2006 D e c i sion s O p inion s of the U nit e d S t at e s C our t of Appe al s for the Thir d C ir c uit 6-8-2006 

# Am at o v . Atty Ge n P A P r e c e de nt i al or N on-P r e c e de nt i al : N on-P r e c e de nt i al D ocke t N o . 05-3011

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w . vi ll anova . e du/thir dc ir c uit_2006/934NOT P RE CE DE NT I AL UNI T E D S T AT E S CO UR T OF AP P E AL F O R T H E T H IR D C IR C U IT N o. 05- 3011 GAR Y AMATO,

A ppel l ant v. PENN SYLV AN I A O FF I CE O F ATTOR NEY GEN ERA L; P E NNS YL VANI A OF F I CE OF AT T OR NE Y GE NE RA L

I NS UR ANC E F RA UD S E CT I ON; DAVI D A. WAUGAM AN; M I CH E L L E KONDR AD

O n A p p ea l from the U n it ed S tat es D istri ct C o u rt f o r th e W e ste rn D istric t o f P e n n sy lv a n ia ( D . C . C i vi l N o. 04- cv- 01782) D istri ct Ju d g e: H o n . T erren ce F . M cV erry Subm i tt ed Pur s uantt o T hi r d C i r cui tL A R 34. 1( a)

M ar ch 30, 2006 B E F O R E : S M ITH and C O W E N , C i rcui tJudg es, and TH O M PSO N *, D i s t r i ctJ udge ( Fi l ed: J une 8, 2006 )

*H onor abl e A nne E. T hom ps on, Seni orU ni t ed St at es D i s t r i ctJ udge forthe D i s t r i ctof N ew J er s ey , s i t t i ng bydes i gnat i on.2 OP I NI ON C O W E N , C i r cui tJ udge. G a ryA m a to a p p e a ls th e o rd e r o f th e d istric t co u rt g ra n tin g S p e c ial A g e n t D a v id W a u g a m a n ’s m o tio n to d ism iss A m a to ’s m a licio u s p ro se c u tio n a c tio n b ro u g h t p u rsu a n t to 4 2 U .S .C . § 1 9 8 3 . W e w ill a f f ir m . I. T he part i es ar e fa m i l i arw i t h the fa ct s , w hi ch ar e onl ybr i efl yr eci t ed. A m at o had an aut om obi l e i ns ur ance pol i cyw i t h St at e Farm M utual A ut om obi l e I ns ur ance C om pany ( “St at e Farm ”) . T he pol i cypr ovi ded, i nt eral i a, fi r s tpart ybenef i t s forw age l os s and m edi cal expens es forbodi l yi nj ur yar i s i ng outof the mai nt enanc e orus e of a m ot or v e h ic le . A gen tW aug am an fil ed a cri m i nal com plai nt and an affidavi tof p robable cause agai ns tA m at o fori ns ur ance fr aud and a t t empt ed theftbydece pt i on pur s uantt o 18 Pa. C ons . St at . A nn. §§ 4117( a) ( 2) and 901( a) . A ccor di ng t o t he af fi davi tof pr obabl e ca us e, A m at o cal l ed 911 tw i ce due t o an al t er cat i on w i t h M ar ci C as s el hoff- Fei nber g on A pr i l 8, 2002. Ser geantM i chae l Shi r eyr es ponded t o t he s cene and t ook s t at ement s aboutthe i nci dentfr om C as s el hoff- Fei nber g and A m at o. C as s el hoff- Fei nber g t ol d Ser geantShi r ey that sh e a n d A m ato w ere arg u ing inside h is r esid en ce w h en sh e struc k h im o n the f o rea rm w ith a d o g co ll ar. A m ato s tat ed that h e w as g o ing to ca ll the p o li ce . C asse lho ff -F einb erg3

l eftt he r es i dence and goti nt o hercar . A m at o t r i ed t o pr eventherfr om l eavi ng by hol di ng hercardoor . W hen A m at o r el eas ed the ca rdoor , C as s el hoff- Fei nber g dr ove dow n the dr i vew ay . W hen s he gott o t he end of the dr i vew ays he dec i ded t o s t ays o s he c o u ld p ro v id e th e p o lice w ith h e r v e rsio n o f th e in c id e n t. W h e n a sk e d w h e th e r sh e h it A m a to w ith h e r c a r, s h e e m p h a tic a lly d e n ie d h ittin g h im . Am a t o p r o v i d e d S e r g e a n tS h i r e ywi t h a s i mi l a rv e r s i o n o f th e a l t e r c a t i o n . He s t at ed, how ever , t hatC as s el hoff- Fei nber g att empt ed t o run hi m overw i t h hercar . W hen as ked w hetherhe w as hi tbyt he ca r , A m at o r es ponded, “N o. ” Ser geantShi r eyobs erved the r ed w el ton A m at o’ s arm fr om bei ng hi tw i t h a dog col l ar . H e di d notobs erve any otheri njur i es. T h e a f f id a v it o f p ro b a b le c a u se f

u rth e r sta tes th a t A m a to su b m itt e d a c laim to S tate Far m , al l egi ng t hathe w as i nj ur ed af t erbei ng hi tbyan aut om obi l e. A m at o al s o cont act ed the pol i ce de part m entt w o day s aft erthe al t er cat i on, and s t at ed thathe w as bei ng tr eat ed atthe hos pi t al fora fr actur ed hi p and t ai l bone. Ser geantShi r eyw as s urpr i s ed by A m at o’ s i nj ur i es beca us e A m at o s t at ed pr evi ous l ythathe w as nothi tbythe ca r . T he 911 tap e s w e re th e n re v iew e d b yS e rg e a n t S h ire ya n d A g e n t W a u g a m a n . A m a to d id n o t sta te i n ei thercal l t hathe had be en hi tbythe ca r . Fur t herm or e, a r evi ew of A m at o’ s m edi cal re c o rd s , in c lu d in g x -r a y s , d id n o t r e v e a l a n yf ra c tu re s o r d is lo c a tio n s . A ft er the cri m i nal com plai nt and affidavitof p robable cause w ere fi l ed, an arr est w a rr a n t w a s is s u e d . A m a to tu rn e d h im s e lf in to th e p o lic e . O n N o v e m b e r 2 0 , 2 0 0 2 , a4

pr el i m i naryhear i ng w as hel d bySeni orD i s t r i ctJ us t i ce Fr ank D el bane. A tthe end of t he h e a ri n g , D is tr ic t J u s tic e D e lb a n e d is m is s e d th e c h a rg e s . A m at o t hen fi l ed a mal i ci ous pr os ecut i on act i on w i t h t he di s t r i ctcourt . A gent W augaman fi l ed a mot i on t o di s m i s s cont endi ng thatpr obabl e ca us e t o arr es texi s t ed and thathe w as ent i t l ed t o qual i fi ed i m m uni t y . O n M ay10, 2005, the di s t r i ctcour tgr ant ed the mot i on t o di s m i s s , fi ndi ng t hatpr obabl e ca us e exi s t ed bas ed on A m at o’ s confl i ct i ng s t at ement s r egar di ng w hetherhe w as hi tand i nj ur ed byC as s el hoff- Fei nber g’ s car . I n the al t ernat i ve, t he di s t r i ctcourthel d t hatSpeci al A gentW augaman w as ent i t l ed t o qual i fi ed im m u n ity. II . T he d i stri ctcou rthad j uri sdi ct i on pu rs uan tt o 2 8 U . S . C . § 1 33 1. W e exerci se appel l at e r evi ew pur s uantt o 28 U . S. C . § 1291. W e have pl enaryr evi ew overa di s t r i ct c o u r t ' s g r a n to f

a mo t i o n t o d i s mi s s f

o rf a i l u r e t o s t a t e a c l a i m. S e e Lu m v . Ba n k o f Am. , 3 6 1 F .3 d 2 1 7 , 2 2 3 (3 d C ir. 2 0 0 4 ). “T o d e c id e a m o tio n to d ism iss , co u rts g e n e ra lly cons i deronl yt he al l egat i ons cont ai ned i n t he compl ai nt , exhi bi t s at t ache d t o t he c o m p lain t an d m a tters o f p u b lic re c o rd .” P e n sio n B e n e f it G u a r. C o rp . v . W h ite C o n so l. I ndus . , 998 F. 2d 1192, 1196 ( 3d C i r . 1993) . A m ot i on t o di s m i s s pur s uantt o Feder al R u le 1 2 (b )(6 ) sh o u ld b e g ra n ted o n lyif , ac c e p tin g a s tru e th e f a c ts a lleg e d a n d a ll r eas onabl e i nfer ence s t hatcan be dr aw n t her efr om , ther e i s no r eas onabl e r eadi ng upon w h ic h th e p la in tif

f m a yb e e n title d to re lie f. S e e L u m , 3 6 1 F .3 d a t 2 2 3 .A n es s ent i al el ementof a mal i ci ous pr os ecut i on cl ai m i s thatthe “pr ocee di ng [be] 1 init iat ed w ith o u t pro b ab le ca u se.” E stat e o f S m ith v . M ara sco , 3 1 8 F . 3 d 4 9 7 , 5 2 1 (3d C ir . 2 0 0 3 ). S tate d d if

f e re n tly , if p ro b a b le c a u se is e sta b lish e d , a m a licio u s p ro se c u tio n c laim f a ils a s a m a tte r o f

la w . 5 T h e f irst iss u e to c o n sid e r is w h e th e r A g e n t W a u g a m a n h a d p ro b a b le c a u se to f ile a cr i m i nal compl ai ntfori ns ur ance fr aud. A per s on comm i t s i ns ur ance fr aud i f he ors he 1 “[k] now i ngl yand w i t h t he i nt entt o defr aud anyi ns ur erors el f- i ns ur ed, pr es ent s orcaus es to b e p re se n ted to a n yin su re r o r se lf -in su re d a n ysta tem e n t f o rm in g a p a rt o f

, o r in s uppor tof, a cl ai m t hatcont ai ns anyfal s e, i ncompl et e orm i s l eadi ng i nform at i on conce rni ng anyfac tort hi ng m at er i al t o t he cl ai m . ” 18 P A . C ON S . S TAT . A NN . § 4117( a) ( 2) . Pr obabl e ca us e exi s t s i f the fa ct s and ci r cumst ance s w i t hi n t he arr es t i ng offi cer ' s know l edge a r e s uffi ci entt o w arr anta prudentper s on t o concl ude thatthe s us pect has comm i t t ed, i s comm i t t i ng, orw as aboutt o comm i ta cr i m e. See M i chi gan v. D e F illip p o , 4 4 3 U .S . 3 1 , 3 7 (1 9 7 9 ). A gentW augaman had pr obabl e ca us e t o bel i eve thatA m at o comm i t t ed i ns ur ance fr aud bec aus e of hi s i ncons i s t ents t at ement s r egar di ng w hetherhe w as hi tbyC as s el hoffFei nber g’ s carand the conf l i ct i ng evi dence r egar di ng hi s i nj ur i es . W hen Ser geantShi r ey f irst a rriv e d a t th e sc e n e , A m a to sa id h e w a s n o t h it b yth e c a r. T h is s tate m e n t co n f licts w ith h is s u b se q u e n t cla im m a d e tw o d a y s la ter th a t h e w a s h it b yth e c a r. A s to h is i nj ur i es , t her e i s no i ndi cat i on t hathe i nform ed Ser geantShi r eyof an i nj ur ed t ai l bone a n d h ip a t th e sc e n e . T w o d a y s la ter , A m a to c laim e d th a t h e f ra c tu re d h is h ip a n d tail bone. T he x- r ay s di d nots uppor thi s cl ai m . B as ed on the i nform at i on w i t hi n Speci al6

A g e n t W a u g a m a n ’s p o ss e ss io n , a p ru d e n t p e rso n w o u ld re a so n a b lyb e liev e th a t A m a to m a d e f a ls e s ta te m e n ts m a te ri a l to h is c la im f o r f ir s t p a rt yb e n e f

its . A m at o cont ends t hatt he di s tr i ctcour tm i s i nt erpr et ed the w or d “cl ai m ” i n 18 Pa. C ons . St at . A nn. § 4117( a) ( 2) . H e as s ert s thathi s al l eged f al s e s t at ement s ar e i m m at er i al t o the ul t i m at e qu est i on of co verage fo r fi rs tpartyben efi t s becau se al l he h as t o est abli sh i s an i nj ur ygener at ed i n connec t i on w i t h a mot orvehi cl e. H e ar gues thatnothi ng i n the aff i davi ts ugges t s t hathi s m edi cal bi l l s w er e gene r at ed i n connec t i on w i t h an occ urr ence o th e r th a n th e in c id e n t w ith C a ss e lh o f f -F e in b e rg ’s v e h icle . W e d isa g re e . T o d e ter m in e if an i ns ur ed i s ent i t l ed t o benef i t s underthe pol i cy , an i ndi vi dual i zed i nqui r ym us tbe conduct ed t o det erm i ne i f the s peci fi c fa ct s and ci r cumst ance s al l eged pr ovi de for r ecove ry . A m at o’ s s peci fi c s t at ement s r egar di ng the s our ce a nd type of i nj ur i es s us t ai ned ar e mat er i al t o hi s cl ai m forfi r s tpar t ybenef i t s . T he di s t r i ctcour tdi d noterrbyfi ndi ng thatA m at o’ s contr adi ct or ys t at ement s r egar di ng w hetherhe w as hi tbythe ca rand the confl i ct i ng evi dence as t o t he type of i nj ur i es he s us t ai ned w er e mat er i al t o hi s cl ai m for f ir s t p a rt yb e n e f

its . A m a to f u rth e r c o n ten d s th a t W a u g a m a n m a d e a m a ter ial o m iss io n in th e a f f id a v it of pr obabl e ca us e bec aus e he f ai l ed t o i ncl ude a di ffe r ent i al di agnos i s fr om an emer gency r oom r ecor d. T he di ffe r ent i al di agnos i s pr ovi ded: “Fx L - s pi ne, Fx pel vi s , Fx coccyx, and [i ] l i an [c ] r es tFx. ” ( A ppel l antB r . at9. ) W e di s agr ee. A m at o’ s x- r ay s r evea l ed no f ra c tu re s o r d is lo c a tio n s , th u s , th e d if f e re n tia l d ia g n o s is w a s n o t a m a te ri a l o m is s io n .7

E v e n if A g e n t W a u g a m a n in c lu d e d th e d if f e re n tial d iag n o sis in th e a f f id a v it o f p ro b a b le caus e, A m at o s t i l l m ade i ncons i s t ents t at ement s aboutw hetherhe w as hi tbyC as s el hoffF e in b e rg ’s c a r. T h e in c o n sis ten t sta tem e n ts a lo n e w e re su f f icie n t to e sta b lish p ro b a b le caus e fori ns ur ance fr aud. Fort he for egoi ng r eas ons , t he j udgm entof the D i s t r i ctC our tent er ed on M ay10, 2005, w i l l be af

fi r m ed.