INSURERS DO NOT AUTOMATICALLY ACT IN BAD FAITH BY RELYING ON THEIR OWN EXPERT’S CONCLUSIONS INSTEAD OF THE INSURED’S EXPERTS (Middle District)

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The insured claimed it was bad faith for the insurer to rely upon its medical expert’s opinion rather than the insured’s medical experts. The court found that such allegations alone do not make out a bad faith case.

The court stated that it “is well-settled that, when making a claim determination, an insurer may reasonably rely on the findings of an independent medical examination—even in the face of contrary medical opinions.” In addressing the allegation that the insurer “improperly favored” its own expert’s conclusions, the court further observed that “an insurer is not required to give greater credence to opinions of treating medical providers.”

Finally, even if relying on its own medical expert amounted to negligence or bad judgment, this does not equate to statutory bad faith in Pennsylvania.

Thus, the court dismissed the bad faith count, but the insured was given leave to replead her claims in an amended complaint if these deficiencies could be cured.

Date of Decision: December 17, 2018

Phillips v. State Farm Mut. Auto. Ins. Co., U.S. District Court Middle District of Pennsylvania No. 4:18-CV-01672, 2018 U.S. Dist. LEXIS 211729 (M.D. Pa. Dec. 17, 2018) (Brann, J.)

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