Tami Browne v. State Farm Mutual Automobile Insurance Co., No. 1825, Sept. Term, 2021.
Tami
Browne was injured in an automobile accident where the at-fault driver fled the
scene. Browne reported low back, hip, and neck pain and received non-surgical
treatment. Subsequently, after continuing pain, Browne underwent an MRI which revealed
a Tarlov cyst near her spine and a protruding disc. Browne underwent a surgical
procedure to remove the cyst and later complained of worsening symptoms due to
the surgery. Browne filed a claim with her insurer, State Farm, who refused to
provide coverage for Browne’s subsequent treatment as there was no
documentation connecting the cyst surgery to the accident. The parties were
unable to settle the claim; therefore, Browne filed a breach of contract action
against State Farm in the Circuit Court for Montgomery County. While the breach
of contract case was pending, she filed an administrative complaint against
State Farm for failure to act in good faith under Insurance Article (“IN”) §
27-1001 and Courts and Judicial Proceedings (“CJP”) §
3-1701.
The Maryland Insurance Administration (MIA) determined that
State Farm did not owe Browne the entire $50,000 within her policy limits, and
that State Farm had not failed to act in good faith. Browne subsequently
appealed the decision to the Office of Administrative Hearings (OAH), which
affirmed the previous MIA decision. Browne then amended her breach of contract
action to include the statutory lack of good faith claim under CJP § 3-1701.
Both parties then moved for summary judgment, where the circuit court
ultimately granted summary judgment in favor of State Farm, determining that
the OAH decision collaterally estopped Browne from litigating a civil action
that involved the same issues at question in the OAH decision. The court then
denied Browne’s motion as moot.
Writing for the Appellate Court of Maryland, formally known
as the Maryland Court of Special Appeals, Judge Adkins first determined that a
CJP § 3-1701 action is not a direct appeal of the OAH decisions as it is an
independent civil claim. Although a civil action authorized by CJP § 3-1701 is
reviewed de novo of MIA decisions, courts have repeatedly stated that
this cause of action is not an appeal. Thompson v. State Farm Mut. Auto.
Ins. Co., 196 Md. App. 235, 238 (2010). The court did not agree with State
Farm’s assertion that collateral estoppel must apply to the circuit court
action as it is a separate judicial proceeding on issues presented before the
OAH. The court looked at the
requirements for a CJP § 3-1701 action including receiving a final decision
under IN § 27-1001. To receive a final decision under IN § 27-1001, one must
either: (1) not appeal to OAH within 30 days of a MIA decision or (2) appeal to
OAH and wait for a final decision. CJP § 3-1701 does not distinguish between
either of these final decisions, therefore the statute allows a cause of action
under CJP § 3-1701 regardless of which path the insured takes.
The Appellate Court of Maryland then examined whether the
circuit court abused its discretion in denying Browne’s motion for summary
judgment. State Farm argued that Browne’s subsequent surgical treatment was
negligent and, thus, a superseding cause. Browne argued that the automobile
collision was the cause of her injuries, and the surgery should be included as
it was an attempt to treat her original injuries. The court ultimately reversed
the denial of Browne’s motion for summary judgment and provided guidance to the
circuit court through § 457 of the Restatement (Second) of Torts, and Maryland
case law requiring medical bills to be fair, reasonable, and necessary.
The subsequent negligence doctrine, as defined in Section
457, explains that negligent actors are subject to liability for any additional
harm resulting from third parties’ normal efforts to tender aid regardless of
if the acts are done properly or negligently. Per the comments to Section 457, if
a person’s actions cause harm requiring medical intervention, the negligent
actor remains liable for harm resulting from the medical services. The purpose
for this rule is that the original tortfeasor should be held responsible for
the inherent risks in treatment of injuries. The key question in subsequent
negligent medical treatment cases is whether the original tortfeasor should have
foreseen the general harm, not the specific manifestation of that harm.
The Appellate Court of Maryland looked to other
jurisdictions for guidance to determine the extent of fair, reasonable, and
necessary medical treatment, and bills. The court ruled that plaintiffs must
first have proper foundation to introduce medical bills as evidence of damages.
This is usually done by expert testimony discussing the bills’ fairness,
reasonableness, and necessity. Once the evidence is admitted, the necessity of medical
treatment is a question of fact for a jury. The jury can determine that the
plaintiff was feigning injury, the treatment was for an ailment unrelated to
the original tort, or the treatment goes beyond what is required by the injury.
On remand, the Appellate Court of Maryland provided some
additional guidance to the circuit court. The burden is on the defendant to
assert and provide evidence of subsequent negligent medical treatment. As such,
the defendant must show that the subsequent negligence was so extraordinary or
unusual that it is a superseding cause alleviating the defendant’s liability.
Ultimately, the court identified five (5) instances where subsequent negligent
treatment could be beyond the scope of the original tortfeasor’s liability: (1)
extraordinary misconduct by medical professionals, (2) intentional torts
committed by medical professionals against the victim, (3) a victim’s elected
treatment of an ailment known to be unrelated to the injuries caused by the
negligent actor, (4) treatment by a medical professional the victim was
negligent in selecting, and (5) aggravation of the injury due to the victim’s
negligence in carrying out the treatment of their injures.
- Sean Delaney, Law Clerk
