2018年5月的每月存档

2018年5月不良信仰案件:撤销了2100万美元的不良信仰判决,撤回了意见,给予了重新认可,但在较差的信仰上提出了原始意见,这几天后又得到了认可(宾夕法尼亚州高等法院)

2018年5月31日,高等法院’s 2018年4月9日2-1决策逆转 初审法院’在Berg诉Nationwide一案中获得2100万美元的赔偿 在法院批准重新考虑后,他撤回了诉讼。几天后,即2018年6月5日,法院又以与第一项裁决相同的方式发布了另一项2-1裁决, 多数再次撤回并指示保险人作出判决前大法官史蒂文斯表示反对.

The 可能31st Order had stated:

在此订购:

考虑到四月份提出的重新申请 2018年3月30日,在本上诉中,法院特此授予 重新考虑;

特此本法院于2018年4月9日提交的裁决 撤销; 和

各方无需提交任何其他摘要。

输入此命令不影响当事方提交或重新提交 在本法院提起诉讼后要求重新考虑或重新提出要求 重新考虑了决定。

我们感谢Daniel E.Cummins的出色表现 侵权谈话博客 引起我们注意此命令。

 

2018年5月不良信仰案件:(1)拒绝给予好处(2)不足的调查和(3)不合理的延迟作为法定不良信仰的潜在依据(费城联邦)

This post 在 cludes two opinions from consecutive days issued by the same judge 在 the Eastern District. In these two opinions, the court sets forth various standards for pursuing potential statutory 恶意 claims, 在 cluding (1) benefit denial; or (2) unreasonable 在 vestigations; or (3) delays 在 either (a) the claim handling process or (b) paying benefits due. As noted before on this blog, there is an issue whether statutory 恶意 can exist for poor 在 vestigation or claim handling practices where no benefit was due.

CASE 1

In the first case, the 在 surer denied disability benefits. The 在 sured sued for breach of contract 和 恶意. The 恶意 claim was based on two theories: (1) unreasonable denial of benefits 和 (2) improper claim handling during the 在 vestigation. The court denied the motion to dismiss the coverage based 恶意 claim for denying benefits, but granted the motion to dismiss the 恶意 claim based on an 在 adequate 在 vestigation.

否认受益不良信念

The court’s 恶意 analysis began with basic statements of statutory 恶意 law:

  1. “To establish 恶意 under 42 Pa.C.S. § 8371, a plaintiff must demonstrate that the 在 surer (1) lacked a reasonable basis for denying benefits 和 (2) knew or recklessly disregarded its lack of a reasonable basis.”

  2. “In the 在 surance context, 恶意 denotes a ‘frivolous or unfounded’ refusal to pay policy proceeds, which imports a dishonest purpose 和 a breach of a known duty, such as good faith 和 fair dealing.”

  3. “To defeat a claim of 恶意 an 在 surer need not show that the 在 surer was correct; rather, an 在 surer must demonstrate that it had a reasonable basis for its decision to deny benefits.”

  4. “A reasonable basis is all that is required to defeat a claim of 恶意.”

  5. “On the other hand, ‘an unreasonable 在 terpretation of the policy provisions as well as a blatant misrepresentation of the facts or policy provisions will support a 恶意 claim.’”

调查不足的信念

These principles, however, were not the sole means to define 恶意. The court cited case law for potential 恶意 conduct that went beyond these basic parameters, beginning with the proposition that “[s]ection 8371 also encompasses a broad range of other conduct 在 cluding 在 adequate 在 vestigations.”

Concerning “inadequate 在 vestigation” 恶意, the court stated the following:

  1. “法院裁定,保险人必须'在拒绝向被保险人支付保单收益之前,对索赔进行适当的调查。'”

  2. “'保险公司进行的调查不足或未能就承保问题进行充分的法律研究时,可能会发生恶意。””

  3. 但是,保险人不必证明其调查得出了正确的结论或其调查是完美的;相反,它必须只是表明其调查“足够彻底,足以证明其拒绝索赔的决定是正确的。””

The 在 sured’s amended complaint based her 恶意 claims on two distinct theories: “(1) a denial of benefits predicated either on an unreasonable 在 terpretation of the terms 和 conditions of the Policy or on imposition of requirements that do not exist 在 the Policy; 和 (2) a failure to conduct a reasonable or adequate 在 vestigation 在 to the nature 和 extent of either Plaintiff’身体状况或原告’s occupation.”

The court refused to dismiss under the first theory, finding that factual issues remained on the coverage questions. However, it did dismiss the 恶意 claim under the second theory. Although the plaintiff had added some allegations to support her 在 adequate 在 vestigation claim, “[t]hese additional allegations fail to successfully move Plaintiff’s 恶意 claim from the realm of mere possibility to that of plausibility.”

修改后的投诉的展览显示,除其他外,该保险公司已经考虑了被保险人的医疗信息以及有关其职业职责的声明。此外,被保险人多年来没有报告其残疾,这种延误及其后果完全是她的责任。当法院总结其驳回意见时:“尽管被告’s 在 vestigation may not have been perfect, the allegations of the Amended Complaint do not raise a plausible inference that it was so deficient as to rise to the level of 恶意.”

Date of Decision: 可能22, 2018

Wiessmann诉西北地区共同人生案。公司美国宾夕法尼亚州东区地方法院民事诉讼编号2018年6月16日至16日,美国区LEXIS 86103(美国宾夕法尼亚州2018年5月22日)(Goldberg,J.)

CASE 2

The second case 在 volved UIM breach of contract 和 恶意 claims. The 在 surer moved for summary judgment on the 恶意 claim. In carrying out its 恶意 analysis, the court observes the same principles quoted above concerning denial of benefits, burden of proof, 和 在 adequate 在 vestigation, but also adds more detailed principles concerning delay as a basis for 恶意.

与第一项裁决类似,法院最初遵循基本的恶意原则:“在宾夕法尼亚州,‘bad faith’在保险案件中被定义为‘任何轻率或无根据的拒绝支付保单收益的行为。 …恶意必须以明确而令人信服的证据来证明,“即使在简易判决中,这种负担也是如此。”… To establish 恶意 under 42 Pa.C.S. § 8371, a plaintiff must demonstrate that the 在 surer (1) lacked a reasonable basis for denying benefits 和 (2) knew or recklessly disregarded its lack of a reasonable basis. … In the 在 surance context, 恶意 denotes a ‘frivolous or unfounded’ refusal to pay policy proceeds, which imports a dishonest purpose 和 a breach of a known duty, such as good faith 和 fair dealing. … While mere negligence or bad judgment are 在 sufficient, a showing of reckless disregard will suffice to establish 恶意.”

不合理的延迟不良信念

其次,与第一个案件一样,法院指出“第8371条不限于保险人’s 恶意 在 denying a claim. An action for 恶意 may extend to the 在 surer’s 在 vestigative practices.” The court then observes standards for another measure of 恶意 not detailed 在 the first opinion: “A 恶意 在 surance practice can also 在 clude an unreasonable delay 在 handling or paying claims. … Thus, even when ‘an 在 surance claim has been settled 和 paid, Pennsylvania’s 恶意 statute provides 在 surance claimants a means of redressing unreasonable delays by their 在 surers.’”

The court sets forth the following principles concerning 恶意 delay claims:

  1. “To establish a claim of 恶意 based on the 在 surer’如果延迟支付索赔,原告必须证明(1)延迟归因于保险人; (2)保险人没有造成延误的合理依据; (3)保险人知道或不顾后果地无视延误的合理依据。”

  2. 原告承担着通过明确而令人信服的证据来确定延误的责任。”

  3. A long period of time between demand 和 settlement does not, on its own, necessarily constitute 恶意.”

  4. “[I]f delay is attributable to the need to 在 vestigate further or even to simple negligence, no 恶意 has occurred.”

The court uses examples from prior case law to show specific time periods that did not constitute 恶意 delays. In one precedent, “a delay of fifteen months to resolve a claim—during which the 在 surer took the 在 sured’通知索赔后九个月的存款,等待一年后才投保’s deposition 和 waited fourteen months to obtain a vocational assessment—was not an unreasonable length of time so as to rise to the level of 恶意, even though the 在 surer could have completed its 在 vestigation with greater speed”. In another, “even if all delay were attributable to the 在 surer, a period of approximately thirteen months between notification of UIM claim 和 resolution of claim through arbitration would not, without more, be sufficient to establish bad faith”.

在运用这些原则时,法院列出了保险人在理算人调查期间处理索赔的详细事实历史记录,包括理算人与被保险人之间的通讯历史以及各种文件和记录的请求。尽管有如此详细的事实记录,但是,被保险人仅依靠其投诉的平均值来反对即决判决。这些都是无法达到明确和令人信服的证据标准的结论性指控。

Independently, the court found “the undisputed evidence reveal[ed] no 恶意 在 vestigation or delay on Defendant’的一部分。”最后,法院指出,“任何拖延都应归因于被告双方’有充分的理由调查原告和原告’s own delays 在 providing the requested 在 formation. Based on this undisputed record, no reasonable factfinder could determine that Defendant acted 在 恶意 在 在 vestigating 和 /or evaluating Plaintiff’s UIM claim.” Thus, the court granted summary judgment on the 恶意 claim.

Date of Decision: 可能23, 2018

威廉姆斯诉自由共同保险宾夕法尼亚州东区美国地方法院民事诉讼,第17-3862号,2018年美国区。 LEXIS 86356(美国宾夕法尼亚州2018年5月23日)(Goldberg,J.)

 

 

2018年5月不良信念案件:因为没有义务掩盖损害,因此没有不良信念索赔(中区)

In this homeowner’s water damage case, after a detailed analysis of the facts 和 coverage issues, the court dismissed the 在 sured’s breach of contract claim for failure to pay 在 surance coverage. The court then quickly addressed the 在 sured’s 恶意 claim.

“[B]ecause [the 在 surer] had a reasonable basis to deny [the 在 sured’s] claim for coverage, the 恶意 claim will be dismissed.” The court explained: “[T]o recover under a claim of 恶意, the plaintiff must show that the defendant did not have a reasonable basis for denying benefits under the policy 和 that defendant knew or recklessly disregarded its lack of reasonable basis 在 denying the claim.”“因此,如果保险公司有合理的理由拒绝原告’s claim, the 恶意 claim necessarily fails.”

具体而言,法院引用了之前的两个案例:(1)“[W]e will affirm the grant of summary judgment … on this claim because [the] 恶意 claim necessarily fails 在 light of our determination that [the 在 surer] correctly concluded that there was no potential coverage under the policy” 和 (2) “由于被告没有义务赔偿原告的损失’ house 和 personal property, there can be no 恶意 claim”.

Date of Decision: 可能18, 2018

Sanko诉Allstate Ins。有限公司美国宾夕法尼亚州中区美国地方法院,第3:16-CV-1620号,2018年美国区。 LEXIS 84943(医学博士宾夕法尼亚州,2018年5月18日)(马里尼,J。)

2018年5月不良信仰案件:没有被拒绝的不良信仰(费城联邦)

注意:该决定于2019年8月2日被第三巡回法院撤销。 这里 .

In something of a contrast with today’s first post, the Court’s analysis of the 在 sureds’ breach of contract claim determined the outcome of their 恶意 claim.

事实涉及租车的保险范围。在仔细分析了事实之后,法院得出结论认为,没有针对保险人因未能向被保险人提供汽车租赁保险而违反合同要求。

On the 恶意 claims, the Court first rejected an argument that the 在 sureds could bring a breach of the implied covenant of good faith 和 fair dealing distinct from their breach of contract claim. After going over the history of this type of claim, the Court concluded “in practice, the covenant of good faith functions ‘as an 在 terpretive tool’ to aid the court 在 evaluating breach of contract claims but the implied duty is never divorced from specific clauses of the contract.” Thus, any effort to assert this claim 在 dependent form the contract claim was rejected.

As to statutory 恶意, the Court cited the well-recognized standards: “To recover for 恶意, a plaintiff must show by clear 和 convincing evidence that the 在 surer (1) did not have a reasonable basis for denying benefits under the policy 和 (2) knew or recklessly disregarded its lack of reasonable basis 在 denying the claim.” The Court made clear that “the essence of a 恶意 claim is the unreasonable 和 在 tentional or reckless denial of benefits.” Further, “an 在 surer may defeat a claim of 恶意 by showing that it had a reasonable basis for its actions.”

The Court found that the evidentiary record did not support a finding that a benefit to which the 在 sureds were entitled was denied. “For this reason, the only conclusion which we can now reach is that [the 在 surers] did not act 在 恶意 within the meaning of Section 8371 和 that judgment is properly entered 在 their favor as a matter of law….”

Date of Decision: 可能17, 2018

Stechert诉旅行者之家& Marine Ins. Co.宾夕法尼亚州东区美国地方法院,民事诉讼编号: 17-CV-784,2018美国区LEXIS 83126(美国宾夕法尼亚州2018年5月17日)(Joyner,J.)

该意见被第三巡回法院推翻。请参阅博客文章 这里 .

2018年5月不良信仰案件:法院允许第8371条对申诉处理提出不良信仰索赔,即使未涉及任何赔偿(中区)

In this action, the Court found that there was no 在 surance coverage due for a variety of reasons, 和 dismissed an 在 sured’s breach of contract claim. However, the Court still gave the 在 sureds leave to file an amended complaint asserting common law 和 statutory 恶意 claims.

The Court cited the general standard that a 恶意 plaintiff has (1) to show that there was no reasonable basis to deny coverage 和 (2) the 在 surer knew or recklessly disregarded this fact. However, the Court then set forth a second standard: “A plaintiff may also make a claim for 恶意 stemming from an 在 surer’s 在 vestigative practices, such as a ‘lack of a good faith 在 vestigation 在 to facts, 和 failure to communicate with the claimant.” It appears to be this second standard, treated 这里 as an 在 dependent basis for a section 8371 claim even if no coverage is actually due under the policy, on which an amendment was allowed. The Court did recognize that section 8371 does no cover alleged 恶意 在 soliciting a policy 和 dismissed that claim outright.

As to whether a 恶意 claim can exist when no coverage is due under a policy, 和 there is no breach of any duty to defend or 在 demnify, 请参阅之前发布在我们博客上的这篇文章.

Date of Decision: 可能15, 2018

Frantz诉Nationwide Insurance Co.美国宾夕法尼亚州中区地方法院3:18-CV-0509,2018美国区LEXIS 81817(医学博士,宾夕法尼亚州,2018年5月15日)(卡普托,J。)

The plaintiff did file an amended complaint, 在 cluding a new 恶意 claim.  此主张随后于2018年9月4日受到不利影响而被驳回.

MAY 2018 BAD FAITH CASES: NO BAD FAITH WHERE MERE DISAGREEMENT OVER CLAIM VALUATION; SOCIAL MEDIA POSTS RELEVANT TO COURT'S结论(中区)

被保险人的行人被汽车撞倒后受伤。被保险人与侵权人的保险人达成和解。被保险人声称受伤使她“永久la腿,疮痛和致残”,并向保险公司提出了UIM索赔。保险人否认了这一主张,并辩称被保险人受伤的总价值不超过100,000美元。

Litigation ensued, 和 the 在 surer successfully moved for summary judgment on the 恶意 claim. The Court stated that “[a]n 在 sured must meet the heightened standard of clear 和 convincing evidence, which ‘is the highest standard of proof for civil claims’, to establish a claim of 恶意.” The Court found that the evidence of record revealed the 在 surer reasonably evaluated the claim, 和 reasonably concluded that the claim did not exceed $100,000.

法院进一步指出,被保险人继续从事她的工作,找到了新的护士工作,从未要求过任何身体上的适应或限制。此外,被保险人在社交媒体上的帖子显示她继续过着非常积极的生活方式,IME的一份报告称她已经从受伤中恢复过来,不需要进一步护理。

In conclusion, the record showed a mere disagreement as to the valuation of the claim. Such a disagreement cannot amount to 恶意 under Pennsylvania law.

Date of Decision: 可能11, 2018

Shaw诉USAA伤亡保险公司。美国宾夕法尼亚州中区地方法院,民事诉讼第17-947号,2018年美国区。 LEXIS 80101(医学博士,宾夕法尼亚州,2018年5月11日)(曼尼翁,J。)

 

2018年5月的不良信仰案件:根据不熟悉的宾夕法尼亚州法律,索赔代表未能就法律排除范围的法律问题与律师进行协商,否则可能导致裁定拒绝承认不良信仰的目的是不合理的(西部地区)

被保险人拥有两栋建筑物,其挡土墙均失效。保险人否认承保。保险人’索赔代表依靠一位专家说,该损失是``由于地球的横向力加上墙体的设计,建造和维护不足而造成的'',索赔代表得出结论认为援引了各种保单。但是,他在拒绝承保之前没有咨询律师,并且他不熟悉宾夕法尼亚州关于任何保险范围问题的法律。

The 在 sured sued for 恶意 和 breach of contract, 和 the 在 surer moved for summary judgment on both claims. As outlined below, the Court found issues with the policy exclusions applicability, which the claim representative had determined himself without the aid of counsel.  Thus, on the 恶意 claim the Court denied the 在 surer’s motion, reasoning “there is a material question of fact as to whether [insurer’s] 在 terpretation of the policy was reasonable given that [the claim representative] was unfamiliar with Pennsylvania law 和 did not consult legal counsel.”

法院基于以下原因拒绝了保险人对违约索赔的简易判决:

  1. 保险公司对保险单中排除地球运动的解释范围不广;

  2. 由于是否可以预见墙壁倒塌的事实,维修和后续损失排除的适用性受到质疑;和

  3. 保险公司对保单下的突然倒闭排除的解释是错误的。

Date of Decision: 可能11, 2018

Burgunder诉United Specialty Ins。公司美国宾夕法尼亚州西区美国地方法院,民事诉讼编号17-1295,2018年。 LEXIS 79477(W.D. Pa.2018年5月11日)(J.Schwab)

2018年5月不良信仰案件:索赔人提出的索赔后陈述不实,与向DENY CLAIM(新泽西州联邦)提出合理依据无关

The 在 sured commenced this coverage action after the 在 surer denied coverage for property damage. The 在 surer argued no coverage was owed because the water damage derived from either freezing pipes or wear 和 tear. The 在 sured argued the 在 surer acted 在 恶意 by “willfully 和 在 tentionally” misrepresenting the communications between the parties, 和 by falsely accusing the 在 sured of failing to preserve evidence relevant to the claim. The 在 surer moved for judgment on the pleadings as to the 恶意 claim.

The Court held the 恶意 claim “may only be supported by factual allegations concerning whether [the 在 surer] lacked a reasonable basis for denying coverage[,]” not whether 在 surer deliberately misrepresented communications between the parties months after coverage had already been denied. The Court reasoned, “[i]t is of no moment what alleged mischaracterizations or misrepresentations [the 在 surer] made . . . because such allegations have no bearing on whether [the] policy . . . covered the water damage from the accident.”

因此,法院批准了保险人对书状进行判决的动议,但也准予了被保险人修改投诉的许可。

Date of Decision: 可能10, 2018

Olirei Investments,LLC诉Liberty Mutual Insurance Co.案,美国新泽西州美国地方法院,民事诉讼第18-524号,2018年美国区。 LEXIS 78949(2018年5月10日由美国新泽西州切斯勒市)

 

2018年5月不良信仰案件:如果保险人未违反保险合同,则没有不良信仰(新泽西联邦)

This action arises from a coverage dispute over a flood 在 surance policy issued under the National Flood Insurance Program. Per federal law, these policies must conform to the requirements of the Standard Flood Insurance Policy (“SFIP”). Among other requirements, 在 sureds must submit a proof of loss that conforms to SFIP standards. After the 在 surer denied coverage 在 this case, the 在 sured sued for breach of contract 和 恶意. The 在 surer moved for summary judgment.

As to the 恶意 claim, the 在 surer argued that its coverage denial was based on the 在 sured’s failure to submit a proof of claim conforming to SFIP guidelines. The Court accepted this argument, finding, among other things, that the 在 sured’s proof of loss was “so confusing as to be impossible to process….” The Court further found “[the 在 sured’s] Proof of Loss submission is 在 comprehensible 和 does not comply with the requirements of the SFIP.” Thus, the denial was not a breach of the 在 surance contract. As to 恶意, the Court found: “This Court has just ruled 在 favor of [the 在 surer] on Plaintiff’s breach of contract claim. Given that, Plaintiff cannot prove a 恶意 denial of coverage.”

Date of Decision: 可能8, 2018

乌多诉选择性保险公司,新泽西州美国地区法院,第13-2719号民事诉讼(SRC),2018年美国区。 LEXIS 77075(于2018年5月8日由美国新泽西州切斯勒(D.N.J.)

该案于2019年5月13日得到第三巡回法院的确认。 可以在这里找到 .

 

2018年5月不良信仰案件:关于UIM索赔处理和和解谈判的实质性问题,防止对一方的简易判决(宾夕法尼亚州西部)

被保险人在车祸中头部严重受伤之后,UIM开始采取这种行动。索赔处理过程跨越了两年半的时间。被保险人要求提供100,000美元的保额限额,而保险公司最初提出要支付17,000美元。最终,保险人支付了保单限额。

The 在 sured sued for 恶意, among other claims. The 在 sured alleged 恶意 在 the delay of payment of benefits. Both parties moved for summary judgment on 恶意. The Court found genuine issues of material fact existed on 恶意, precluded relief to either party.

法院认为,被保险人的律师在提出索赔后近两年没有要求解决索赔,一旦提出,保险人便立即采取行动。法院进一步认为,陪审团可以断定最初的$ 17,000报价是合理的,因为被保险人承认在索赔处理过程中某一时刻她的特殊赔偿金仅为$ 15,000,并且作证说“头部受伤特别难以评估”。 。 。 。 。”

但是,法院也拒绝了保险人的即决判决,因为陪审团可以得出结论,支付给养恤金的不合理拖延,而17,000美元的报价是低价报价。陪审团可以发现,保险人在提出申请到被保险人的律师要求18个月后和解之间,没有进行有意义的调查或试图和解。此外,有人可能会争辩说17,000美元是低价报价,因为保险公司对索赔的估价在46,800美元至61,800美元之间。

[It is 在 teresting to compare this result to New Jersey’s fairly debatable standard on 恶意, where an 在 sured’s 在 ability to obtain summary judgment on 恶意 means there can be no 恶意.]

Date of Decision: 可能7, 2018

Parisi诉State Farm Mut。汽车。英斯有限公司美国宾夕法尼亚州西区地方法院,民事诉讼第16-179号,2018年美国区。 LEXIS 76246(W.D. Pa.2018年5月7日)(吉布森,J。)