In Neal v. State Farm Mut. Auto. Ins., the plaintiff sought relief on the basis that she was denied benefits based on a biased independent medical examination (IME), and that the insurer abused the IME process. Defendant moved to dismiss for a a failure to adequately plead under Twombly, and because any claims of bias are directly solely to the doctor, and not the carrier engaging him.
The court considered the following allegation boilerplate: “Plaintiff’s complaint makes general, conclusory allegations of bad faith concerning Defendant’s failure to pay benefits due, failure to effectuate prompt, fair and equitable coverage, failure to evaluate Plaintiff’s claim, compelling Plaintiff to institute litigation in order to recover amounts due, and failure to use an approved Peer Review Organization in exploring Plaintiff’s claim.” However, the following paragraphs were sufficient to make out a claim for bad faith based on a biased IME.
40. It is believed, and therefore averred, that Defendant employed [the doctor] to perform the independent medical examination in bad faith.
41. [The doctor] had previously split from a joint practice with [another doctor who was] Plaintiff’s primary physician.
42. Moreover, it is believed, and therefore averred, that [the IME doctor] does a substantial amount of work for Defendant and other insurance companies, and has, or may have been, continuously providing negative [IME] reports to Defendant and other insurance companies for the purposes of maintaining a steady source of business.
The court found it reasonable to infer that the carrier was aware of the doctor’s alleged bias and providing negative reports, and that he was engaged for a bad faith purpose.
Date of Decision: February 18, 2014
Neal v. State Farm Mut. Auto. Ins. Co., No. 1:13-cv-02309, 2014 U.S. Dist. LEXIS 20017 (M.D. Pa. Feb. 18, 2014) (Kane, J.)