DISAGREEMENT WITH AN EXPERT’S CONCLUSIONS, STANDING ALONE, IS NOT BAD FAITH (Philadelphia Federal)

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The insured claimed lost wages resulting from an auto accident that reduced his ability to work full time. The insurer’s examining physician concluded the insured could work full time. The insurer denied the claim.

The insured brought suit. The insurer moved to dismiss all claims. The court analyzed each of the potential claims in the complaint, including a bad faith claim.

The court observed the two elements of statutory bad faith, i.e., a knowing or reckless decision to unreasonably deny benefits. The court also apparently included a showing of self-interest or ill will as a third element. [Per the Pennsylvania Supreme Court’s 2017 Rancosky decision, however, a showing of self-interest or ill will may be evidence of the second bad faith element, but is not itself a third required element.]

The court found that the insured failed to set out a bad faith claim. The complaint alleged “the insurer relied on the findings of its own medical professional that [the insured] was able to return to work full time. While [the insured] might disagree with the doctor’s assessment, that does not mean his insurer acted without a reasonable basis when it denied [the] work loss benefits. Accordingly, the facts plead in the Complaint, without more, fail to show [the] insurer acted in bad faith when it denied his claim.”

The claims were dismissed without prejudice, with leave to amend.

Date of Decision: December 9, 2019

Elansari v. Liberty Mutual Insurance Co., U. S. District Court Eastern District of Pennsylvania Case No. 2:19-cv-03404-JDW, 2019 U.S. Dist. LEXIS 211369, 2019 WL 6698209 (E.D. Pa. Dec. 9, 2019) (Wolson, J.)

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