JUNE 2013 BAD FAITH CASES: DELAYED RESPONSE AND LACK OF COMMUNICATION IN ADDRESSING CLAIM ALLOWS COMPLAINT TO PROCEED (Philadelphia Federal)
The plaintiff suffered damage to her home on August 27, 2011 and provided notice to her insurance provider (the “carrier”) on August 31, 2011. On September 26, the carrier sent an adjuster to inspect the property and take pictures. During the inspection, the adjuster took photos, measurements, and notes, and observed the damage from the incident. After several inquiries into the status of her case, plaintiff received a letter from the carrier on October 12, stating the investigation was ongoing.
On October 13, the carrier made a request for a second inspection of the property, but did not provide a reason for the second inspection or the delay in determination of coverage. Plaintiff placed several calls to the carrier, and was ultimately informed that the original inspector had failed to inspect the roof, and that failure was likely the cause for the second inspection.
The second inspector came to plaintiff’s home on October 20 to complete the inspection of the roof. On October 24, the second inspector provided a completed estimation of damages, estimating $632.47, but only included the damage to the roof and siding in his estimate. On October 25, plaintiff contacted the carrier and requested a copy of all work product produced by the various investigators and carrier personnel, but the carrier refused her request. Plaintiff provided proof of loss on October 27. On October 28, plaintiff was informed that her case was transferred to a different claims representative.
Plaintiff again requested all documentation in reference to her claim, but was this time told the original inspector could not be contacted, and his work product could not be retrieved. On November 1, Plaintiff sent a final email requesting all materials relating to her claim. On November 11, plaintiff received two estimates, one from the original investigator who allegedly had been contacted, and one from the second investigator, who had changed, without explanation, his estimate to match that of the original investigator, $24,185.70. Defendant ultimately determined plaintiff had suffered a loss to the property, but plaintiff alleges the carrier failed and refused to indemnify her for the loss.
Plaintiff filed suit on August 14, 2012, alleging breach of contract, bad faith, and violation of the Unfair Trade Practices and Consumer Protection Law. On the bad faith claim, the court found that the facts pled, while they might all have reasonable explanations, could also be evidence of bad faith.
In particular, the original investigator’s unexplained disappearance and reappearance, the discrepancies in whether or not he investigated the roof, the carrier’s shifting of plaintiff’s claim to at least eleven claims agents, and the carrier’s refusal to furnish the plaintiff with information about her claim were all suspect. Based on the allegations, the court found plaintiff had pled sufficient facts to raise the allegation of bad faith “above the “speculative” level and into that of “plausible.”” As such, the carrier’s Motion to Dismiss was denied.