Court Opinion

ID: 9599346
Source: CourtListenerOpinion
Date Created: 2023-08-22 01:18:07.260476+00
Date Added: 2024-06-11T15:21:00.342885
License: Public Domain

Barnes, Judge,
concurring specially.
Although I concur fully in the majority opinion under the evidence in this case, I write separately to point out that an insurance company’s mere assertion that the termination of benefits was based on an independent medical examination is not conclusive in the face of evidence that the independent medical examiner (IME) report was not the real reason the benefits were terminated.
An independent medical examination may provide a reasonable and probable cause to terminate benefits and thus be sufficient to preclude imposition of bad faith penalties (Lancaster v. USAA Cas. Ins. Co., 232 Ga. App. 805, 807 (3) (502 SE2d 752) (1998)), but that rule is not without limitation. If the recommendation of the IME is patently wrong and the facts are brought in a timely manner to the *99insurer’s attention, an IME report would not provide a reasonable basis for the denial of a claim. See Haezebrouck v. State Farm &c. Ins. Co., 216 Ga. App. 809, 811 (2) (455 SE2d 842) (1995); Colonial Life &c. Ins. Co. v. Donaldson, 172 Ga. App. 211, 212-213 (1) (322 SE2d 510) (1984). In the same manner, an IME report that was a mere pretext for an unwarranted prior decision to terminate benefits would not constitute reasonable and probable cause for termination of benefits because it would not be a “reasonable defense which vindicates the good faith of the insurer.” (Citation and punctuation omitted.) Progressive Cas. Ins. Co. v. Avery, 165 Ga. App. 703, 707 (1) (302 SE2d 605) (1983).
Decided September 12, 2000
Reconsideration denied November 30, 2000.
S'. Robert Hahn, Jr., for appellant.
Harper, Waldon & Craig, Thomas D. Harper, Trevor G. Hiestand, for appellee.
Here, I concur with the majority even though Wallace’s affidavit alleged that State Farm told him before the independent medical examination was performed that his benefits would be terminated regardless of what the IME said. His affidavit was contradicted, without explanation, however, by his deposition testimony that no one at State Farm contacted him before his benefits were terminated and he did not contact State Farm until after his benefits were stopped.
Thus, applying the contradictory testimony rule, Wallace’s unexplained, self-conflicting testimony is of no assistance to him. Gentile v. Miller, Stevenson &c., Inc., 257 Ga. 583 (361 SE2d 383) (1987); Prophecy Corp. v. Charles Rossignol, Inc., 256 Ga. 27, 30 (343 SE2d 680) (1986). Once the self-contradictory favorable portions of Wallace’s affidavit are eliminated, the remaining evidence construed in Wallace’s favor is not sufficient to create an issue of fact on this issue because the record shows that the IME report is dated before his benefits were terminated.
Consequently, the issue of pretext is not properly raised in this case.