question in this case is are there issues of material fact under summary judgment standards whether am paks you i am adjustment claims adjusting and ling was reasonable or was frivolous or was unfounded the term reasonable if we just put it out there in the air is kind of ambiguous because what's reasonable to me might not be reasonable to somebody else and that's the way it's used sort of ambiguously throughout the briefing admitted but what it really means in the insurance adjusting world is conforming with the stablished standards or rules there are rules which govern bereft of standards in claims adjustor if there weren't any standards then any insurance company could argue what that that what they were doing or failed to do was reasonable or unreasonable in it it's too vague but there are well established standards in washington and elsewhere  on claims adjustment by statute by washington administrative code section by regulations in other words by industry standards which was well briefed in the in the summary judgment case in the cases i should say below here and by backs own claims adjustment standards and i followed your chronology of events in this claim ok and i'm like question what point do you contend that and case the essential time period for this is and this is probably probably the most important issue is april twenty one two thousand and fifteen that's the point that's the point two days later the lawsuit was filed and we're in a different we're in a different sphere but april twenty one two thousand and fifteen was the point at which an package made its offer of twenty five thousand dollars new money but council with respect  as i understand this record there was a if you will a dialogue between you and packs of people they made offers you didn't respond they ask you for his ation to review your client's medical records you didn't respond you basically kept putting him off putting and putting him off and then finally threatening to file the action also struggle with the fact that i don't see where it was clear that ampeg knew were should have known that the claim in aggregate with the earlier with the century and what had already been paid t valued in excess of two hundred ten thousand dollars so from my perspective and i hope you can help me with this looking at the industry standard to question for a juror would be  was it really unreasonable for the insurance company in this case and pack to be required to make an additional tender when it didn't have essential information that it was entitled to one of the documents themselves as well as under respond you were the great sphinx how is that reasonable the i kind of agree with you i apologized to am back for some of the delays that were here but that's why the judges question is so crucial is because with all the with all the delays the still the question still is by the time before suit was filed what information did they have or should they have had that they could have made a reasonable evaluation of the claim it did did they have all of the medical records that they'd requested at that point ok that what they had here was and there's a chart in the in the in the in the record that shows all this i did it day by day each and each entry of each medical care care they had by this by the time of the lawsuit was filed they had their own records that they had secured directly from the medical providers which were part of their file on part of the pip adjustment they had a whole they had a complete set of records they were missing a couple of dates of the chiropractors records but that's really a treatment was basically over by then they had those records in the demand package which was sent out in mid april two thousand fact as an insurer investigating a claim like this isn't allowed to investigating consistencies because i think in the letter you sent in there were so many consistencies from which in the records in your letter to them you talk about her being suicidal you talked about brain injury that a brain bleed from the diagnostic studies in those didn't pan out and those weren't part of what could be related to this accident yeah i guess in  the situation there's a lot of ins and outs but here's what here's what here's why that's not quite correct because as to answer the further question they had available to them a third set of records which they got directly from the providers admittedly appropriate to ask what the reasonable basis for the with a what they wanted and i me that policy says they had to have a reasonable basis for it and they just said do it and they asked me how i do it i thought they wanted me to jump and they wanted me to ask just how high but that wasn't it but that wasn't the issue what happened then and just talk about the suicidal aspect the am pack had available to them they never sought the adjuster never ok you say a third set i mean talk about records from individual providers or there was an individual individual person provided they didn't didn't receive it that there was there was one individual provider that i refused to allow them to have because it was unrelated which was a psychiatric help for the children and the other provider that i had that i didn't even know about was because it was a she she swore stepped on her hand lay after the case which had nothing to do with the case so they didn't have those two records but they had the original set of medical records directly from providers on pip they had the set of records i provided and one of the things that's interesting here is a lawyer really going to going to mislead an insurance company by provide the doctoring the records and i've been at the for forty four years i wouldn't danger my my bar permit but then they got a third set of records after we signed the permit to do that they got a third set of records again directly from all the providers so they had the three sets of records but what they also had not just addressing sums some specifics on the suicidal aspect they had a three and a half hour deposition examination under oath of ruth jelinek again that evaluation of a claim is it is it reasonable to ignore three and a half hours of testimony where she detailed in exquisite detail her background and all the harms and that she was suffering from this from this brain damage is that reasonable to ignore that is it reasonable to ignore medical records that they have in their file what was their specific information in that statement she gave that you feel was should have been evaluated but wasn't all of it i mean she had she she didn't she discussed how she was it not able to function on a daily basis and in my reply brief i think i put that in there she was not able to function on a daily basis all the all the elements of mild traumatic brain the time as you claim the insurance company should have known it had a more they have all the evidence that they had requested regarding your client's fault on two occasions in the four to six year period prior to the accident where she struck her head the they didn't they had all the information at that what the what the trial judge had available to him is the testimony of the adjuster the testimony of the claim supervisor the testimony of the insurance expert that and packet hired and based on the same set of records that empacher had threw out they could find no evidence of concussion no evidence of  clinical anxiety no evidence of any of the symptoms that she was having or treatments for them so please let me be sure your answer did they have with respect to those two prior  falls where she had her head did the insurance company have all of the records or other information that they had requested from you at the time that you say they should have known that they needed to pay more yes they had all the records from the when and when the next move to washington they stablish care with dr ct as a primary care doctor two thousand and five and pac had to hold those historical records it was all there for them it was all laid out  there's some some of the records indicated that she did have some prior concussions and are false none so there was that as that as the judge said there is there are there were incidents where she admitted that she had had bumped her head  was never any treatment for it there was never any sequela to that it was and that was years old so the it's there and i pointed that the records do reflect history at least from provided by your client of  prior concussions or prior to his there's a big difference between dumping your head which we all do and a concussion which has sequel it for for brain damage they had all the same information that they had at the end and i'm at the same information was evaluated by the three people i just indicated and in fact the court found that there was no there was no dispute about the fact that she was suffering from post in customs and from it what then and arose from this claim i'm not saying they couldn't have investigated but all they had to do was look at the records to see that there was no treatment for any of these things to go back to that i mean for a second did you fault in fact for requesting and i mean never happened and i'm not i can understand for the record why it didn't happen well it didn't happen before th critical time period and it did happen eventually but the the what i was asking for is a reasonable basis for it because we had a clinical neuropsychologist who had tested her and found that the brain damage deficits  thirteen there was a neural psychological evaluation by care and sanders that's right doctor and that your client related that two occasions in the previous four to six years she fell off a horse right struck her this is not just banging against the wall she fell off a horse and hitter had people die from that sort of thing so it's not exactly a strange request to want to know what the impact if any was right but the but that there were no there were no  effects of that that she ever had and in fact if you go on to the dr sanders neuropsychological evaluation she says there are no relevant prior incidents so is it your your representation to the court that in the in the record there is nothing that says that these earlier falls had any impact on your client's mental and physical state right i'm saying on the record and i am also stating as a fact that empacher knew that because there are three of their of the people said in october of two thousand and thirteen when she said that she had mild post concussive syndrome complicated by anxiety and depression that should resolve within the pursuing any kind of treatment with regard to her cognitive difficulties and and in fact had not reported any treatment in that packet since february of two thousand and fourteen so the disconnect the adjuster was looking to resolve is how is she now is this a permanent injury is there are there still that the troubles some symptoms that she's been talking about and then so we asked for first of all impact offers ten her current condition both her report of her condition that would be covered by the e o you know and then also any medical opinion as to her current condition any treatment that she was receiving at the time to her current condition and that would be the i am so on the one hand when dylan jackson said that's the attorney for and pack he sent a letter to mr baylen explaining the ten thousand dollar offer in august of two thousand and fifteen twenty fourteen he said in order to move forward we have a disagreement he said about the value of this claim in order to move forward we want to do three things number one we want your client to sign an author contacted a neuropsychologist and also i believe a neurologist in order to get first of all the raw data from dr sanders and evaluate that and then to set up the irony for a bit with both of those doctors so they could get a look at what was going on at that moment with so as far as the they had reviewed the records investigation of the by the claims adjuster she had reviewed the records she'd reviewed the claims package they had been meeting with the claims committee and saying we need more information we need the we need more medical records if they're out there we need the oh we need the i am so that was the investigation and took a really long time for mr beilin to cooperate and there were letters going back and forth etc but at the same time what we were trying to do what the what that the undernourished psychologist lined up to review the records to what was the continuing problem that mr jelinek was suffering from miss dr sanders said in october of two thousand and thirteen this should resolve the should go back to baseline she should continue to have treatment for her anxiety and depression and she should also look into cognitive rehabilitation and so what and pack is looking for is has it resolved now and why not and if it hasn't resolved now why isn't she looking for why isn't she treating why isn't she looking for treatment so there was and also in the records there is nothing to suggest that mr jelinek had received any treatment for these cognitive difficulties she didn't as far as we know she didn't get any cognitive rehabilitation therapy been nearly two years since the sanders evaluation but she had not apparently return for retesting as was suggested and so it wasn't clear to  the claim would come from if she doesn't have any more medical record medical expenses her only medical expenses were eighteen thousand dollars eighteen thousand six hundred dollars ten of those were paid in the med pay claim and then she received one hundred thousand dollars from country the tarte fees are insurance so from your impacts perspective yes even if her medical expenses and her losses were more than the eighteen thousand dollars because of this brain injury because it's after the offer of ten thousand dollars in new money that it seems to me the problems arise for your client because i can certainly understand why your client one of the deposition and that's something that you had a right to insist on but i don't i guess i don't understand the district court's rationale for saying that once your client obtained three and a half hour deposition which provided answers to many of the questions you just posed that impact was was wondering about  and then the seems like it's undisputed evidence that the person who was supposed to adjust the claim never actually reviewed the transcript itself and the summary is a joke frankly that that summary cannot substitute for reading the entirety of the transcript and so i guess i find myself pretty seems pretty easy to me that a reasonable jury could say that you can't make any kind of final twenty five thousand dollar offer come april  without at least having reviewed the transcript of the deposition that you insisted upon which provided answers to many of the questions relating to valuation that you just pose and i understand that notion to claim committee meetings where they talked about the the problems with the treatment the lack of treatment where is how is this claim going to result in more than one hundred sixteen thousand dollars losses in the future it cetera they had discussed this at these claims committee meetings and they knew why they wanted the and then they had to when jackson do it and in the report back she said she talked to him about it and that the evaluation was they still didn't  as a pall letterman said it was in an attempt to try to resolve the issue in a way that was satisfactory to both parties because there was not there was no medical evidence no evidence of out of pocket losses no description of what what she could be paying in the future that would require the up the evaluation of the claim to be more  what's awful but don't worry this shouldn't be permanent what it seemed clear by march of two thousand and fifteen when the deposition was taken is that no this actually was not going to go away and it had permanently or not probably it drastically affected the quality of her life and i think you know as lawyers we can appreciate the the loss of the ability to do a camera that medical terms like executive functioning that high level critical thinking for someone with her background in the line of work she was engaged in for the rest of your life when she was what in her fifty's i just like how extra one hundred thousand dollars you don't think would be called for to compensate someone for permanent cognitive damage that was going to basically ruin the quality of their life going forward for the next twenty thirty years i just t it reasonable jury could certainly find that regardless of the dispute over the valuation to not review carefully all of the information that she provided about her present condition during that deposition which she had asked for why  strikes me as the definition of unreasonable at the same time we have the second the second issue that there was a disconnect about about in this case that both edith elliott and paul letterman talked about and was seen in the claims committee no to that second question is really cause asian and because miss challoner's walked away from the accident and then later went to the e r and she said she did not she remember the accident she didn't hit her head she didn't have vision or memory problems or anything like that and then she came to her doctor later and said there were memory problems and then a few months later ninety percent better on the memory problems and then by the time the dr sanders report my old concussive disorder complicated by anxiety and depression and and then very i mean honestly by the time of the e u oh it sound significantly different  much different and that and the question as far as medical causation dr sanders you know she talked to or about what had happened in her past said no three bumps in the head to the horse incident of the horses that this is part of your past but at the same time there was no definite connection between i mean dr sanders i don't think that supported by the medical records the doctors all the doctor she saw said that no the symptoms you are suffering now came from this car accident not from some i mean i think she testified in the deposition that when she fell off the horse she didn't even hit her head so she was going to helmet and i so but she also she also testified she didn't hit her head in th accident i mean that being part of the problem right but i'm saying that so she went to qualified highly qualified medical doctors who ran all sorts of tested all sorts of evaluations and if i'm remembering right they all can conclude that the reason you are having this in these symptoms is because of what you experienced during the car accident no my understanding of the deposition testimony of elliott and paul letterman is that there is a question of whether or not that and pac felt that it was a question of whether or not the motor vehicle actually caused the accident and that would be the purpose of the i am me because they're in their experience and the in the art of adjusting claims they believe that this is not good enough this is not enough evidence that it was necessarily connected when you have these discrepancies when you have the fact that she said she didn't hit her head when you have the fact that the symptoms come and go over time and when you have this she hasn't been treating at all since february of two thousand and fourteen so yes yes  i understand the idea that it is very significant the person of her educational background is experiencing these kinds of of these kinds of symptoms at the same time it was complicated by other things anxiety depression that it may or may not have been a result of the accident that if that is not i believe dr sanders report it does not necessarily say i'm sure this was caused by the accident so and fifteen so the plan was after they finished the e u oh they were going to actually they had actually scheduled they said it in this office in a wimpier these are the dates we're holding it was it was requested and i just wanted to point out th a contractual right to have medical authorizations do you have the e u and to have an eye on me before making a decision on whether or not to pay that's in the contract in the policy and they attempted to exercise that right away in july in august when mr barrett rejected the first offer and it and that timeframe was stretched out because mr beilin refused to cooperate and extended the time  then the the time at at the time in between the time of the euro and the and the second offer and the lawsuit the question was will you please submit to this i mean that we've scheduled so we can complete this investigation so can have all the information that we need and go forward in valuing the claim can i ask you though about the april twenty first email then from mr jackson because i guess everything you you're saying now sounds perfectly reasonable but it seems to me a reasonable jury could look at the text of what stated in that e mail and conclude that actually everything you've just said is not what unpack was considering because in connection with making the twenty five thousand dollars offer what stated is that the this offer is the most that and pack will pay it so you're you're claiming that oh well no we need all this information we were trying to do this we were for the extras are right on the policy what i think a reasonable jury could conclude looking at the that begins in necessary and just read the last sentence if i just read the last sentence right so what i read that again maybe you're right maybe you're wrong but a reasonable jury could infer from that that know what your client had decided the this is a nuisance will give you twenty five thousand dollars if you'll just shut up and go away but this is it stop stop making demands we are done negotiating take it or leave it and that's totally inconsistent with everything you just said a second ago at the same time what also have been happening through all this time is mr jackson had repeatedly said to mr baylen we don't think this is worth two thousand and ten two hundred ten thousand please give us a counteroffer we offered you ten thousand dollars new money based on one sixteen  sixty seven if you don't like that tell us why and he never came back he did not want to negotiate and also the tenor of these letters are ratcheting up in nastiness quite honestly with mr beilin threatening a lawsuit in every in every almost every letter and finally if the claimant cetera and when you read that depositions as well there's a lot of getting after each other the lawyers so this is the that's the tone of what's going on very interesting in the insurance industry and the act require that every important item in a claim to judgment file be documented so there is no documentation in the file that the adjuster ever looked at the medical records made available to or we know that third set wasn't reviewed because it was never even provided or a reasonable investigation requires that you at least read the materials that are available to you so you can evaluate a case there is no evidence here or anywhere that they evaluate it now let  ask you this is it your position that impact had to rely solely on the reports from the treating doctors in in the statement from the insured in shouldn't have had been allowed to do or niamey no i'm really basically saying that they didn't do any investigation at all the let's look at the offers offers ten thousand dollars the offers of twenty five thousand dollars where that's going to be the final and most were ever going to pay well is that i am me a part of an investigation i mean if they're truly concerned about ca's ation in the extent of the damage afterwards the claims they offer as they were made ten thousand dollars twenty five thousand dollars were not based on any of valuation of the medical records or the damages or they they were admittedly only to save costs for amtrak in other words am back really a jury could find in this case that am pack never even considered the real damages to ruth jelinek never even looked at it and the documentation does not support that anyone looked at any of those records at any time they threw out a ten thousand dollar offer on a brain damage case and then a twenty five thousand dollars offer based on nothing no evaluations all three of of and the fact that the it was like a four line description of the deposition goes along with what you're saying and how she cries a lot and that's the your time is up let me ask my colleagues but i think you both of arguing your case well we thank you for your