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Case Breakdown: Insurance Company's Reliance on Hired Medical Examiner to Deny Claims is 'Bad Faith'

Recently, the United States District Court for the Middle District of Pennsylvania, in the case of Phillips v. State Farm Mut. Auto. Ins. Co., dismissed a plaintiff’s insurance bad faith claim, holding it was reasonable for an insurance company to refuse to pay some of its insured’s claims upon its own medical expert’s opinion rather than the plaintiff’s treating physician. Phillips filed a claim with State Farm following an automobile accident. Her auto insurance policy provided her with $100,000 in first-party, no-fault medical benefits and required State Farm to pay for medical expenses arising out of the use of her car. When State Farm refused to pay some of Phillips’ claims, she filed complaint against State Farm alleging that State Farm violated 75 P.a.C.S. § 1716 by failing to pay first-party benefits (Count I), breached the insurance contract by failing to pay those first-party benefits (Count II), acted in bad faith (Count III), and breached the insurance contract by failing to pay underinsured motorist benefits (Count IV). At issue before the District Court was State Farm’s motion to dismiss Phillips’ complaint for failure to state a claim upon which relief can be granted. First, State Farm sought dismissal of Count III, arguing that Phillips failed to plead a bad faith claim. Second, State Farm sought dismissal of Phillips’ demand for attorney’s fees as part of her Count II breach of contract claim, alleging attorney’s fees are not recoverable in such a claim. In Pennsylvania, in order to prevail on a bad faith claim pursuant to 42 Pa.C.S.A. § 8371, a plaintiff must “present clear and convincing evidence (1) that the insurer did not have a reasonable basis for denying benefits under the policy and (2) that the insurer knew of or recklessly disregarded its lack of a reasonable basis.” In this case, the District Court agreed with State Farm, holding that Phillips did not allege sufficient facts to support a bad faith claim. Specifically, Phillips claimed that State Farm acted unreasonably and recklessly disregarded its lack of a reasonable basis to deny her claim for medical benefits by accepting the opinions of its defense medical examiner over her treating physician. The District Court determined that an insurance company may reasonably rely upon the findings of an “independent” medical examination even in the face of contrary medical opinions. It further held that while an insurance company may be found negligent for relying upon the opinions of its examiner over the opinions of an insured’s treating physician, those facts do not give rise to a bad faith claim. Thus, in Pennsylvania, it is insufficient to simply claim that an insurance company was unreasonable in accepting its retained examiner’s opinion to support its denial of an insured’s claim. To support a bad faith claim, a plaintiff needs to show that the insurance company knew that it had no reasonable basis to accept its examiner’s opinion. For instance, if there were facts to show that the insurance company knew that its examiner was incompetent and/or relied upon insufficient information when he/she offered his/her opinion, then a plaintiff may have sufficient facts to support such a claim. With respect to Phillips’ claim for attorney’s fees, 75 Pa.C.S. § 1716 provides that “Benefits are overdue if not paid within 30 days after the insurer receives reasonable proof of the amount of the benefits. If reasonable proof is not supplied as to all benefits, the portion supported by reasonable proof is overdue if not paid within 30 days after the proof is received by the insurer. Overdue benefits shall bear interest at the rate of 12% per annum from the date the benefits become due. In the event the insurer is found to have acted in an unreasonable manner in refusing to pay the benefits when due, the insurer shall pay, in addition to the benefits owed and the interest thereon, a reasonable attorney fee based upon actual time expended. While the District Court determined that while Phillips correctly argued that she may recover attorney’s fees under Count I of her complaint because she alleges a violation of 75 Pa.C.S. § 1716 and that statute expressly provides for attorney fee awards, she could not show that that attorney’s fees are recoverable in a breach of contract claim. Therefore, the District Court dismissed her claim for attorney’s fees as part of breach of contract claim.    
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$3.77 Million in Medical Malpractice Case Against Wheeling Doctor and PA

WHEELING, WV / PITTSBURGH, PA — An Ohio County, West Virginia jury has returned a $3.77 Million verdict in a medical malpractice case against a doctor and a physician’s assistant at WVU Medicine Wheeling Hospital. Following a four-day trial, the jury found both Dr. Barry Mitchell and Physician’s Assistant Michelle Porembka negligent in their medical care of 64 year old Julie Daley when she presented with abdominal complaints at the Wheeling Hospital emergency room in June 2022. As a result of the medical care providers’ failure to timely and properly treat her condition, Daley ultimately sustained a perforated colon along with necrosis which ultimately lead to her needing to have a permanent colostomy. The jury found that the conduct of both Mitchell and Poermbka fell below the standard of care for medical care providers in their field and that their negligence proximately caused injuries and damages to Mrs. Daley.  Daley was represented at trial by Geoff Brown and Tyler Smith of the Wheeling law firm of Bordas & Bordas. Following the verdict, Smith commented, “We are pleased that the jury recognized that this should not have happened to Julie Daley and that they compensated her for the life-long effects that she will have as a result of the negligence of the medical providers.” Mark Robinson and David Givens of Flaherty, Sensabaugh, and Bonasso represented the medical providers at trial.  Circuit Court Judge Jason Cuomo presided over the case. Brown stated “Our practice is based upon fighting for justice for people who have been injured or wronged by others.  Helping others is at the root of everything that we do and we are glad that we were able to help Julie and her family obtain a measure of justice through this case and this result.” About Bordas & Bordas Founded in 1985, Bordas & Bordas Attorneys PLLC has earned a reputation as one of the region’s premier personal injury and plaintiff litigation law firms. With offices in Wheeling and Moundsville, West Virginia; Pittsburgh, Pennsylvania; and St. Clairsville, Ohio, the firm represents clients in cases involving automobile and trucking accidents, medical malpractice, workplace injuries, nursing home negligence, product liability, wrongful death, insurance bad faith, and more. The firm operates on a contingency fee basis (clients pay only if there is a recovery) and offers free initial consultations. Rooted in its core values of experience, family, community, and results, Bordas & Bordas continues to stand as a trusted advocate for individuals and families across the Ohio Valley and beyond. Visit www.bordaslaw.com for more information.

The Pennsylvania Superior Court Analyzes the Federal Public Readiness and Emergency Preparedness Act in Denying Defendants’ Motion for Judgment on the Pleadings

The Pennsylvania Superior Court Analyzes the Federal Public Readiness and Emergency Preparedness Act in Denying Defendants’ Motion for Judgment on the Pleadings

The Pennsylvania Superior Court Analyzes the Federal Public Readiness and Emergency Preparedness Act in Denying Defendants’ Motion for Judgment on the Pleadings In Boyle v. Meyer, 2025 PA Super 198 (September 9, 2025), the Pennsylvania Superior Court denied a physical therapy company’s motion for judgment on the pleadings based on the immunity provisions contained in the federal Public Readiness and Emergency Preparedness Act (PREP Act). Background of the Case Plaintiff Boyle required physical therapy following open-heart surgery. To minimize the risk of contracting COVID-19, he arranged for OSPTA Home Care to provide in-home services. On November 8, 2020, physical therapist Meyer arrived without gloves, a face shield, or a proper mask — only wearing a thin, disposable surgical mask. Meyer also shook Boyle’s hand without gloves, did not wash her hands before treatment, and performed therapy as usual. Days later, OSPTA informed Boyle that Meyer had tested positive for COVID-19. Boyle soon developed symptoms, was hospitalized for ten days, and continued to suffer complications five months later. Boyle sued OSPTA and Meyer, alleging: Meyer was negligent in failing to wear proper personal protective equipment (PPE). Meyer exposed him to unreasonable risk and performed therapy despite known exposure. OSPTA failed to properly train and supervise Meyer and implement safeguards to prevent the virus’s spread. Defendants’ Motion and PREP Act Defense In response, Defendants admitted Meyer was not wearing gloves or a face shield but stated she wore a surgical mask and used hand sanitizer earlier in the day. They argued they were immune from liability under the Public Readiness and Emergency Preparedness Act, 42 U.S.C. §§ 247d-6d, 247d-6e. Defendants asserted that they met all four requirements for immunity: Public health emergency – The COVID-19 pandemic triggered PREP Act protections. Covered persons – They qualified as both “program planners” and “qualified persons” under the Act. Covered countermeasure – Meyer’s “thin, disposable surgical mask” was a device authorized for emergency use by the FDA. Causal relationship – Meyer’s use of the mask had a causal connection to Boyle’s COVID-19 claim. The trial court denied their motion for judgment on the pleadings. Superior Court’s Analysis On appeal, the Superior Court found several factual disputes that prevented judgment for the Defendants. Specifically: It was unclear whether Meyer’s surgical mask qualified as a “covered countermeasure.” The pleadings did not conclusively establish that the Defendants were “covered persons.” Even if both were true, PREP Act immunity applies only to the use or administration of a covered countermeasure — not to its non-use. Citing Hampton v. California, 83 F.4th 754 (9th Cir. 2023), the Court noted that the PREP Act shields defendants from claims related to administering a covered measure, but not from claims alleging failure to administer one. Because Boyle’s complaint focused on the failure to use proper PPE, inadequate screening, and lack of training, his claims fell outside the scope of federal immunity. Conclusion The Superior Court concluded that the PREP Act did not preempt Boyle’s state-law negligence claims, affirming the trial court’s denial of the motion for judgment on the pleadings. The full opinion in Boyle v. Meyer, 2025 PA Super 198 (September 9, 2025), is available on the Pennsylvania Judiciary website. To learn more about legal issues surrounding immunity and negligence in Pennsylvania courts, visit our post on how the PA Superior Court reviews evidentiary challenges in medical cases.

Lead Risk Prompts Nationwide Recall of Ground Cinnamon

Lead Risk Prompts Nationwide Recall of Ground Cinnamon

Lead Risk Prompts Nationwide Recall of Ground Cinnamon The U.S. Food and Drug Administration (FDA) has issued a nationwide recall of 12 ground cinnamon brands after testing revealed elevated levels of lead. Roughly 21,690 units were sold through retailers like Dollar Tree and Save-A-Lot before being pulled from shelves. Consumers are urged to immediately throw away any affected products and avoid purchasing them until further notice. See the official FDA recall notice. Why This Recall Matters Although no injuries have been reported yet, the FDA warns that prolonged consumption of contaminated cinnamon can cause lead accumulation in the body. Children are especially at risk, since lead exposure can impact neurological development. Cinnamon is often used in foods like cereals, baked goods, and snack mixes — staples in many households with kids. This makes the recall a major public health concern for families nationwide, including those in West Virginia, Ohio, and Pennsylvania. FDA’s Broader Effort This recall is part of a larger FDA initiative to monitor imported spices more closely. Several cinnamon brands have been flagged in prior alerts, and surveillance is ongoing. For example: The FDA recently added Asli brand ground cinnamon to the list of affected products after new testing revealed unsafe lead levels. Additional products may be named as investigations continue. See the expanded FDA alert. What You Should Do If you purchased ground cinnamon recently: Check your spice cabinet against the recall list. Dispose of any recalled products immediately. Do not repurchase affected brands until the FDA clears them. If you suspect your child or another family member has been exposed, consult a healthcare provider for guidance. For ongoing updates, visit the FDA’s cinnamon recall page. Protecting Consumers This recall is a reminder that product safety issues extend beyond toys, appliances, and vehicles — even everyday food staples can carry risks. Families in WV, OH, and PA should stay informed about recalls and understand their rights if a defective or dangerous product causes harm. At Bordas & Bordas, our attorneys help consumers hold corporations accountable when safety takes a backseat to profit.