Opinion ID: 2651525
Heading Depth: 3
Heading Rank: 5

Heading: January 17, 2007-July 11, 2007 (~25 weeks)

Text: State Farm asserts its active investigation of James’s claim provides a legitimate or arguable basis for its delay. Because State Farm was not engaged in an active investigation between January 17, 2007 and July 12, 2007, we reject this argument. State Farm also presses that James’s lawyer, Joe Clay Hamilton, failed to provide medical records, the delay of which should not be 14 Case: 11-60458 Document: 00512514313 Page: 15 Date Filed: 01/28/2014 No. 11-60458 attributed to State Farm. Because the record contains no evidence that State Farm informed James’s lawyer that it was concerned about the etiology of James’s injuries, we decline to attribute the delay to James. State Farm also argues that the delay is attributable to Staggs, whose medical records allegedly caused further confusion as to the cause of James’s injuries. We similarly reject this argument because Staggs sufficiently responded to State Farm’s inquiry, and State Farm did not follow up with Staggs to seek further clarification. On December 11, 2006, Hamilton notified State Farm that he was representing James and advised that he would forward James’s medical bills and records when she had completed treatment. The same day, Powell acknowledged Hamilton’s representation and added, “Please forward all related medical and wage information you have concerning your client’s injuries.” Over the next several months, Powell sent Hamilton several letters, requesting “material” for James. Critically, it was not until July 12, 2007 that Powell notified Hamilton that she required prior medical records to fully assess James’s claim. State Farm argues on appeal that Staggs’s January 16, 2007 medical records further confused its claim representatives, but the record does not disclose that Powell ever mentioned that confusion to Hamilton or the need for prior medical records until her July 12, 2007 letter. While it is true that Powell sent several letters to Hamilton during this time period to which he did not respond, Powell’s letters do not indicate any active investigation into State Farm’s concern about the etiology of James’s injury. The record does not demonstrate that Powell ever communicated to Hamilton during this time period that she was concerned about the possible preexisting nature of James’s injuries, nor does the record show that Powell indicated to Hamilton that he should seek to gather prior medical records, not 15 Case: 11-60458 Document: 00512514313 Page: 16 Date Filed: 01/28/2014 No. 11-60458 just evidence of current treatment.8 Specifically, in her letter, Powell explained that “the initial [radiologist] reports indicated the compression fractures that Ms. James has are probably old. . . . We will likely need some of her prior records to confirm her condition prior to loss as opposed to following the loss so you may want to request those as well.” There is no evidence in the record that Powell obtained these records after she became aware of Hamilton’s representation. To the contrary, there is ample evidence that, prior to January 17, 2006, she had these records and had noted the possibility that James’s injuries pre-dated the accident. Therefore, the record demonstrates no reason why Powell waited until July 2007 to inform Hamilton of her concerns and her need for prior medical records. Under Mississippi law, a delay is not attributable to an insurer where the insured or his counsel refuses to cooperate or provide the necessary information. See Pilate, 865 So. 2d at 397. If an insured’s lawyer advises the insurer to stop its investigation pending his sending medical records, the resulting delay until the lawyer sends the records is attributable to the insured. However, as the burden is on the insurer to gather all necessary medical records, if the insurer fails to inform the lawyer of critical information necessary to further its investigation, the delay in obtaining that information is not attributable to the lawyer but to the insurer. As State Farm did not inform Hamilton that it needed James’s prior medical records to resolve questions about the causation of her injuries, State Farm is responsible for the resulting delay in investigating James’s claim. State Farm also argues that its delay should be attributed to Staggs because he did not provide clarification as to whether James’s injuries were a 8 Indeed, it was not until September 25, 2007 that Powell informed Hamilton that she required one year of prior records from all of James’s physicians, whom she specifically named. James had disclosed the names of her physicians to Powell in October 2006. 16 Case: 11-60458 Document: 00512514313 Page: 17 Date Filed: 01/28/2014 No. 11-60458 result of the motor vehicle accident. We disagree. We do not express an opinion as to whether Staggs’s medical records actually were confusing. Instead, we observe that after Powell received Staggs’s medical records in January 2007, she never contacted Staggs to seek further clarification nor did she notify Hamilton of her confusion. Moreover, the delay is not attributable to Staggs because, as James argues, he reasonably could have believed that he had complied with Powell’s request to provide further information. If Staggs believed his records were clear, he needed to provide no further information. That they were unclear to Powell, who did not seek further clarification, is not Staggs’s fault and thus is not chargeable to James. See Stewart, 846 So. 2d at 204 (citation omitted). Accordingly, we conclude that James has met her burden by raising a fact issue as to whether State Farm had a legitimate or arguable basis for delaying its payment during this time period.