Opinion ID: 615133
Heading Depth: 3
Heading Rank: 1

Heading: The Accident and Insurance Claims1

Text: In March 1999, a van driven by Maccari and insured by Bituminous was hit by another car. The parties agree that the driver of the other car, Eman Zaki, was entirely at fault for the collision. The insurance policy for Maccari‟s van included personal injury protection (PIP) as well as underinsured motorist (UIM) coverage. The parties agree that the UIM coverage entitled Maccari to compensation, up to $1,000,000, for damages incurred in excess of Zaki‟s insurance coverage, which had a limit of $100,000. In February 2004, Maccari advised Bituminous that he sought compensation pursuant to the UIM coverage. Maccari initially demanded $650,000 on this claim, largely on the basis of a medical report stating that he was suffering from chronic cervical pain and recurring migraine headaches that prevented him from performing his job as a painting contractor and estimator. Over the course of 2004 and 2005, Bituminous investigated Maccari‟s claim, the parties discussed its value, and Maccari increased his demand to $900,000 and requested an arbitration hearing. In March 2006, on the recommendation of his doctors, Maccari had a cervical fusion operation. Maccari‟s doctors reported that the surgery went well but that it would not be possible to determine its effects on his disability for six to twelve months. 1 Because we write only for the parties, we briefly summarize the undisputed facts, drawing all inferences in favor of Maccari, the non-moving party. See Barefoot Architect, Inc. v. Bunge, 632 F.3d 822, 826 (3d Cir. 2011). 3 During that period, Bituminous arranged for a second examination of Maccari by its medical expert and for another report from its private investigator. In May 2006, one of the company‟s claims examiners sent an email to her superiors providing an update on Maccari‟s claim. A printed copy of the email contains her handwritten tally of the various types of compensation sought by Maccari, which totals $534,000. This calculation conflicts with the text of the email itself, which observes that “[i]f we use their figures the projection is 419k but we do expect those to go down because of the results thus far of his surgery and his atty will be completing new reports,” and recommends an indemnity reserve of “350-400k.” Claims evaluation sheets from this period do not indicate that Bituminous valued Maccari‟s claim at $534,000. Moreover, in a deposition, a Bituminous representative denied that the handwritten notes represented the company‟s internal valuation of Maccari‟s claim. In December 2006, Bituminous‟s medical expert provided a report in which he stated his conclusion that Maccari could work a light-duty position. Additionally, Bituminous‟s private investigator surveilled and videotaped Maccari going to work and performing chores outside his home over the course of several days. Finally, Bituminous‟s vocational expert provided a report finding that Maccari was qualified for a number of light-duty positions with wages averaging about $30,000 per year and as high as $45,000 per year. In January 2007, Maccari withdrew the $900,000 claim and instead demanded the policy limit of $1,000,000 plus pre-judgment interest of $600,000, arguing that 4 Bituminous had unreasonably delayed the handling of his claim. The parties agreed to arbitrate their dispute and a hearing was scheduled for January 26, 2007. The week before the arbitration hearing, Bituminous revised its internal estimate of Maccari‟s claim, assessing the value of the claim at $381,000. Shortly before the hearing, Bituminous offered Maccari first $500,000, and then $750,000, to settle his claim. Maccari rejected these offers and the parties proceeded to arbitration, which resulted in an award of $1,000,000 to Maccari but no award of pre-judgment interest.