A 41-foot-long, 7,300-pound tree limb crashed onto the home of appellants Michael and Lorie Bock, an incident they reported to their homeowners insurer, Travelers Property and Casualty Insurance Company (Travelers). Travelers assigned respondent Craig Hansen to adjust the loss, whose behavior, as alleged by the Bocks, can best be described as appalling. On Hansen's first visit to the scene (which lasted no more than 15 minutes), he altered the scene before taking pictures, spoke derogatorily to Mr. Bock, and misrepresented the policy coverage, causing the Bocks to begin the cleanup themselves, in the course of which Mrs. Bock was injured. Travelers refused the Bocks' request to replace Hansen, who in the course of adjusting the loss is alleged to have revised an estimate to include a false statement by the Bocks, conspired with an unlicensed contractor to create a false report, and engaged in various other misconduct.
The facts for our analysis are those alleged by the Bocks, all of which are admitted by Hansen's demurrer (Aubry v. Tri-City Hospital Dist. (1992) 2 Cal.4th 962, 966-967 [9 Cal.Rptr.2d 92, 831 P.2d 317]), as are any facts that may be implied or inferred from those expressly alleged. (Traders Sports, Inc. v. City of San Leandro (2001) 93 Cal.App.4th 37, 43 [112 Cal.Rptr.2d 677] (Traders Sports, Inc.).) Those facts must be accepted no matter how unlikely or improbable (Del E. Webb Corp. v. Structured Materials Co. (1981) 123 Cal.App.3d 593, 604 [176 Cal.Rptr. 824]), and without regard to the Bocks' ability to prove them. (Committee on Children's Television, Inc. v. General Foods Corp. (1983) 35 Cal.3d 197, 213-214 [197 Cal.Rptr. 783, 673 P.2d 660].) Those facts are these:
In December 2001, the Bocks purchased from Travelers a homeowners policy covering their home in the city of Angwin, Napa County. The policy covered certain risks of physical loss to their home and provided additional coverage for debris removal.
Early on the morning of September 9, 2010, a large limb — 41 feet long, some two feet in diameter, and weighing 7,300 pounds — broke off from an oak tree in the Bocks' front yard, "crashing into the chimney, the front of the house, and through the living room window." The giant limb caused three other large limbs to fall, which came to rest on a portion of the Bocks' chimney. The limbs "caused significant damage to the Bocks' chimney, which had been in working condition prior to the incident and was used as the Bocks' primary heating source for their home." The limbs also broke three windows and caused damage to the interior of the home, the Bocks' fence, and Mrs. Bock's car.
The Bocks reported the incident to Travelers that same day. Travelers did not send an adjuster to the scene until the following day, September 10, when
Before leaving, Hansen wrote a check for $675.69. When Mrs. Bock said that the amount would not be enough to even clean up, let alone repair, the damage, Hansen told her that cleanup was not covered under the policy and that she should contact "friends and family members with chainsaws" to clean up the limbs and the mess in the house and backyard. Relying on these statements, Mrs. Bock attempted to clean up the broken glass, sustaining a cut on her hand.
After Hansen left, Mr. Bock discovered that the fallen limbs had caused significant damage to the chimney. The next day, September 11, Mrs. Bock sent an e-mail to Travelers property field manager Frank Blaha, reporting the chimney damage. She also requested that another adjuster be assigned to their claim because Hansen was "rude, disinterested, and rushed during his initial visit."
Travelers ignored the request, and Hansen prepared an estimate, which Blaha sent to the Bocks on September 13. The estimate, which totaled $3,479.54, reflected minimal amounts for each category of repairs needed, and was unreasonably low, as the Bocks had obtained an estimate the same day in the amount of $2,065 for cut up and removal of the tree limbs alone.
On September 15, Hansen again came to the house, this time accompanied by Blaha. The Bocks were present, as was Ron Priest, a licensed general contractor who was there at the Bocks' request. Hansen and Blaha were shown the significant cracks in the chimney, as well as gouges where the limbs had hit it, and Hansen took pictures of the damage to the chimney. Again, Hansen falsely told the Bocks that their policy did not cover the cost of cleanup, explaining, "If a car had hit the tree causing it to fall, then the clean-up would be covered but since the wind caused the limb to fall, the cost to clean up the limbs was not covered." Hansen told Mr. Bock to get his chain saw and remove the limbs himself, and as he did so, Hansen yelled, "Atta boy! See you can do it! Now go get a few friends to finish it up."
That same day, acting at the request of Travelers, Roy Anderson of Vertex Construction Services (Vertex) inspected the Bocks' house. Neither Vertex nor Anderson had a valid California contractor's license. Because the limbs and debris had already been removed, Mrs. Bock provided Anderson a disk containing digital images that showed the fallen limbs and damage on the morning of the accident. Anderson sent Hansen a report dated September 29, detailing the results of his inspection and which concluded — falsely, the Bocks alleged — that "[n]o scarring, gouging, or scuff marks were noted on the siding or trim materials on the northeast corner of the residence." Anderson's report also falsely stated that "[t]here was no visual evidence that the fallen tree branch impacted the chimney, or that the fallen tree branch ... propagated any damage to the natural rock chimney," instead concluding that the "fireplace appear[ed] to be in good and serviceable condition." Finally, Anderson's report concluded that the observed cracks in the chimney were minor and were "due to the age of the chimney and the residence," and that inspection of the interior and exterior of the house revealed that "[t]he only damage ... due to the fallen tree branch [was] the broken window and frame." Hansen did not perform any tests to support his conclusion, and did not include in his report any statements from the Bocks or Priest.
By letter dated October 1, Hansen informed the Bocks that based on the Vertex report Travelers was denying coverage for the chimney damage.
The Bocks asked Priest, a licensed contractor, to review the Vertex report and provide a response. He did, preparing a report disputing the false statements contained in the Vertex report and describing how the tree limb damaged the chimney, a conclusion he reached having inspected the property three times. On January 14, 2011, the Bocks, through their attorney, submitted additional information to Travelers, including Priest's report, and requested that Travelers reconsider its coverage determination. Travelers never responded.
The Bocks filed a complaint naming Travelers, Hansen, and Vertex. The complaint asserted six causes of action, including five against Travelers, styled as follows: first, breach of contract; second, breach of the implied
Travelers demurred to the third, fourth, and sixth causes of action on the ground that each failed to state a claim. Travelers also filed a motion to strike all allegations that it acted with malice, oppression, and fraud, and all requests for punitive damages and attorney fees. As to the third cause of action, promise without intent to perform, Travelers argued that the complaint failed to allege any facts demonstrating that Travelers never intended to perform under the terms of the policy at the time it was issued to the Bocks. As to the fourth cause of action, false statement, Travelers argued that the complaint failed to allege the specificity required of a fraud claim, and was an improper attempt by the Bocks to turn a contract dispute into a fraud claim. And as to the sixth cause of action, violation of Business and Professions Code section 17200, Travelers argued that the Bocks failed to identify a California law that Travelers allegedly violated and failed to allege conduct that was unfair or fraudulent, since a section 17200 claim cannot be based on mere claims mishandling.
Before Travelers's demurrer came on for hearing, the Bocks filed a first amended complaint (FAC). They withdrew their claim for intentional misrepresentation based on a false statement, but added claims for negligent misrepresentation (fourth cause of action) and intentional infliction of emotional distress (a new fifth cause of action). Both claims were alleged against Travelers and Hansen, and are the causes of action involved in this appeal.
The fourth cause of action, negligent misrepresentation, alleged that Hansen falsely told the Bocks that their policy did not cover the cost of cleanup; that Hansen either knew the representations were false when he made them, or he made them with reckless disregard of their truth; and that the Bocks relied on Hansen's false statements and performed the cleanup on their own, to their detriment.
The fifth cause of action, intentional infliction of emotional distress, alleged that the actions of both Travelers and Hansen were extreme and
Travelers again demurred to all causes of action except for the breach of contract and bad faith claims. Travelers's fundamental argument was that the causes of action were all premised on Travelers's alleged mishandling of a claim, and was in essence a dispute properly asserted only as claims for breach of contract and bad faith. Travelers also filed another motion to strike, again seeking to strike all allegations of malice, oppression, and fraud, and all requests for punitive damages and attorney fees.
Following the Bocks' opposition, and Travelers's reply, the demurrer and motion to strike came on for hearing on March 13, 2012. Ten days later, the court issued its brief, three-paragraph ruling, sustaining the demurrer without leave to amend. The substance of the order reads in its entirety as follows:
"Defendant's demurrer to the causes of action for intentional and negligent misrepresentation, intentional infliction of emotional distress and unfair business practices is SUSTAINED, without leave to amend.
"It is clear from the allegations, and from the arguments made in plaintiffs' opposition, that this action is strictly contract based. None of the facts alleged in the [FAC] support a fraud based claim, and plaintiffs have not suggested any facts they could allege that would support a misrepresentation claim or a claim for intentional infliction of emotional distress. Because none of these causes of action are [sic] supported, there is also no basis to include a claim for unfair business practices.
"The court notes that plaintiffs previously amended their complaint in response to a demurrer raising these same arguments as to fraud claims in the original complaint. Because plaintiffs have not successfully cured the defects noted in that earlier demurrer, and have not set forth facts and argument suggesting that the defects can be cured, the court will sustain the demurrer to the subject causes of action without leave to amend."
The court also granted Travelers's motion to strike, again without leave to amend, explaining in full as follows: "Defendant's motion to strike plaintiffs' claims for punitive damages and for private attorney general attorney's fees is
The court ordered Travelers to answer the remaining causes of action within 10 days, which it did.
The next month, Hansen filed his own demurrer to the two causes of action against him, negligent misrepresentation and intentional infliction of emotional distress. As to the claim for negligent misrepresentation, Hansen argued that the claim failed for four reasons: (1) the Bocks failed to show that Hansen owed them an actionable legal duty; (2) the Bocks were simply trying to reconstitute their breach of contract claim against Travelers as a negligent misrepresentation claim against him; (3) the Bocks had constructive knowledge of their policy and thus could not justifiably rely on Hansen's statement; and (4) the documents attached to the FAC showed that Travelers did actually pay for debris removal. As to the claim for intentional infliction of emotional distress, Hansen argued that the Bocks failed to allege extreme and outrageous conduct, and that a mere denial of benefits is insufficient to support a claim of infliction of emotional distress.
The Bocks filed opposition. As to the cause of action for negligent misrepresentation, the Bocks argued that, while case law may hold that an adjuster cannot be held liable for breach of contract or bad faith, such authority is "wholly irrelevant to whether [Hansen] can be held liable for his own deceit." The Bocks also disputed Hansen's claim that Travelers paid all cleanup and removal costs.
As to the emotional distress claim, the Bocks argued that Hansen ignored overwhelming evidence that the tree limb hit and cracked the chimney; insulted and disparaged them; altered the scene of the accident before taking photographs; misrepresented the terms of the policy; prepared false claim reports; conspired with Vertex to prepare an intentionally false report; and knowingly relied on the false report in order to deny a legitimate claim. Finally, the Bocks requested leave to amend if the court determined that the FAC lacked specificity.
The court heard argument on Hansen's demurrer, at the conclusion of which it took the matter under submission.
Hansen moved for dismissal of the FAC and requested judgment in his favor. The court granted the motion, and entered judgment for Hansen. This timely appeal followed.
Our standard of review is de novo, as we exercise our independent judgment to determine whether the complaint states a cause of action as a matter of law. (Traders Sports, Inc., supra, 93 Cal.App.4th at p. 43.) We give the complaint a reasonable interpretation, reading it as a whole and viewing its parts in context. (Blank v. Kirwan (1985) 39 Cal.3d 311, 318 [216 Cal.Rptr. 718, 703 P.2d 58].)
As noted, the trial court held that a negligent misrepresentation claim cannot lie against an insurance adjuster as a matter of law, adopting the argument made by Hansen below. Hansen makes the same argument here, beginning his brief with the fundamental argument that he cannot be held personally liable for negligent misrepresentation "based on conduct that
Lippert involved insurance agents who were involved in the initial procurement of the insurance policy, not an adjuster involved in adjusting a loss. It has nothing to do with the circumstances here. And Sanchez is distinguishable.
Sanchez v. Lindsey Morden Claims Services, Inc., supra, 72 Cal.App.4th 249 (Sanchez), arose in the context of a cargo insurance policy issued to Sanchez, a mover. Some property he was moving for a customer was damaged during a move, and Sanchez made a claim on the policy for repair of that property, which Sanchez said would cost $12,000 and take a week. The insurer retained defendant Lindsey Morden Claims Services (Lindsey), an independent adjuster, to investigate and adjust the loss. Sanchez advised Lindsey that immediate repairs were required because the purchaser of the property was suffering business losses. Sanchez's advice went unheeded, and three months passed before the claim was paid and the repairs completed. As a result the customer sued Sanchez, and obtained a judgment against him for $1,325,000. (Id. at p. 251.)
Sanchez sued the insurer for breach of the insurance policy and also sued the adjuster on a negligence theory. The adjuster demurred, arguing it had no contract with Sanchez and owed him no duty of care. The trial court sustained the demurrer without leave to amend, and the Court of Appeal affirmed, following a six-page analysis of why no duty of care was owed that would support a claim for negligence. (Sanchez, supra, 72 Cal.App.4th at pp. 250-255.)
Such special relationship leads to the conclusion that Hansen, the employee of the party in the special relationship, had a duty to the Bocks. Likewise, the general law of negligent misrepresentation applies.
Hansen attempts to diminish the extent of Mrs. Bock's injury, deeming it nothing but an "incidental injury [that] does not render the negligent misrepresentation claim actionable." We find the potential consequences of such assertion dangerous. Perhaps Mrs. Bock's injury was merely an "incidental injury." Perhaps not. But if it were, Hansen should consider himself lucky. It is not difficult to imagine Mr. Bock, being told that the cleanup of a 3.6-ton
Hansen cites three federal cases, two published, one not, which he cites for the proposition that insurance adjusters can never be liable for negligent misrepresentation claims if the false statement was made in the course of the adjuster's employment: Good v. Prudential Ins. Co. of America (N.D.Cal. 1998) 5 F.Supp.2d 804; Icasiano v. Allstate Ins. Co. (N.D.Cal. 2000) 103 F.Supp.2d 1187, 1190; and Moreno v. Allstate Ins. Co. (C.D.Cal., Sept. 10, 2002, No. CIV-S02-1426 DFL JFM) 2002 WL 31133203. We find Good distinguishable and Icasiano and Moreno unpersuasive. Good involved an insurance agent who made representations about the benefits of an increased variable life insurance policy, not an adjuster. As to Icasiano, the entire "analysis" of the issue was this: "An agent of an insurance company is generally immune from suits brought by claimants for actions taken while the agent was acting within the scope of its agency. (See Lippert v. Bailey [(1966)] 241 Cal.App.2d 376, 382 [50 Cal.Rptr. 478] ...; Gasnik v. State Farm Ins. Co. [(E.D.Cal. 1992)] 825 F.Supp. 245, 249 ...; Good, [supra], 5 F.Supp.2d at [p.] 807.) In such cases, the cause of action lies against the insurance company and not its agent. (See Lippert, [supra,] 241 Cal.App.2d at [pp. 383-384].)" (Icasiano, supra, 103 F.Supp.2d at pp. 1189-1190.) And Moreno did nothing more than follow Icasiano.
Hansen makes two other arguments, essentially fact based, as to why the Bocks cannot state a claim for negligent misrepresentation. Neither has merit. The first asserts that the Bocks did not justifiably rely on Hansen's misrepresentation. In Hansen's words: "[The Bocks'] reliance was unjustified as a matter of law. An insured cannot justifiably rely on an adjuster's representations about coverage when they contradict the express terms of the policy," and, he goes on, "[h]ad [the Bocks] read the policy ... they would have seen that Hansen's alleged statements clearly were incorrect." We are nonplussed: not only does Hansen acknowledge his "clearly" erroneous statement to the Bocks, but he then faults them for believing him. In any event, the argument has no merit.
Hansen's other fact-based argument asserts that the Bocks did not rely, and did not "sustain any damage as a result of the representation," as they had notice when they received their first estimate, which included a minimal amount for debris cleanup, that the policy provided coverage. This argument ignores the fact that the Bocks immediately relied upon Hansen's statement before an estimate was ever received, the allegation being that the Bocks began cleaning up the debris while Hansen was still present. Moreover, the fact that Travelers paid some of the cleanup costs does not mean that the Bocks did not sustain any damages. Indeed, they expressly alleged that they submitted an estimate of $2,065 for removal of the limbs, and that Travelers paid only a fraction of the total cost. And, of course, the Bocks' own time and effort in the cleanup has value.
The negligent misrepresentation claim against Hansen may proceed.
As quoted above, the trial court held that the Bocks "presented no convincing argument for allowing these claims to stand against defendant Hansen in what is a contract based action," apparently holding that such claim failed as a matter of law. Hansen does not make such argument here, understandably, as the law is otherwise. (See, e.g., Hailey v. California Physicians' Service (2007) 158 Cal.App.4th 452, 473-476 [69 Cal.Rptr.3d 789]; Hernandez v. General Adjustment Bureau (1988) 199 Cal.App.3d 999, 1007 [245 Cal.Rptr. 288]; Fletcher v. Western National Life Ins. Co. (1970) 10 Cal.App.3d 376, 385, 408 [89 Cal.Rptr. 78] [claims supervisor].) Rather, Hansen's position is that the Bocks did not allege, and cannot amend their complaint to allege, the requisite outrageous conduct. We agree with Hansen's first statement. But find the second statement premature.
The law was confirmed in Hughes v. Pair (2009) 46 Cal.4th 1035, 1050-1051 [95 Cal.Rptr.3d 636, 209 P.3d 963] (Pair), where, affirming a summary judgment for defendants, the Supreme Court observed as follows:
"Liability for intentional infliction of emotional distress `"does not extend to mere insults, indignities, threats, annoyances, petty oppressions, or other trivialities." [Citation.]' [Citations.] ...
Seemingly recognizing this, the Bocks contend their allegations "are similar to the allegations that were made in Younan[ v. Equifax, Inc., supra,] 111 Cal.App.3d 498, and Little v. Stuyvesant Life Ins. Co. [(1977)] 67 Cal.App.3d 451 [136 Cal.Rptr. 653]."
In Younan v. Equifax, Inc., supra, 111 Cal.App.3d 498, the Court of Appeal held that the insured sufficiently pled outrageous conduct where he alleged
In Little v. Stuyvesant Life Ins. Co., supra, 67 Cal.App.3d 451, 461-462 — which was not a pleading case but followed a jury verdict for the insured — the Court of Appeal found outrageous conduct when the defendant disability insurer "purposely ignored the great bulk of the medical information it had and withheld that information ... to justify its predetermined course of discontinuing disability benefit payments justly due" under the insured's policy. Specifically, the disability insurer terminated benefits after ignoring "overwhelming" evidence that the insured was totally disabled. (Id. at p. 457.) The insurer then withheld from its evaluating physician information about the insured's job duties and reports from other physicians in order to elicit a proinsurer opinion from the evaluating physician. (Id. at pp. 459-460.) As a result of the termination of benefits, the insured was forced to sell her home and subsequently attempted suicide by ingesting an entire bottle of Valium. (Id. at p. 460.)
Relying on these cases, the Bocks argue that their pleading was sufficient. In their words, "Similar to the factual situation in Little and Younan, the Bocks alleged that Hansen ignored the overwhelming evidence that supported coverage; altered the scene of the accident in order to later deny the claim; created a false claim report stating that the Bocks had confirmed no damage to their floor and fence even though the Bocks never made those statements...; conspired with an unlicensed contractor to create a knowingly false report that was used to wrongly deny the Bocks' claim for damage to their chimney; and that Hansen knew the chimney was the Bocks' primary source of heat and that winter was approaching. [Citation.] [¶] The FAC also alleged that when the Bocks submitted documentation, including and [sic] expert report and photographs, directly refuting the stated grounds for the denial, Hansen refused to even acknowledge, let consider [sic] the information. [Citation.] [¶] The Bocks also alleged that Hansen made rude and disparaging remarks to them as part of his outrageous course of conduct. [Citation.] Insults, indignities, and threats are also part on [sic] an outrageous course of conduct that will subject a defendant to liability. [Citation.]"
We are not persuaded. The setting here is a far cry from those in Younan or Little, where the insureds were particularly susceptible to distress, the insured in Younan unable to provide for his family, the insured in Little forced to sell
As noted, Pair was a summary judgment case citing other summary judgment cases. The Bocks contend that whether conduct is outrageous is "usually a question of fact," citing Spinks v. Equity Residential Briarwood Apartments (2009) 171 Cal.App.4th 1004, 1045 [90 Cal.Rptr.3d 453] and Ragland v. U.S. Bank National Assn., supra, 209 Cal.App.4th 182, 204. While both cases say what the Bocks represent, many cases have dismissed intentional infliction of emotional distress cases on demurrer, concluding that the facts alleged do not amount to outrageous conduct as a matter of law. (See, e.g., Mintz v. Blue Cross of California (2009) 172 Cal.App.4th 1594, 1608-1609 [92 Cal.Rptr.3d 422]; Coleman v. Republic Indemnity Ins. Co. (2005) 132 Cal.App.4th 403, 416-417 [33 Cal.Rptr.3d 744]; Ricard v. Pacific Indemnity (1982) 132 Cal.App.3d 886, 895 [183 Cal.Rptr. 502].) This case may be another. But it is too early to tell.
As noted, the Bocks requested leave to amend below, which the trial court denied without explanation, indeed, probably without reflection, given the basis of its ruling. We review that denial for abuse of discretion. "While the decision to sustain or overrule a demurrer is a legal ruling subject to de novo review on appeal, the granting of leave to amend involves an exercise of the trial court's discretion. [Citations.] When the trial court sustains a demurrer without leave to amend, we must also consider whether the complaint might state a cause of action if a defect could reasonably be cured by amendment. If the defect can be cured, then the judgment of dismissal must be reversed to allow the plaintiff an opportunity to do so. The plaintiff bears the burden of demonstrating a reasonable possibility to cure any defect by amendment." (Traders Sports, Inc., supra, 93 Cal.App.4th at p. 43.)
The Bocks contend that they can allege additional facts to support their claim that Hansen acted outrageously. According to them, these facts include that "Hansen deliberately withheld information from Vertex and Roy Anderson in order to ensure that the Vertex report would support Hansen's pre-determined decision to deny the Bocks' claim"; that Hansen sent Anderson his own conclusions as to why the chimney damage was not caused by the tree limbs before Anderson wrote his report; that Hansen subsequently edited Anderson's report before it was finalized; and that Hansen's supervisor took notes that acknowledged damage to the Bocks' home, which were never
The judgment for Hansen is reversed, and the matter remanded for further proceedings consistent with this opinion. The Bocks shall recover their costs on appeal.
Kline, P.J., and Haerle, J., concurred.