Bad Faith

 In the Context of Article 21.21, “Reasonably Clear” Does Not Mean “Completely Certain”
 
The Corpus Christi Court of Appeals reviewed a jury finding of a knowing violation of Article 21.21.  The court of appeals explained that Article 21.21 requires a good faith attempt to promptly settle claims once liability has become reasonably clear.

The insurer argued that its liability did not become reasonably clear until it actually received additional hospital records that it had requested. In rejecting this argument the court emphasized that the insurer was essentially asking it to adopt a rule allowing insurers to delay settlement of a claim until liability is absolutely and conclusively established, not just reasonably clear.

The court determined that an interpretation equating reasonably clear with completely certain would allow insurers to delay indefinitely concluding their own research of a claim without violating Article 21.21 and, therefore, was clearly unacceptable.

Accordingly, the court concluded that once the insurer received the proof-of-loss documents noting an accidental cause of death, the insurer’s liability became reasonably clear and the insurer was under a duty to use its best efforts in good faith to avoid further delay, and therefore affirmed the jury’s finding of a violation of Article 21.21. ⁿ³³

TRAVELERS FACES BAD-FAITH SUIT OVER KATRINA CLAIM PAYMENT

Judy Greenwald- 5 June 2006

Insurance Information Institute Database

Travelers Property & Casualty Co., a unit of St. Paul Travelers Cos. Inc., is the target of a lawsuit in the U.S. District Court in New Orleans seeking $28.7 million. The suit charges the company and four employees with bad faith for failing to pay more than an initial sum of $700,000 for repairs to St. Charles General Hospital in New Orleans, La. The suit says that $6.5 million is needed to complete repairs and seeks $14.6 million in penalties, including double damages, as well as $8.4 million in attorneys’ fees. The suit was filed by Building Concepts & Design Construction Inc. (BCDC), a Florida company contracted to handle all repairs and the insurance claims for the hospital. The policyholder is Preferred Continuing Care-New Orleans. BCDC president and chief executive Stephen D.

Vaughan alleges that a Travelers vice president acted in an “aggressive, abusive, and shockingly unprofessional manner” while accusing him of being an out-of-state contractor “looking for any work available.” Mr. Vaughan says Travelers has ignored the claim after hundreds of calls: “They don’t respond, they don’t do anything.” The plaintiff’s attorney commented, “The environment in Louisiana right now, especially in New Orleans, is very antagonistic toward insurance companies.”

Source: Business Insurance

Copyright (c) 2000 Allegheny County Bar Association 
The Lawyers Journal
October 20, 2000
2 Lawyers J. 5
LENGTH: 1525 wordsARTICLE: Understanding O’Donnell: When Aggressive Defense Can Lead to Bad FaithNAME: By Anthony Williott, Esq., For The Lawyers Journal BIO:
 
Anthony Williott is an insurance defense attorney with the Pittsburgh law firm of Dickie, McCamey & Chilcote. Mr. Williott concentrates in the defense of bad faith and personal injury claims. For further information on O’Donnell and bad faith issues in general, contact Mr. Williott at willioa@dmclaw.com or via telephone at 412-392-5258.TEXT:
 [*5]  Defending insurance bad faith suits has never been easy, but recent case law developments suggest that more trying times are ahead, particularly when first party claims are involved. Specifically, Pennsylvania’s O’Donnell v. Allstate n1 decision, and how it has since impacted insurers and their defense counsel, clouds the issue of how aggressively insurers may defend first party and bad faith claims.

n1 734 A.2d 901 (Pa. Super. 1999)
 Facts of O’Donnell In July of 1994, Mary O’Donnell’s home was burglarized. At the time of the burglary, an Allstate homeowners policy covered the property. The burglary was discovered by Jay McAtee, her son-in-law, who then notified the police. Ms. O’Donnell, who suffered from dementia, had been admitted to a nursing home approximately six months before. Her home was for sale at the time of the burglary and had been unoccupied ever since her admission to the nursing home. When police arrived at the scene, they noticed no forced entry and noted the lack of valuables in the home.O’Donnell’s daughter, Joan Mitro, contacted Allstate approximately two weeks after the burglary and stated that, because her mother was hospitalized, she would handle the claim on her mother’s behalf. Allstate sent Mitro a letter requesting a list of all stolen items, the date and place of purchase of each item and receipts or other proof of ownership. Mitro’s list of stolen items included rare coins, sterling silver, jewelry, electronics and other items estimated by Mitro to be worth approximately $ 12,000.Allstate became concerned when receipts for stolen items turned out to be in Ms. Mitro’s name, and not Ms. O’Donnell’s. Allstate then made additional requests, including requests for original receipts, a sworn proof of loss statement, and contact information for other relatives who could verify the purchases. Mitro declined to provide this information. Allstate considered her refusal and other issues to be “red flags” that required further investigation. Allstate also contacted Ms. O’Donnell at the nursing home to request further verification regarding the allegedly stolen items.Ms. Mitro, frustrated with Allstate’s handling of the claim, filed a complaint against Allstate for breach of contract, bad faith and violations of the Unfair Trade Practices Act, stating that Allstate had unreasonably refused her claim and had issued neither payment nor denial of the claim. The matter proceeded to a jury trial, resulting in a verdict in favor of Allstate. Mitro appealed the decision. The appellate court ruled in favor of Allstate, finding that the evidence supported the verdict in favor of Allstate.But it’s not the court’s ruling in favor of the insurer that makes O’Donnell matter. What’s significant are the appellate court’s statements that an insurer’s conduct during or even after litigation can also be construed as bad faith.
 
Counsel’s Behavior and Bad FaithAt issue in O’Donnell was whether discovery requests could be considered evidence of bad faith. In this regard, the appellate court stated: Specifically, we are asked to determine whether the jury is restricted to considering only evidence of bad faith which occurred prior to the filing of the lawsuit, or, whether [the jury] may consider evidence of an insurer’s bad faith conduct occurring during the pendency of litigation [emphasis added].
734 A.2d at 904. Mitro claimed that since she had already provided statements under oath prior to the institution of her lawsuit against Allstate, Allstate’s requests for additional sworn statements after the lawsuit commenced were in bad faith. Mitro also claimed that Allstate’s refusal to accept or deny the claim even after having taken her sworn statement also constituted bad faith. Mitro contended that Allstate submitted interrogatories for “frivolous” and irrelevant information, which constituted, in her mind, clear acts of bad faith.The court ultimately ruled that sworn statements before a lawsuit and depositions and other typical discovery after commencement of suit were both permissible and, in and of themselves, did not constitute bad faith. However, the appellate court clearly stated that Pennsylvania’s Bad Faith Statute n2 is not restricted solely to an insurer’s denial of a claim, but instead extends to the insurer’s investigative practices and conduct during litigation.n2 42 Pa.C.S.A. § 8371
 Impact on Defense Counsel From the defense counsel’s perspective, O’Donnell is highly significant. It raises the question of whether a lawyer’s behavior in representing an insurance company in first party and bad faith litigation brought by an insured can somehow be construed as bad faith on the part of the insurance company. This concept potentially conflicts with the lawyer’s ethical obligation to zealously defend his or her clients. O’Donnell muddies the waters because, if further extended or expanded upon by the courts, it could impose a duty on the defense lawyer to the insured, who is the defense’s adversary in the lawsuit.Historically, once litigation was initiated, the insurance company hunkered down, prepared for litigation and took steps to defend the claim. That meant scheduling depositions, conducting discovery, filing requests for production of documents and hiring experts. While O’Donnell doesn’t prohibit an insurance company from engaging in these activities, it suggests that requests in discovery may not be frivolous and that the conduct of the attorney may not be abusive. The insurance company is also obligated under O’Donnell to continue to recognize and meet its obligations to a policy holder even though that policy holder has entered into litigation against his/her insurer. In fact, the Superior Court in O’Donnell devoted seven pages of its opinion to an insurer’s obligation to treat its insureds in good faith, despite ruling in Allstate’s favor.
 
Putting the File on TrialBecause an insurer’s behavior during litigation may be open to scrutiny, any additional file materials the insurance company generates during litigation may also be open to scruting at a bad faith trial. Prior to O’Donnell, only the conduct of the insurance company prior to litigation was considered. Now, a jury can consider everything that the insurer does up to and including their actions during a bad faith trial. This presents a Catch-22: even if the original first party claim is rejected by the fact-finder, there is still the risk that a bad faith claim could arise from an insurer’s behavior during the underlying litigation.
 
Improper Purpose of DiscoveryIt’s important to remember that the O’Donnell court recognizes that there is nothing improper in defense counsel conducting typical discovery. The insurer is still fully entitled to use the discovery process to conduct an investigation. However, if the insured’s investigation (including that of its counsel) entails harassment of the insured or frivolous or excessive discovery, there may be a basis for a claim for bad faith.The recommendation to counsel is to use caution during discovery and investigation. More particularly:. During depositions of the insured, limit questioning to proper areas of inquiry and avoid any acrimony or sarcasm.. Avoid excessively and unnecessarily long depositions.. Avoid unnecessarily lengthy or repetitive Interrogatories and Production Requests. Avoid irrelevant requests.. Be circumspect in reports to the carrier. Avoid insults and derogatory comments about the insured and carefully choose words (e.g., “claim lacks merit” as opposed to “claim is bogus.”)
 
ConclusionBad faith case law is complicated by the fact that each state has its own statutes and regulations. The significance of O’Donnell nationally is that, since nearly every state now recognizes first party bad faith, it is only a matter of time until arguments and legal theories from one state impact the law in other states.Does O’Donnell tie the hands of the insurance company? Maybe. The point to be taken is this: Don’t overreact to cases like O’Donnell. Attorneys still have an obligation to zealously defend their insurance company clients and carriers still have the right to fully investigate claims. Insurers and defense attorneys should simply keep in mind  [*15]  that their conduct in defending first party and bad faith claims may be later scrutinized for bad faith by a jury. One Federal Court judge sitting in Pennsylvania, in fact, interpreted O’Donnell to stand for the proposition that behavior of an attorney defending an Underinsured Motorist claim may constitute bad faith and that such bad faith may be imputed to the insurance carrier. Adjusters, too, must remember that their actions during litigation may make or break a bad faith claim. For that reason, adjusters must continue to treat an insured fairly through the pendency of the claim and any related litigation. Legal Topics: For related research and practice materials, see the following legal topics:
Healthcare LawActions Against FacilitiesGeneral OverviewHealthcare LawAntitrust ActionsFacilitiesInsurance LawIndustry RegulationUnfair Business PracticesClaims Investigations & Practices