Progressive Insurance is facing a federal lawsuit alleging it refused to factor in future surgeries when valuing a $500,000 underinsured motorist claim after a catastrophic pedestrian accident.
The case, filed in the United States District Court for the Eastern District of Pennsylvania, centers on a May 11, 2023, collision in Pittsburgh. Plaintiffs Idalia Bernal and John Pankratz say they were crossing Main Street and Dawson Street when a vehicle driven by Brandon Orlando struck them in the crosswalk.
Bernal suffered injuries including six pelvic fractures, fractured ribs, a torn meniscus, a full-thickness tear of the right rotator cuff requiring surgical repair, bursitis in the left knee, L3-L4 and L4-L5 spinal stenosis, an L4-L5 disc bulge, and a right knee injury requiring a total knee arthroplasty. Pankratz sustained a displaced bony Bankart lesion and a glenoid fracture in his left shoulder.
After the crash, Bernal was hospitalized for 15 days at UPMC-Shadyside and then spent 27 days in a rehabilitation facility. Her recovery included extensive physical therapy, surgery to repair her right shoulder, and, later, a left hip replacement. The couple settled with Orlando’s insurer, Esurance/Nationwide, for the $25,000 policy limit per claimant.
The dispute began when Bernal and Pankratz sought underinsured motorist (UIM) benefits from Progressive. Their policy carried $500,000 in UIM coverage per person. According to the case filing, Progressive repeatedly declined to consider the cost of future medical treatment—despite medical records and physician reports detailing the necessity of additional surgeries, including a reverse shoulder arthroplasty and possible further knee procedures.
The filing details a lengthy negotiation. On June 17, 2024, the plaintiffs’ attorney submitted a demand package, including medical records and a narrative from Bernal’s orthopedic surgeon. Progressive’s adjuster, Lauren Gieseler, responded with an initial offer of $155,000 for Bernal and $22,000 for Pankratz on August 1, 2024.
In subsequent conversations, Gieseler stated that Progressive “normally needs to wait until surgery happens before they can consider it in an evaluation” and later confirmed that Progressive “cannot consider any surgery that hasn’t happened yet, even with doctors’ reports stating that they are necessary.”
The plaintiffs argue that this approach is inconsistent with Pennsylvania law, which allows juries to award damages for future medical expenses when such care is reasonably certain and necessary. The filing cites the Pennsylvania Standard Suggested Jury Instructions, which direct jurors to compensate plaintiffs for both current and future damages.
Despite further documentation—including a narrative from Bernal’s orthopedic surgeon confirming the need for additional surgeries and records of a completed hip replacement—Progressive’s offers increased only marginally. By December 2024, the company had raised its offer to $175,000 for Bernal. After her hip replacement in July 2025, Progressive’s final offer stood at $275,000, still below the policy limit and, according to the plaintiffs, not accounting for the full scope of her future medical needs.
Throughout the process, the filing states, Progressive never requested an in-person interview, an examination under oath, or an independent medical examination. Nor did the insurer conduct a records review by a medical expert until after its initial offer, despite having all relevant medical documentation for months.
The lawsuit accuses Progressive of breach of contract, breach of the duty of good faith and fair dealing, and statutory bad faith under Pennsylvania law. The plaintiffs seek compensatory damages, interest, punitive damages, and attorney fees. Pennsylvania’s bad faith statute allows courts to award interest at the prime rate plus 3 percent, as well as punitive damages and legal costs, if an insurer is found to have acted in bad faith.
Bernal’s medical bills listed in the filing totalled more than $300,000 at the time of submission, with future costs expected to rise as she continues to require additional surgeries and rehabilitation. The case documents a drawn-out claims process, with Progressive allegedly refusing to change its approach to future medical expenses, even as evidence of ongoing and future treatment was provided.
For insurance professionals, the case spotlights whether insurers can lawfully refuse to consider documented, necessary future medical expenses in UIM claim evaluations.
