Monthly Archive for January, 2020

BAD FAITH CLAIM CAN PROCEED TO TRIAL WHERE RECORD SHOWED A POTENTIAL BASIS FOR COVERAGE, EVEN THOUGH INSURER BELIEVED THAT BASIS WAS ONLY PUT FORWARD IN AN ATTEMPT TO EVADE A WAIVER (Middle District)

In this bad faith case, one type of injury was specifically not covered under a disability policy, pursuant to a waiver, but other forms of injury might be covered. The insurer denied the claim on the basis that the uncovered injury was the only injury that could have caused the disability at issue. The insured two types of injury were at issue, and brought breach of contract and bad faith claims.

The insured moved for summary judgment on the bad faith claim.

Middle District Judge James Munley found the record showed evidence of both uncovered and covered injuries. The insurer argued that the covered injury type was merely put forward as a make weight to avoid the true, uncovered, injury being the only basis for the disability claim.

As this was a summary judgment motion, the court could not disregard record evidence of either injury. Taking the evidence in the non-movant’s favor, the court found that (1) because the insurer reviewed the record before denying coverage and (2) the record included a covered claim as well as an uncovered claim, then (3) “these facts may show that [the insurer] knew it lacked a reasonable basis for denying the plaintiff’s disability insurance claim, or it recklessly disregarded its lack of a reasonable basis for doing so.”

“Therefore, plaintiff has sufficient evidence, which if credited by the jury, would support his bad faith claim making summary judgment for the defendant inappropriate here.”

Date of Decision: January 13, 2020

Dileo v. Federated Life Ins. Co., U. S. District Court Middle District of Pennsylvania No. 3:18cv628, 2020 U.S. Dist. LEXIS 5003 (M.D. Pa. Jan. 13, 2020) (Munley, J.)

THERE IS NO CAUSE OF ACTION FOR “INSTITUTIONAL BAD FAITH” (Pennsylvania Superior Court) (Non-Precedential)

In this unpublished opinion, Pennsylvania’s Superior Court addressed whether “institutional bad faith” states a private cause of action under Pennsylvania law. Much like yesterday’s post, the Superior Court emphasized that Pennsylvania bad faith law requires focusing on the case and parties at hand, and not the insurer’s conduct toward other parties or its alleged universal practices. The court also addressed other issues concerning statutory bad faith and Pennsylvania’s Unfair Trade Practices and Consumer Protection Law (UTPCPL), among other matters. In this post, we only address all the bad faith and  UTPCPL claims against the insurer.

Factual Background and Trial Court Rulings

The case begins with a home remodeler’s attempt to destroy a bee’s nest in one small section of a house. This unfortunate effort only caused larger problems, contaminating and damaging the house. The chain of misfortune continued when remediation efforts led to more damage, with the home allegedly becoming uninhabitable. At a minimum, all sides agreed some level of reconstruction work was now needed.

The homeowners’ insurer engaged a contractor to fix the original problem. The homeowners eventually challenged the quality of that contractor’s work, which they contended added to the damage. They eventually refused to allow that contractor on site, and unilaterally hired a second contractor to take over. Both the insured and insurer retained their own engineers, who disagreed on the scope of the damage and reconstruction work required.

The second contractor was owned by the insured husband’s parents. The husband himself was the second company’s project manager on the job. The trial court stated that the husband agreed with the position that he “negotiated an oral contract on behalf of … himself and his wife… with himself, as project manager of and on behalf of [the second contractor]” for the reconstruction work. The insurer and first contractor disputed the necessity and cost of the work carried out by the second contractor, as well as other costs.

The trial court ruled for the insurer on breach of warranty, emotional distress, UTPCPL, and bad faith claims, but in favor of the insureds on their breach of contract claim.

There is no Cause of Action in Pennsylvania for Institutional Bad Faith

The insureds argued that institutional bad faith could be the basis for asserting statutory bad faith. Under this theory, a claim can be based solely on an insurer’s policies, practices, and procedures as applied universally to all insureds. The present plaintiffs wanted to introduce evidence to support such institutionalized bad faith conduct. Both the trial and appellate courts rejected this theory.

The Superior Court emphasized that a bad faith action is limited to “the company’s conduct toward the insured asserting the claim.” Thus, “’bad faith claims are fact specific and depend on the conduct of the insurer vis-à-vis the insured.’” The Superior Court agreed with the trial court “that there is no separate cause of action of institutional bad faith.” It stated, that the bad faith statute “authorizes specified actions by the trial court ‘if the court finds that the insurer has acted in bad faith toward the insured . . . ,’ not to the world at large.” (Court’s emphasis).

The Insurer did not Act in Bad Faith

  1. The policy and procedure manual/guideline arguments failed on the merits.

The Superior Court ruled that the trial court’s findings did not result in a refusal to consider evidence relating to the insurer’s conduct and practices. In fact, the insurer’s manuals, guidelines, and procedures were admitted as evidence, all of which were considered by the trial court. This evidence, however, was not considered as part of an institutional bad faith case. Rather, it was only relevant to determining if the insurer acted in bad faith toward the specific plaintiff-insureds, and not to the universe of all insureds.

In deciding the bad faith issue, when the trial court was presented with evidence of the insurer’s policies and procedures, it “did not find them to be improper when applied to the [insureds’] claim, although not a separate claim concerning ‘institutional bad faith.’” (Court’s emphasis) Thus, the actual plaintiffs could not make out a case for themselves on this evidence because they “failed to establish a nexus between [the insurer’s] business policies and the specific claims … asserted in support of bad faith.”

  1. The insureds could not meet the clear and convincing evidence standard.

The trial court found the insurer had not acted in bad faith on other facts of record, and the Superior Court found no abuse of discretion in this ruling. Both courts emphasized the insured’s burden of proof is clear and convincing evidence. Thus, the trial court stated, “[i]cannot be reasonably said, given the facts and evidence adduced at trial, that [the insurer] lacked a reasonable basis for denying benefits and/or that [it] knew or recklessly disregarded its lack of a reasonable basis to deny benefits…. Mere negligence or bad judgment in failing to pay a claim does not constitute bad faith. An insurer may always aggressively investigate and protect its interests. Particularly in light of the higher burden of proof, specifically the requirement that [insureds] must prove a bad faith claim by ‘clear and convincing’ evidence, the record in this case does not support the assertion of statutory bad faith….”

Specifically, the court focused on alleged (i) failures to pay engineering fees, (ii) delays in hiring engineers, (iii) unduly restricting the engineer’s ability to opine, and (iv) instructions that the first contractor and its engineer disregard building codes.

The insurer adduced evidence that (i) it paid engineering fees, (ii) its original decision not to hire an engineer was done based on information provided by the first contractor and a building code officer, (iii) it did agree to hire an engineer once the insureds provided their list of concerns, and (iv) the engineer opined the home was not uninhabitable. The insurer also put on evidence that its adjuster never told the first contractor to ignore the building code, but rather expected the contractor to comply with existing code requirements.

On these facts, the Superior Court found that the trial court did not abuse its discretion in finding the insureds failed to meet the clear and convincing evidence standard.

The UTPCPL does not Apply to Claim Handling

Both the trial court and Superior Court concluded that the UTPCPL does not apply to insurer claim handling cases.

Date of Decision: January 14, 2020

Wenk v. State Farm Fire & Cas. Co., Superior Court of Pennsylvania No. 1284 WDA 2018, No. 1287 WDA 2018, No. 1288 WDA 2018, 2020 Pa. Super. Unpub. LEXIS 178 (Pa. Super. Ct. Jan. 14, 2020) (Lazarus, Olson, Shogan, JJ.) (non-precedential)

Our thanks to Daniel Cummins of the excellent Tort Talk blog for brining this case to our attention.

THIRD CIRCUIT FINDS: (1) EXPERT PROPERLY EXCLUDED FROM TESTIFYING ABOUT OTHER CASES; (2) REPORT NEVER PROVIDED TO INSURER DURING CLAIM HANDLING CANNOT BE CONSIDERED DURING BAD FAITH CASE; (3) INSURED WAS FULLY ABLE TO PRESENT CLAIM HANDLING EVIDENCE THROUGH HERSELF AND ADJUSTER; (4) USING HAND GESTURES IN JURY INSTRUCTION ON CLEAR AND CONVINCING EVIDENCE NOT AN ERROR (Third Circuit – Pennsylvania Law)

This is a post-verdict appeal after the jury found for the insurer in a UIM bad faith case. The insured challenged various pre-trial evidentiary rulings from the District Court Judge, and one of the judge’s jury instructions.

Before trial, the insurer moved to preclude plaintiff’s expert report and testimony, medical evidence that was not provided to the insurer during the UIM claim’s pendency, evidence of mental suffering and emotional distress, and evidence concerning non-recoverable damages. The insured also challenged the trial judge’s use of hand gestures during jury instructions to explain the clear and convincing evidence standard.

  1. Decision to Exclude Expert Upheld

The Third Circuit agreed there was no abuse of discretion by the trial judge in not holding a Daubert hearing. There was a sufficient record on the papers, making a hearing unnecessary. Further, the insured failed to explain how a hearing would have benefitted her or the court.

Next, the appellate court found no abuse of discretion in the trial court’s decision barring the expert’s testimony. Plaintiff wanted her expert to testify “for the very limited purpose of establishing a range of value for [her] underlying UIM claim.” However, this involved looking at other cases not before the court. The District Judge found that “’what other cases have paid is not relevant to this case, [and] what the value of this case is’ and [] the jury ‘will be instructed to use their common sense’ in compensating [the insured] should she prevail.”

The Third Circuit found no abuse of discretion in the District Court’s determination that the proposed expert testimony would not aid the jury, which had to rely on the facts in the case before it to determine bad faith.

  1. Medical Report Never Given to Insurer During Claim Handling Inadmissible

The insured wanted to introduce a medical report as evidence, addressing the extent of her injury and damages. However, she never provided that report to the insurer during the claim process. The Third Circuit found no abuse of discretion in the District Court excluding this evidence. “Because [the insurer] was not in possession of the report when it was evaluating [the] claim, it could not have considered the report’s findings when making its settlement offers. Therefore, the report had no relevance to the issue of whether [the insurer] acted in bad faith. Accordingly, we see no abuse of discretion in the District Court’s decision to exclude the report.”

  1. The Insured was Able to Present the Value of Her Case through Her Own Testimony and that of the Claim Adjuster

The insured argued the trial judge’s rulings prevented her from putting on a full case from which the jury could evaluate her claim. The Third Circuit found no abuse of discretion. Rather, the insured was able to put on her case directly through her own testimony, and to examine the claim adjuster at length on the relevant issues as to how the adjuster evaluated the claim.

  1. The District Judge’s Use of Hand Gestures to Explain the Clear and Convincing Evidence Standard was not an Error

The insured challenged the jury charge on the applicable burden of proof because the judge used “hand gestures demonstrating [the insured’s] burden in the ‘clear and convincing’ standard as a point midway between proof by preponderance of the evidence and proof beyond a reasonable doubt.” The Third Circuit found no plain error here that would merit relief for the insured.

“The District Court instructed the jury that clear and convincing evidence ‘means that the evidence is so clear, direct, substantial that you are convinced without hesitation that a fact is true.’ Language used by the District Court was substantially similar to language we have previously approved of. While [the insured] takes issue with the District Court’s use of ‘hand gestures’ during the jury charge, there is no reason to believe that those ‘hand gestures’ confused or in any way distracted the jury from the District Court’s correct instruction on clear and convincing evidence. Therefore, we find no error, much less plain error.”

In sum, the Third Circuit affirmed the District Court’s decisions.

Date of Decision: January 8, 2020

Antonio v. Progressive Insurance Co., U.S. Court of Appeals for the Third Circuit No. 19-1074, 2020 U.S. App. LEXIS 455 (3d Cir. Jan. 8, 2020) (Fuentes, Scirica, Shwartz, JJ.)

COMMON PLEAS JUDGE FINDS BAD FAITH FOR (1) RELYING ON UNWARRANTED RED FLAGS; (2) REACHING COVERAGE CONCLUSIONS UNSUPPORTED BY ACTUAL FACTS; (3) UNREASONABLE INTERPRETATION OF POLICY’S COVERAGE LANGUAGE; (4) DRAWING UNWARRANTED CONCLUSIONS FROM EXPERT REPORT; (5) FAILING TO INVESTIGATE FULLY; (6) VIOLATING UIPA (Common Pleas Lehigh)

Today’s post summarizes Lehigh County Judge Melissa Pavlack’s Findings of Fact and Conclusions of Law in this breach of contract and bad faith case.

The Court’s Factual Findings

The insureds’ car was stolen. It was recovered, but with considerable damage. The insureds’ license plate was replaced with a stolen plate. The court found that the thieves never intended to return the vehicle. The insureds sought coverage based on the theft and vandalism, relying on policy language covering theft, larceny, vandalism, and malicious mischief.

The court found the insureds were not involved in any way with the theft or vandalism, nor was there any fraud on their part. The car was deemed a total loss, and valued at around $13,000. There were additional costs for hauling and storage, bringing the total claim to approximately $17,000.

The insurer denied the claim, citing insufficient evidence the car had been stolen. It refused to consider a separate vandalism claim because the damages arose out of an alleged theft. Thus, the insurer did not investigate the vandalism claim, and the denial letter never addressed the vandalism claim’s merits. The insurer never cited any policy exclusions applying to the vandalism claims. There was also no denial based on fraud.

The insurer’s investigation included a claim’s adjuster and supervisor, a fraud investigator, an appraiser, an appraisal report, an investigator and three investigator reports, an examination under oath over the telephone and in person, document requests, and a site visit to the loss location. At trial, the adjuster could not recall which of the insured’s statements under oath led to the claim denial.

The investigator reported to the carrier that one of the insureds was uncooperative because she did not bring unredacted tax returns and cell phone records to her examination under oath. Relying on this alleged lack of cooperation, the claims supervisor wrote to the insured that she had failed to cooperate by not bringing these tax returns and records, and failed to cooperate with the insurer’s investigation. However, the investigator was not aware that another of the insurer’s representatives had actually instructed the insured to bring redacted copies of the tax returns to the examination under oath, which she did.

As to other document issues allegedly evidencing a failure to cooperate, it was made clear during the examination under oath that the insured was a medical professional. She could not simply produce her phone records without violating HIPAA. She attempted to cooperate during the examination under oath by showing some messages in her phone from the days in question; but the adjuster was also concerned about HIPAA, and was hesitant to proceed with looking at her phone. Further, the court found the insured could not respond to the insurer’s request for the car purchase documents because these had been stolen from the glove compartment.

Moreover, in contrast to assertions that the insureds failed to cooperate, the court found that the insurer’s fraud investigator conceded the insureds had cooperated, and had provided documents requested in the manner requested.

As to the allegation there was insufficient evidence of theft, the insurer relied upon its expert report. The expert opined there was no forced entry, and that the car only could have been moved using a key. The court found (1) the insurance policy did not require forced entry as a condition precedent to establish theft, and (2) the car could be moved without a key. Further, the insurer’s fraud investigator testified that cars can be stolen without noticeable signs of forced entry, and there was other testimony to the same effect. The court also found that the fraud investigator never communicated with the claim adjuster that forced entry was not required to steal a car.

In sum, the court found these conclusions (forced entry and use of a key) were not reasonable bases to deny the very existence of a theft.

Most significantly, the expert only opined the car was not stolen by means of forced entry, and that a key had to have been used. Whether or not these conclusions were correct was irrelevant in the court’s view, because the expert never opined the car was not stolen. Thus, it was an error to make the leap that the car was not stolen, as it could have been stolen by some means other than forced entry, or could have been moved without a key.

There was Coverage for Theft, Vandalism, and Malicious Mischief

In addressing the breach of contract claim, the court looked at the policy’s plain language. The policy expressly covered theft, larceny, vandalism, and malicious mischief. There were no applicable exclusions in this case, so the court only had to interpret the coverage language.

The court looked at the dictionary definition of these terms, rather than any criminal statutes or case law defining vandalism, theft, etc. It concluded the facts of the case fell within these coverage terms, and the insureds claims were covered. As to bad faith, it was unreasonable to conclude the facts at hand did not fall within the policy’s plain and unambiguous language. Further, the court found the insurer’s conduct unreasonable in failing to consider coverage for vandalism and malicious mischief when denying the claims.

Court uses Unfair Insurance Practices Act and Unfair Claim Settlement Practices Regulations as Standards

The court cited (1) Unfair Claim Settlement Practice regulations (UCSP), 31 Pa. Code § 146.4, on obligations to fully disclose coverages and benefits; and (2) the Unfair Insurance Practices Act (UIPA), 40 Pa.S.A. § 1171.5(a)(10)(iv), on failing to reasonably explain a claim denial.

The court cited these UCSP and UIPA provisions in the context of the first bad faith prong, lack of a reasonable basis to deny benefits. The court then observed the insurer had completely failed to consider the vandalism and malicious mischief claims covered under the policy. This supported the existence of bad faith, though it is not wholly clear whether the UCSP and UIPA violations were evidence of bad faith conduct, or were bad faith per se.

[We have previously posted on how courts treat alleged violations of UCSP regulations and the UIPA in bad faith cases, ranging from (1) their being completely outside the scope of consideration in determining bad faith, (2) as constituting potential evidence of bad faith, or (3) as amounting to statutory bad faith. It is not quite clear in the present case which of the latter two standards applied. Even without citing the UCSP or UIPA, however, it would seem the court’s finding that the insurer gave no regard to plainly covered vandalism claims was a basis for bad faith, regardless of any UCSP or UIPA violations.]

Erroneous Red Flags

The insurer justified its conduct by identifying certain “red flags” that caused legitimate doubt in the insureds veracity. When scrutinized, however, the court found these red flags were based on factual errors or erroneous assumptions.

  1. The insured was deemed uncooperative for failing to attend a unilaterally scheduled examination under oath. In fact, however, the court found the insured gave sufficient notice she could not attend on that date, and cooperated in rescheduling the examination under oath on another date, at which she appeared. She also had agreed to, and participated in, an examination over the phone.

As to the original date for the in-person examination, the court observed that the insurer knew in advance the insured was not going to appear on the first scheduled date, but still had its representatives appear to make a record against the insured for failing to appear.

  1. The insurer also asserted the insured was uncooperative because she provided redacted tax returns. As stated above, the insurer’s own representative had informed the insured in writing that certain redactions could be made. Further, when the insurer later requested an unredacted return, the insureds provided it.

  2. As to the alleged lack of cooperation on cell phone records, this was fully addressed during the examination under oath. As stated above, the insured was a medical professional and there were certain items on her phone records that could not be produced under HIPAA. That being said, she still offered to let the insurer’s representative look at her cell phone during the examination under oath, regarding non-HIPAA messages from the date the car was stolen. The adjuster was concerned about violating HIPAA, and was hesitant to do so.

  3. The insurer also deemed it a red flag that the loss came shortly after the policy’s purchase. This turned out to be an error. The court found the policy was purchased at least six months earlier. Another suspicion surrounded alleged excessive mileage on the car, which the court found was likewise not factually the case.

Failure to Fully Investigate the Red Flags

The court observed that while the insurer took the insured’s examination under oath, and conducted various investigations based on these alleged red flags, it failed to contact the police. Nor did the insurer follow up on evidence that drugs reportedly were found in the glove compartment. Though not expressly stated in the conclusions of law, this implies that the presence of drugs, under all the facts, favored the idea that strangers had stolen the car for nefarious purposes.

The Insurer Relied on its Expert Report for the Wrong Conclusion

For the court, the coverage issue concerning the insurer’s expert was simple: Was the car stolen? The issue was not: How was the car stolen?

The expert opined on two means by which the car was not stolen. The court found the expert never opined, however, that the car was not stolen. Moreover, the insurer never argued that the insureds faked a theft or lied about it.

The court pointed out that other means could have been used to steal the car, including non-intrusive and non-mechanical means. For example, after the car was recovered it was towed twice. The court found this demonstrated the car could be moved without forced entry and/or without a key.

Thus, the insurer’s reliance on the expert report to deny the fundamental existence of theft was unreasonable. The court found relying on the expert report to reach a conclusion (no theft) on which the report did not render an opinion, amounted to a knowing or reckless unreasonable denial of benefits, i.e. bad faith.

After finding bad faith on all the foregoing grounds, the court stated it would schedule a hearing on attorney’s fees, interest, and punitive damages.

Date of Decision: December 27, 2019

Unterberg v. Mercury Insurance Company of Florida, Court of Common Pleas of Lehigh County Case No. 2016-C-806 (Dec. 27, 2019) (Pavlack, J.)

Thanks to Daniel Cummins of the excellent and extremely useful Tort Talk Blog for bringing this case to our attention.

MERELY RECITING THE ELEMENTS OF A BAD FAITH CLAIM WITHOUT SUPPORTING FACTS MERITS DISMISSAL; COMPENSATORY, CONSEQUENTIAL, AND INCIDENTAL DAMAGES NOT RECOVERABLE UNDER BAD FAITH STATUTE (Western District)

The insured and insurer disputed the amount of coverage due on a homeowner’s property loss claim. The insured brought breach of contract and bad faith claims. The insurer moved to dismiss the bad faith claim for (1) inadequate pleading and (2) seeking damages not available under the bad faith statute.

The court observed, among other principles, that “[m]ere restatements of the elements of a claim are not entitled to the assumption of truth.” Similarly, the “generic invocation of statutory language is insufficient to satisfy [the] federal pleading burden.” Further, a plaintiff fails to state a plausible basis for recovery under the bad faith statute if the complaint is devoid of facts describing the “who, what, where, when, and how the alleged bad faith conduct occurred.” The insured’s complaint failed the test.

The complaint only set out “boilerplate legal conclusions such as [the insurer] failed to pay [the insured], failed to objectively and fairly evaluate the Claim, unreasonably withheld Policy benefits, acted unreasonably and unfairly, and denied the Claim without justification or good faith basis to deny the Claim.” Thus, the court dismissed the bad faith claim for failing to plead a plausible claim. It relied on the following cases, summarized previously on this Blog: Mondron, Myers, and Plummer.

Still, the dismissal was without prejudice, and the insured was given leave to amend her complaint.

On the other hand, the court dismissed with prejudice the insured’s statutory bad faith claims for compensatory, consequential, and/or incidental damages. Such damages are only available in common law bad faith cases, not for statutory bad faith claims.

Date of Decision: December 31, 2019

Bick v. State Farm Fire & Casualty, U. S. District Court Western District of Pennsylvania No. 2:19-cv-00821-CRE, 2019 U.S. Dist. LEXIS 222775 (W.D. Pa. Dec. 31, 2019) (Reed Eddy, M.J.)

PLAINTIFF CANNOT PLEAD ALTERNATIVELY THAT DEFENDANT IS AN INSURER OR AN HMO WITHOUT FACTUAL SUPPORT; BAD FAITH CLAIM INADEQUATELY PLEADED AS A WHOLE (Middle District)

The insured failed to plead adequately on two levels in this case.

First, the insured attempted to plead in the alternative that the defendant was either an insurer or an HMO. HMOs are not subject to the bad faith statute, so the difference is significant. Moreover, there were facts over which the court could take judicial notice indicating defendant was an HMO.

The court concluded that alternatively alleging the defendant was an insurer or an HMO amounted to mere legal conclusions. Without any supporting facts, the bare bones legal allegation that defendant might be an HMO was inadequate, resulting in dismissal on that basis.

Next, even assuming defendant was an insurer subject to the bad faith statute, plaintiff again only pleaded conclusory legal statements with no factual support. These inadequate allegations included:

  1. Defendant denied plaintiff’s “appeal of a denial of payment of certain benefits, thereby first communicating the results of its inadequate investigation . . . follow[ing] presentation of new evidence and persuasion that [defendant] should have paid coverage for certain benefits”.

  2. Defendant’s “inadequate investigation included a … determination that an appeal was untimely, when [defendant] [k]new that the appeal had been timely submitted”.

  3. Plaintiff was an insured of defendant.

  4. “[A]ll of the aforementioned acts, omissions, and malfeasance were motivated by [defendant’s] self-interest and ill will toward [plaintiff] and those similarly situated, and constitute bad faith”, and

  5. “[A]ll of the aforementioned acts, omissions, and malfeasance are outrageous.”

The court stated that “[e]ach of these assertions constitute unsupported conclusions that need not be credited on a motion to dismiss.”

In its order dismissing the case, the court did not provide the plaintiff with leave to amend the complaint, and directed that the case be closed.

Date of Decision: December 27, 2019

Brown v. Kaiser Found. Health Plan of the Mid-Atlantic States, Inc., U.S. District Court Middle District of Pennsylvania No. 1:19-CV-1190, 2019 U.S. Dist. LEXIS 221471 (M.D. Pa. Dec. 27, 2019) (Jones, III, J.)

NO BAD FAITH WHERE EXCLUSION APPLIES AND NO COVERAGE DUE (Western District)

Plaintiff loaned her car to her boyfriend. Unknown to her, the boyfriend’s license was suspended. He got into an accident, and the carrier denied coverage based on an exclusion for drivers with suspended licenses. Plaintiff sued for bad faith and breach of contract. The parties filed cross motions for summary judgment. The court granted the insurer’s motion.

The dispute centered on the policy exclusion. The court analyzed the exclusion in detail based on the policy language and facts of the case, finding the exclusion applied. The court rejected the insured’s piecemeal policy reading as contrary to governing standards requiring the policy to be viewed “in its entirety, giving effect to all of its provisions,” with the policy’s words “construed in their natural, plain, and ordinary sense”.

Thus, the insured’s “attempts to read ambiguity into [policy] sections where none exist [] cannot demonstrate bad faith or breach of contract as a matter of law.”

Date of Decision: December 20, 2019

Lewandowski v. Nationwide Mutual Insurance Co., U.S. District Court Western District of Pennsylvania Civil Action No. 18-1441, 2019 U.S. Dist. LEXIS 218713, 2019 WL 7037587 (W.D. Pa. Dec. 20, 2019) (Bissoon, J.)

BAD FAITH NOT ADEQUATELY PLEADED; NO PRIVATE ACTION FOR UIPA VIOLATIONS; ATTORNEY’S FEES NOT AVAILABLE FOR BREACH OF CONTRACT CLAIM (Middle District)

The court reiterates here that (1) bad faith claims must be pleaded with supporting factual allegations, (2) there is no private cause of action for UIPA or Unfair Claims Settlement Practices regulation violations, and (3) attorney’s fees are not recoverable under a breach of contract claim.

This is a UIM case for breach of contract and bad faith, as well as unfair claim settlement practices violations. The insurer moved to dismiss the bad faith claim as improperly pleaded. It moved to dismiss the unfair claim settlement count on the basis that the Unfair Insurance Practices Act (UIPA) and Unfair Claim Settlement Practices regulations do not provide for a private cause of action. Finally, the insurer moved to dismiss the attorney’s fee claims in the breach of contract count.

  1. Bare-bones bad faith claims dismissed without prejudice

The court dismissed the bad faith claim, without prejudice, because the insureds only pleaded conclusory bare-bones allegations. The complaint did not include any factual allegations supporting the conclusory pleadings.

These inadequate bare-bones allegations were as follows:

Delay. Even after determining that Plaintiffs had a right to the insurance proceeds claimed, the Defendant has delayed paying Plaintiffs their policy proceeds for unknown reasons.

Forcing Insured to Seek Legal Redress. By delaying payment of Plaintiffs’ claim, Defendant Progressive Corporation, knowing that it had no legal justification for doing so, purposefully forced Plaintiffs to file this Complaint in order to obtain the insurance proceeds to which they are entitled. Defendant, Progressive Corporation, forced Plaintiffs to seek legal redress for unknown reasons.

Deception. Defendant realizing that it had no legal grounds for denying or delaying payment of Plaintiffs’ claim, and/or engaged [sic] in deceptive acts relating to Plaintiffs’ policy for the purposes of creating an apparent reason for denying the Plaintiffs’ claim where no such reason existed.

False Accusations. Defendant realizing that it had no legal grounds for denying or delaying payment of Plaintiffs’ claim, made false statements to the Plaintiffs’ representatives and/or other persons for the purposes of creating an apparent reason for denying the Plaintiffs’ claim where no such reason existed.

Oppressive Demands. In the course of adjusting Plaintiffs’ claim, Defendant made oppressive demands of the Plaintiffs for the purposes of delaying payment of Plaintiffs’ claim.

The court looked to the following decisions in supporting this result: Myers, Peters, Sowinski, Moran, and Grustas.

  1. There is no private cause of action under the UIPA or under Pennsylvania’s Unfair Claim Settlement Practices Regulations

The insureds relied upon the Supreme Court’s 1981 D’Ambrosio decision in asserting causes of action for UIPA and Unfair Claim Settlement Practices violations. They contended the Supreme Court’s 2017 Rancosky decision superseded D’Ambrosio, and created these private causes of action. The court rejected this argument, observing that Rancosky simply observed that the 1989 bad faith statute superseded D’Ambrosio to the extent it created a new statutory bad faith cause of action years after D’Ambrosio was decided. Rancosky, however, still recognized D’Ambrosio’s holding there is no private UIPA cause of action.

The insurer “therefore did not err in relying on D’Ambrosio for the proposition that there is no private cause of action under UIPA. It remains the case that neither UIPA nor the regulations governing unfair claim settlement practices allow a plaintiff to bring a private cause of action.” The “unfair claim settlement practices claim will accordingly be dismissed with prejudice because there is no private cause of action for unfair claim settlement practices under Pennsylvania law.”

The court looked to the recent Excel and Neri cases in reaching this decision.

3. Attorney’s fees cannot be recovered under a breach of contract theory

Litigants are responsible for their own attorney’s fees and legal costs absent a statute authorizing fees, a contractual provision for fees, or some other recognized exception to the general rule. None of these circumstances applied to the insureds’ breach of contract claim. The court rejected the argument that fees were allowed because attorney’s fees may be permitted during the pendency of litigation for dilatory, obdurate, vexatious or bad faith conduct in the course of litigation. This was irrelevant as neither party filed a sanctions motion, and such behavior was not part of the actual case pleaded.

Date of Decision: December 17, 2019

Kline v. Progressive Corp., U.S. District Court Middle District of Pennsylvania Civil No. 1:19-CV-00676, 2019 U.S. Dist. LEXIS 216258 (M.D. Pa. Dec. 17, 2019) (Wilson, J.)

INSURED SANCTIONED UNDER 28 U.S.C. § 1927 FOR “ACTING IN BAD FAITH BY PERPETUATING A NONSENSICAL LAWSUIT AGAINST THE INSURER AT EVERY TURN”

The court earlier found the insured, an attorney, prosecuted her suit against the carrier in bad faith. This case addressed sanctions against the insured and her one-time co-counsel under 28 U.S.C. § 1927, after finding Rule 11 inapplicable.

The Court had identified fifty-two filings evincing “an unreasonable and vexatious multiplication of the proceedings.” It ordered the insured and co-counsel “to pay the carrier’s reasonable excess costs, expenses and attorneys’ fees associated with those filings….”

The court found 217.3 hours of the insurer’s legal fees reasonable, totaling $39,114. The court, however, rejected the argument expert fees could be awarded under section 1927. It left open for a later date a request for court costs.

The court then looked at whether it should reduce the sanctions, after balancing the equities between the parties. The court found no basis to reduce the fee award, stating that the insured and her co-counsel “acted in bad faith by perpetuating a nonsensical lawsuit at every turn.” By contrast, the insurer handled itself with “professionalism”.

The court then looked at the respective equities as between the insured and her co-counsel in dividing their payment obligations. The court described the insured as “the ring master of this circus.” The court found: “She devised this suit ‘to try to con [the insurer] into paying for damage most likely caused by [her] own neglect of her properties.’”Moreover, the court found the insured’s “bad-faith conduct was borne of malice.”

On the other hand, the court observed: “To be sure, [co-counsel] willingly enabled [the insured’s] worst instincts, and he is neither as naïve nor as guiltless as he pretends to be.” However, counsel lacked the insured’s “malice, and his misconduct pales in comparison to [the insured’s].” The court also considered that co-counsel already had been disbarred for unrelated conduct, blunting the deterrent effect of present sanctions. By contrast, the court stated, the insured “will exploit her law license and continue abusing the civil justice system unless and until she is discouraged from doing so.”

For all of the court’s stated reasons, it required the insured to pay $35,000 and co-counsel to pay $4,114.

A motion to seal the insurer’s time record’s was denied without prejudice, as the insurer neither specified what documents should be placed under seal, nor provided the good cause basis for sealing any documents.

Date of Decision: December 17, 2019

Doherty v. Allstate Indem. Co., U. S. District Court Eastern District of Pennsylvania CIVIL ACTION NO. 15-05165, 2019 U.S. Dist. LEXIS 216253 (E.D. Pa. Dec. 17, 2019) (Pappert, J.)

Earlier Blog summaries concerning this case can be here (2016), and here (2017).