Opinion ID: 2651525
Heading Depth: 3
Heading Rank: 2

Heading: May 31, 2006-July 20, 2006 (~6 weeks)

Text: State Farm argues its active investigation of James’s claim provides a legitimate or arguable basis for its delay. We agree with this contention for the time period lasting from May 31 through July 20, 2006. The record shows that State Farm received James’s signed medical authorization form, authorizing State Farm to obtain James’s medical records, on February 20, 2006. Thereafter, James continued to experience significant back pain for which she sought treatment. On May 8, 2006, she began seeing Dr. Ken Staggs at the Pain Treatment Center. 10 Case: 11-60458 Document: 00512514313 Page: 11 Date Filed: 01/28/2014 No. 11-60458 On June 5, 2006, State Farm requested James’s medical records and bills from three medical facilities. James continued to apprise State Farm of her ongoing medical treatment for which State Farm continued to promptly request medical records and bills. On June 21, 2006, State Farm received medical records from the Pain Treatment Center. The records stated that James had “compression fractures at T2, T3, T5, and T11 all ensuing from a motor vehicle accident presumed February 03, 2006 as there is edema on the MRI indicating that these are new.” Soon after, Renee Powell, the State Farm claim representative recently assigned to James’s file, noted that she had received the Pain Treatment Center records and reported that they diagnosed James as having “traumatic multi-thoracic compression fractures w/out retropulsion, T7-8 HNP w/o myelopathy or radiculopathy . . . .” Powell also observed the records listed past medical and surgical treatment James had received, and she specifically noted that the list did not include any spinal surgery. On July 18, 2006, Powell repeated her earlier entry about James’s diagnosis and further stated that “[i]f records do not show any more evidence of pre-existing issues, it seems that the medical records are supporting that [James’s] problems are a result of the [motor vehicle accident].” On July 20, 2006, Powell noted in James’s file, “Records from Wayne General indicate some degenerative changes in thoracic vertebrae with compression, but apparently the condition had not been causing any symptoms prior to loss, but I will review material closely as rec’d [sic].” By requesting and reviewing James’s medical records related to the accident, State Farm was engaged in an active investigation of James’s bodily injury claim during this time period.