her insurer had altered the statutorily required forms by adding additional language. The plaintiff filed a declaratory judgment complaint against her insurer. We filed a motion to dismiss the complaint on behalf of the defendant, which was granted by the federal court. The court reasoned that the UIM rejection form “specifically complied” with the applicable requirements of Pennsylvania’s Motor Vehicle Financial Responsibility Law because the additional language, contained on the same page as the statutorily required rejection language, was “inconsequential.”
Successful Defense of Bad Faith Case Against Insurer
Secured summary judgment in federal court in a bad faith case against a large insurer. The case arose from a pedestrian-motor vehicle accident that occurred in 2008 and dealt with the insurer’s handling of the plaintiff’s UIM claim following that accident. The plaintiff was run over by a rollback truck that was being repossessed on behalf of the owner. Because there were conflicting versions of events regarding how the accident occurred, the case went to arbitration on the issue of liability. The arbitrators found that the plaintiff was 33 1/3% causally negligent for his injuries, and the UIM claim later settled. The plaintiff then pursued a statutory bad faith claim, contending the insurer had delayed its investigation of the UIM claim without a reasonable basis and had unreasonably refused to pay the plaintiff UIM benefits. At the close of discovery, the insurer filed a motion for summary judgment, which was granted by the court, and the case was dismissed in its entirety.