Reported / Citable
Background
Don David Del Grande was struck by a passing car while setting traffic cones at work in February 2023. He received medical treatment and workers’ compensation benefits, including medical benefits and temporary income benefits. He later sued State Farm, seeking benefits under the personal injury protection (PIP) and uninsured/underinsured motorist (UM/UIM) provisions of his auto policy, along with fraud, misrepresentation, DTPA, and civil-conspiracy claims.
State Farm sought medical records, bills, and workers’ compensation materials needed to evaluate the claims. Although the court granted State Farm’s motion to compel, Del Grande produced incomplete records and did not provide the requested workers’ compensation correspondence or a written authorization allowing State Farm to obtain the information.
The Court’s Holding
Magistrate Judge Henry J. Bemporad recommended denying Del Grande’s motion for partial summary judgment. Del Grande did not conclusively establish that he performed his policy obligations, including providing claim-related information and authorizations, or that State Farm committed a false, misleading, or deceptive act required for DTPA liability.
The magistrate judge further recommended granting State Farm summary judgment on the breach-of-contract claim and dismissing that claim. The record showed Del Grande had not supplied the documentation required to substantiate PIP or UM/UIM benefits. For UM/UIM coverage, he also did not show that the policy’s nonduplication clause—excluding damages already paid or payable through workers’ compensation—did not apply. State Farm’s motion was recommended to be denied as to the remaining noncontract claims because it had not developed arguments or evidence addressing them.
Key Takeaways
- An insured seeking PIP or UM/UIM benefits must comply with policy requirements to provide reasonably requested claim documentation and authorizations.
- Failure to establish that workers’ compensation will not pay the claimed losses may defeat UM/UIM recovery under a nonduplication clause.
- A summary-judgment movant must address each claim it seeks to dismiss; State Farm’s motion did not support judgment on Del Grande’s noncontract claims.
Why It Matters
The recommendation underscores that an insurer may obtain summary judgment on a coverage-based contract claim where the insured has not furnished policy-required information necessary to evaluate benefits. It also illustrates the importance of workers’ compensation offsets and nonduplication provisions in UM/UIM litigation arising from workplace accidents.
Because this is a report and recommendation, the district judge may review timely, specific objections before entering a final ruling.