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Smith v. Auto-Owners Insurance Co.

United States District Court, D. New Mexico

July 27, 2017

MELVIN SMITH and STAN FOWLER, Plaintiffs, [1]
v.
AUTO-OWNERS INSURANCE COMPANY, Defendant.

          MEMORANDUM OPINION AND ORDER

          STEPHAN M. VIDMAR United States Magistrate Judge

         THIS MATTER is before the Court on Defendant Auto-Owners' Insurance Company's Motion for Summary Judgment [Doc. 99], filed on February 13, 2017. Briefing is complete, [2][Docs. 106, 119], and oral argument was held on June 19, 2017. Having considered the briefing, record, oral argument, and the relevant law, the Court finds that Defendant is entitled to summary judgment on Plaintiff's claim for damages arising from his shingles but not from his other alleged injuries. Defendant fails to show that it is entitled to summary judgment on Plaintiff's claim for declaratory judgment at this time.

         Background

         Plaintiff Melvin Smith was an employee of a company called Principal Mobility. He was traveling in an automobile owned by Principal Mobility and insured by Defendant Auto-Owners Insurance Company (“AOI”) when it was struck from behind by a vehicle driven by a State Farm insured. State Farm's driver was at fault for the accident. State Farm adjusted the claim and ultimately contributed its $100, 000 policy limits to satisfy the claims of the various injured parties, including Plaintiff. As a result of the accident, Plaintiff received a payment of $26, 731.10 from State Farm. The policy issued by Defendant provided $5, 000 in medical payment coverage and $1, 000, 000 in underinsured motorist (“UIM”) coverage. AOI paid $5, 000 to Plaintiff under the med-pay coverage. Thus, he has received a total of $31, 731.10 from State Farm and Defendant.

         Plaintiff contends, however, that his damages far exceed $31, 731.10, thus entitling him to UIM benefits under the policy. Plaintiff initiated this lawsuit, claiming, among other things, that Defendant's failure to pay him the UIM benefits constitutes a breach of the insurance contract.[3][Doc. 1-1].

         Defendant moves for summary judgment on Plaintiff's claims for breach of contract and declaratory judgment.[4] [Doc. 99] at 1, 20. The crux of Defendant's position is that there was no breach of contract because the $5, 000 it paid to Plaintiff, combined with the money received from State Farm, fully compensated Plaintiff for the injuries he sustained in the accident. Plaintiff disagrees, claiming that his damages from the accident far exceed the compensation he has already received, thus entitling him to UIM benefits under the policy

         Standards

         Summary judgment will be granted “if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fed.R.Civ.P. 56(a). The movant must support its request by “citing to particular parts of materials in the record, including depositions, documents, electronically stored information, affidavits or declarations, stipulations . . ., admissions, interrogatory answers, or other materials . . . .” Fed.R.Civ.P. 56(c)(1)(A).

         The movant has the initial burden of establishing that there is no genuine issue as to any material fact and that the movant is entitled to judgment as a matter of law. Celotex Corp. v. Catrett, 477 U.S. 317, 323-24 (1986). If this burden is met, the non-movant must come forward with specific facts, supported by admissible evidence, which demonstrate the presence of a genuine issue for trial. Id. at 324. Although all facts are construed in favor of the non-movant, the non-movant still has a responsibility to “go beyond the pleadings and designate specific facts so as to make a showing sufficient to establish the existence of an element essential to [his] case in order to survive summary judgment.” Johnson v. Mullin, 422 F.3d 1184, 1187 (10th Cir. 2005) (alteration in original) (internal quotation marks omitted).

         Analysis

         Defendant is entitled to summary judgment on Plaintiff's claim for damages arising from his shingles, because he has no admissible evidence that the accident caused the shingles. However, Defendant is not entitled to summary judgment on Plaintiff's breach-of-contract claim based on his other personal injuries. Even if Plaintiff's left rotator cuff was torn prior to the accident, Plaintiff may still recover for the aggravation of the torn rotator cuff. Additionally, Defendant concedes that Plaintiff suffered at least a temporary soft tissue neck injury. Whether he has received all the compensation to which he is entitled under his UIM coverage remains a question of fact precluding summary judgment. Finally, Plaintiff's claim for declaratory judgment appears to seek relief that is not available under the Declaratory Judgment Act. Nevertheless, Defendant has not persuaded me that it is entitled to summary judgment for that reason, on the briefing as it stands today, and its motion will be denied without prejudice at this time.

         Plaintiff's Shingles

         Plaintiff contracted shingles after the accident. He claims that the accident caused the shingles. Defendant argues that Plaintiff is not entitled to any damages arising from the shingles because there is no admissible evidence in the record on which a reasonable fact-finder could rely to find that the accident caused the shingles. [Doc. 99] at 9-10, 17-18 n.9.

         “Ordinarily, what constitutes the proximate cause of any injury is a question of fact. However, the question of proximate cause becomes a question of law when the facts are undisputed and there is no evidence from which a jury could reasonably find a causal connection between the allegedly negligent act and the injury.” Eck v. Parke, Davis & Co., 256 F.3d 1013, 1023 (10th Cir. 2001) (internal citation and quotation marks omitted). Under New Mexico law, it is well-settled that the plaintiff bears the burden of proof on medical causation, and he cannot prevail on the issue of medical causation without expert testimony directly supporting his conclusion. Woods v. Brumlop, 1962-NMSC-133, ¶ 15, 71 N.M. 221 (“[T]he cause and effect of a physical condition lies in a field of knowledge in which only a medical expert can give a competent opinion.”); ...


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