C.A. 4th;
G052603

The Fourth Appellate District reversed a judgment. The court held that an insurer was not entitled to rely on the genuine dispute doctrine when it failed to investigate its insured's most recent treatment recommendations.

In March 2011, Carmen Zubillaga was injured in a car accident. Police found the other driver to be at fault. Zubillaga settled with that driver for his $15,000 policy limit. She thereafter sent her own insurer, Allstate Indemnity Company, a demand for $35,000, the full amount of remaining underinsured motorist coverage under her policy. Allstate offered to settle for a significantly lower amount. In July 2012, Zubillaga advised Allstate that both an osteopath and a physician had opined that she would require costly lumbar epidural steroid injections to manage chronic back pain resulting from the accident. Allstate retained its own medical expert, orthopedic surgeon Milton Legome, who saw Zubillaga in October 2012. Legome found no indication for epidural steroid injections. Legome submitted an additional report in November 2012, after reviewing Zubillaga's hospital records, in which he confirmed his earlier findings. Relying on Legome's assessment, Allstate steadfastly denied Zubillaga's demands for the full amount available under her policy. In September 2013, Zubillaga sent Allstate a report from physician Neil Soni, who opined that Zubillaga, who had already received one steroid injection, would likely need further injections, at a cost of $12,000 each, in addition to medications and physical therapy costing some $12,000 per year. Allstate did not seek Legome's review of Soni's report. Aribtration later that month resulted in an award to Zubillaga in the full amount of her remaining UIM policy limits.