Appellant Ted Maslo was the insured on an automobile insurance policy issued by respondent Ameriprise Auto & Home Insurance (insurer).
On October 9, 2012, appellant filed a first amended complaint (FAC) for damages against his insurer, alleging one cause of action for breach of the covenant of good faith and fair dealing. According to the FAC, appellant was an insured on an automobile insurance contract that provided up to $250,000 in coverage for injuries and damages resulting from the negligence of an uninsured motorist. During the policy term, an uninsured motorist struck appellant's vehicle from the rear, forcing it to collide with a third vehicle. The FAC alleged that "[a]t no time did [appellant] contribute any fault or negligence concerning said accident." The FAC further alleged that on or about September 3, 2008, the accident was investigated by the Los Angeles Police Department (LAPD), which prepared a traffic collision report. The report concluded the uninsured motorist was the sole cause of the accident.
As a result of the accident, appellant suffered numerous bodily injuries, including a severe injury to his shoulder. Appellant was referred to an orthopedic surgeon, and an MRI revealed an "internal derangement of the left shoulder; a SLAP lesion of the left shoulder; a split tear of the superior rotator cuff; and downsloping of the acromion and impingement syndrome." Appellant underwent two surgeries to repair his shoulder.
The FAC further alleged that appellant reported the accident to his insurer on September 3, 2008, and provided a statement about the accident the following day. The insurer also received a copy of the LAPD traffic collision report. On August 13, 2009, appellant supplied his insurer with copies of all his medical records and billing statements regarding his treatment. In that letter, appellant sought settlement of the uninsured motorist claim in the amount of the policy limit of $250,000. The insurer did not respond to the settlement demand.
From February 26, 2010, through November 2, 2011 (the date of the arbitration), the parties engaged in discovery for the arbitration proceeding. The FAC alleged that appellant's discovery responses provided the insurer with "all documents concerning liability and damages that [the insurer] needed to fully and fairly evaluate the case." The FAC further alleged that "[a]t no time prior to the Arbitration hearing did [the insurer] schedule the depositions of Plaintiff's treating physicians or interview them." Nor did the insurer "request a defense medical examination, conduct a defense medical examination, or obtain a defense medical record review."
The FAC alleged that the insurer's failure and refusal to make any offer of settlement was contrary to Insurance Code section 790.03, subdivision (h)(5), which provides that it is an unfair claim settlement practice not to "attempt[] in good faith to effectuate prompt, fair, and equitable settlements of claims in which liability has become reasonably clear."
The parties stipulated that appellant's medical expenses totaled $64,120.91. At the conclusion of the arbitration, the arbitrator awarded appellant that amount in medical damages and $100,000 in general damages, for a total award of $164,120.91.
The FAC alleged that the insurer had "a duty of good faith and fair dealing[] to properly and fairly investigate and handle Plaintiff's claim and to enter into a prompt[,] fair and equitable settlement with Plaintiff." The FAC further alleged that the insurer breached this duty by, among other acts, "fail[ing] to attempt in good faith to effectuate a prompt, fair, and equitable settlement of Plaintiff's claim for uninsured motorist bodily injury in which liability had become reasonably clear." The insurer made no offer of settlement prior to the arbitration, which was more than three years after the accident and more than two years after the insurer had all appropriate medical
Finally, the FAC prayed for compensatory and consequential damages for the delay and withholding of benefits under the uninsured motorist provisions of the automobile insurance policy, for reimbursement of all costs and attorney fees, for general damages, for punitive damages, for all costs of the lawsuit, and for interest on all sums.
The insurer filed a demurrer to the FAC. It argued that the complaint failed to state a cause of action for breach of the covenant of good faith and fair dealing, as allegations in the complaint established the existence of a "genuine dispute" over the amount of payment due under the insurance policy. Relying on an insurance law treatise, the insurer argued that the elements of an insurance "bad faith" claim are (1) that the insured made a claim for which liability was clear, (2) that damages plainly exceeded the uninsured motorist coverage limits, and (3) that the insurer unreasonably refused to pay. As the damages in the instant case did not plainly exceed $250,000, the insurer argued that the superior court should sustain the demurrer. In the alternative, the insurer argued that the complaint failed to adequately allege causation. According to the insurer, "it was not [the insurer's] failure to make a settlement offer that resulted in the need for arbitration; rather, it was [appellant's] overvaluation of his claim that was the cause of the delay in resolution of his claim."
On November 29, 2012, the superior court sustained the demurrer with leave to amend. The court ruled that appellant had properly set forth the duty and breach elements of the bad faith claim by alleging that the insurer did not attempt in good faith to effectuate prompt, fair and equitable settlement of a claim in which liability had become reasonably clear. The court found that "the genuine di[sp]ute rule does not cut-off [sic] liability under the facts alleged." However, the court determined that causation was not supported by sufficient factual allegations.
On December 13, 2012, appellant filed his SAC. It mirrored the FAC, but contained additional factual allegations detailing the specific costs appellant incurred as a result of being compelled to arbitrate a claim the insurer had made no attempt to settle. The insurer filed a demurrer to the SAC, repeating the same argument regarding causation and relying upon the same legal authorities. The insurer further contended that causation on an insurance "bad faith" claim could be shown only where the arbitrator determined that the claim was worth more than the initial demand made by the insured.
"In reviewing an order sustaining a demurrer, we assume well-pleaded factual allegations to be true and examine the complaint de novo to determine whether it alleges facts sufficient to state a cause of action on any legal theory. [Citation.]" (Kyablue v. Watkins (2012) 210 Cal.App.4th 1288, 1292 [149 Cal.Rptr.3d 156].) To the extent our analysis requires interpretation of certain provisions of the Insurance Code, we apply a de novo review. (Honig v. San Francisco Planning Dept. (2005) 127 Cal.App.4th 520, 524 [25 Cal.Rptr.3d 649].)
Appellant contends his SAC alleged facts sufficient to state a cause of action for breach of the covenant of good faith and fair dealing against his insurer. We agree.
Applying these principles, we conclude the SAC stated an insurance bad faith cause of action. Appellant alleged (1) that the insurer was apprised that appellant, its insured, had suffered bodily injuries resulting from the negligence of an uninsured motorist; (2) that the insurer knew the LAPD traffic collision report had concluded the uninsured motorist was solely at fault; (3) that appellant made a demand for payment of the $250,000 policy limit on his uninsured motorist coverage; (4) that appellant submitted his medical records and billing statements; (5) that the insurer rejected the demand without an adequate investigation, as the insurer failed, among other things, to conduct a defense medical examination or interview appellant's treating physicians; (6) that despite clear evidence of liability, the insurer made no offer of settlement; (7) that the insurer agreed to pay the claim only after the arbitration, which was more than three years after the accident and more than two years after the insurer had all appropriate medical documentation in its possession; and (8) that as a result of the insurer's refusal to investigate and evaluate his claim, appellant was compelled to incur the costs of an arbitration necessitated solely by the insurer's intransigence. Under this factual scenario, a reasonable jury could find the insurer liable for breach of the covenant of good faith and fair dealing. (See Wilson, supra, 42 Cal.4th at pp. 721, 723 [affirming denial of summary judgment of an insurance bad faith claim and finding triable issues of fact on reasonableness of insurer's denial of claim where (1) insured complained of neck pain after accident and in subsequent weeks and months, (2) insured's treating physician concluded the pain was a result of the accident, (3) an MRI corroborated the medical conclusion, and (4) insurer's claims examiner rejected conclusion without any medical basis for doing so].)
Appellant's reliance on Rappaport-Scott, supra, and Behnke v. State Farm General Ins. Co. (2011) 196 Cal.App.4th 1443 [127 Cal.Rptr.3d 372] (Behnke) is misplaced. In those cases, the insurer fairly investigated, processed and evaluated the insured's claim. In Rappaport-Scott, supra, 146 Cal.App.4th at page 834, the insurer made an offer of settlement and participated in meditation prior to arbitration. In Behnke, the insurer provided a reasonable explanation for disputing the hourly rate charged by the insured's Cumis counsel (see Behnke, supra, 196 Cal.App.4th at p. 1470).
The insurer further contends that an insurer's failure to investigate, evaluate, or attempt in good faith to settle its insured's claim does not constitute bad faith except under limited circumstances, as an insurer has a statutory right to arbitrate disputes over the amount of damages. (See § 11580.2, subd. (f) ["The policy ... shall provide that the determination as to whether the insured shall be legally entitled to recover damages, and if so entitled, the amount thereof, shall be made by agreement between the insured and the insurer or, in the event of disagreement, by arbitration."].) According to the insurer, it may be liable only where the damages plainly exceed the policy limits. In all other circumstances, the insurer contends, when faced with a claim for which liability is shown with reasonable certainty, it may refuse to investigate, evaluate or even respond to its insured, force the insured to incur the costs of arbitration, and avoid liability for breaching its common law and statutory duties so long as the ultimate award is less than the insured's initial demand. This position is at odds with California common law and the statutory requirements of the Insurance Code.
The insurer's reliance on Castronovo et al., California Uninsured Motorist Practice (Cont.Ed.Bar 2d ed. 2013) to support its position is misplaced.
Thus, an insurer may be liable for bad faith in failing to attempt to effectuate a prompt and fair settlement (1) where it unreasonably demands arbitration, or (2) where it commits other wrongful conduct, such as failing to investigate a claim. An insurer's statutory duty to attempt to effectuate a prompt and fair settlement is not abrogated simply because the insured's
Finally, the insurer argues that its alleged failure to investigate, evaluate, or process appellant's claim could not, as a matter of law, be the legal cause of appellant's damages. Specifically, it contends that in the absence of an allegation that the appellant would have settled for anything less than his initial demand, arbitration was inevitable. We disagree. It was not appellant's initial demand that made arbitration inevitable, but the insurer's alleged refusal to investigate and process his claim. Even in the face of reasonably certain damages, the insurer offered nothing. Contrary to the insurer's suggestion, the SAC did not allege appellant's demand was nonnegotiable; indeed, it alleged that appellant had offered to mediate the claim, but the insurer refused. Thus, it was not appellant's conduct, but the insurer's that precluded any possible settlement and made arbitration inevitable. In short, the SAC adequately alleged causation by asserting that the insurer's conduct was the direct and proximate cause of appellant's damages, including unnecessary costs and fees incurred for the arbitration.
There can be no serious dispute that an insurer is required to thoroughly and fairly investigate, process, and evaluate its insured's claim. The SAC alleged facts sufficient to state a tort claim for the insurer's breach of the duty of good faith and fair dealing under common law and for failure to attempt to effectuate a prompt and fair settlement under the Insurance Code. It further adequately alleged that the insurer's breach of its duty of good faith and its failure to attempt to effectuate a prompt and fair settlement directly and proximately caused appellant to suffer damages, including incurring unnecessary costs and fees of arbitration. Accordingly, the court erred in sustaining the demurrer and dismissing the SAC with prejudice.
The judgment is reversed, and the matter is remanded with directions to the trial court to vacate its order sustaining the demurrer to the SAC and to enter a new order overruling the demurrer. Appellant is awarded his costs on appeal.
Epstein, P. J., and Edmon, J.,
In Beck, the Utah Supreme Court noted that this was not the law in Utah. It cited Lyon, in which that same court had held that in the "third party" situation — where the insurer contracts to defend the insured against claims made by third parties against the insured — the insurer must act in good faith and be as zealous in protecting the interests of the insured as it would be in regard to its own, but that in the "first party" situation, the insurer had no such duty. (See Lyon, 480 P.2d at p. 745.)