Smith v. Auto-Owners Insurance Company
2:15-cv-01153
D.N.M.Jul 27, 2017Background
- Melvin Smith, insured by Auto-Owners Insurance (AOI), was rear-ended while in an employer-owned vehicle; State Farm (other driver) paid its $100,000 policy limits and Smith received $26,731.10 from State Farm and $5,000 med-pay from AOI (total $31,731.10).
- Smith sued AOI seeking UIM benefits (breach of contract) and declaratory relief, claiming his total injuries exceed amounts received; AOI moved for summary judgment on breach and declaratory claims.
- Medical disputes: Smith developed shingles after the crash; he also has a preexisting torn left rotator cuff (which he says was aggravated by the accident) and at least a temporary soft-tissue neck injury conceded by AOI’s expert.
- AOI argues its payments fully compensated Smith and that there is no admissible evidence causally linking the accident to the shingles; AOI also contends declaratory relief is improper.
- The court held AOI entitled to summary judgment on damages for shingles (no admissible expert causation evidence) but denied summary judgment on breach-of-contract for shoulder/neck injuries (aggravation and compensation remain factual issues) and denied without prejudice AOI’s summary judgment on declaratory judgment.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether AOI must pay UIM for shingles (causation) | Smith: accident caused shingles; seeks recovery | AOI: no admissible expert evidence linking accident to shingles | Held: For AOI — summary judgment for shingles; expert causation required and absent |
| Whether preexisting rotator cuff tear bars recovery | Smith: accident aggravated preexisting tear; entitlement to damages for aggravation | AOI: tear preexisted, so no contractual obligation to pay for shoulder condition | Held: For Smith on factual issue — aggravation claim survives; summary judgment denied |
| Whether AOI already fully compensated Smith for neck/soft-tissue injuries | Smith: compensation insufficient given aggravation and disability claims | AOI: payments (State Farm + med-pay) fully compensate him | Held: For Smith on factual issue — whether fully compensated is for jury; summary judgment denied |
| Whether declaratory judgment action is proper | Smith: seeks declaration on causation/entitlement to UIM benefits | AOI: declaratory relief improper because no dispute about coverage/limits and merits are breach issues | Held: AOI not entitled to summary judgment on declaratory claim now; court skeptical declaratory relief appropriate but denies AOI motion without prejudice |
Key Cases Cited
- Eck v. Parke, Davis & Co., 256 F.3d 1013 (10th Cir.) (proximate-cause can be decided as a matter of law when undisputed facts show no reasonable causal connection)
- Celotex Corp. v. Catrett, 477 U.S. 317 (summary-judgment burdens and procedure)
- Johnson v. Mullin, 422 F.3d 1184 (10th Cir.) (non-movant must present specific admissible facts to avoid summary judgment)
- Woods v. Brumlop, 71 N.M. 221 (N.M. 1962) (medical causation requires expert testimony)
- Baca v. Bueno Foods, 108 N.M. 98 (N.M. Ct. App.) (reasonable-medical-probability standard requires expert proof)
- Folz v. State, 797 P.2d 246 (N.M.) (expert testimony not always necessary where causation falls within common experience)
- Gerety v. Demers, 92 N.M. 396 (N.M.) (trial court decides when expert testimony is necessary to inform jurors)
- Martin v. Darwin, 77 N.M. 200 (N.M.) (plaintiff must prove extent of aggravation of preexisting condition)