FEBRUARY 2018 BAD FAITH CASES: EXAMPLE OF ADEQUATELY PLEADING UIM BAD FAITH CASE (Philadelphia Federal)
This is another UIM bad faith case. The court found the following allegations were sufficient to defeat a motion to dismiss the bad faith claim.
First, the court found the following allegations were adequate to meet the standard that the insurer lacked a reasonable basis to deny benefits:
Defendant did not request a written statement from plaintiff;
Defendant never requested a statement under oath;
Defendant never requested a medical examination;
Defendant did not request authorizations from plaintiff to secure any medical records;
Defendant did not have a medical expert review plaintiff’s MRI;
Defendant did not have Plaintiff’s medical records reviewed or evaluated;
Defendant did not put its aforementioned offer in writing
Defendant made no reference to any record or diagnostic firm review in making its offer;
Defendant offered no explanation of its offer
Defendant did not request current records of plaintiff’s treatment even though he was actively treating at the time of the oral offer; and
Defendant assigned an inexperienced and/or inadequately experienced adjuster to plaintiff’s claim.
Second, the insured adequately pleaded knowing or reckless disregard of the alleged lack of a reasonable basis to deny coverage. Plaintiff alleged that the insurer’s “denial of full coverage for Plaintiff’s claim is unsupported by factual evidence; Defendant did not have Plaintiff’s medical records reviewed or evaluated; it made no request for current records of Plaintiff’s treatment; it did not reference any record or diagnostic firm review in making its offer; and it did not offer any explanation of its offer.”