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Timestamp: 2019-04-22 05:20:46+00:00

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The Legal Intelligencer Blog: Charles E. Haddick Jr.
Below the fold on Page 1, reporter Saranac Hale Spencer writes that the Chemical Weapons Act was upheld by the U.S. Court of Appeals for the Third Circuit on remand from the U.S. Supreme Court. The court was hearing the case of a spurned spouse’s alleged revenge plot, which included the use of highly toxic chemicals from her employer, chemical manufacturer Rohm and Haas, but declined to say the act was unconstitutional.
In more Regional News on Page 3, reporter Ben Present writes that Penn State has appealed the venue decision in its insurance dispute, seeking to keep the litigation between the university and its insurer from unfolding in Philadelphia.
In an Environmental Law column on Page 5, Jessica R. O’Neill writes about “disinvesting” in the federal enforcement of environmental laws.
In an Employment Law column on Page 7, Michael D. Homans writes that banning smokers may harm your company’s health in the long term.
By Charles E. Haddick Jr.
Recently, U.S. District Judge Thomas N. O’Neill Jr. of the Eastern District of Pennsylvania dismissed a bad faith claim against Allstate Insurance Co. arising out of a property damage claim made by plaintiffs Paul and Mary Ann Blasetti in the case of Blasetti v. Allstate.
O’Neill reviewed the claim’s brief history, noting that there was some discrepancy in the insureds’ reporting of the date of loss. He also wrote that the insureds undertook repairs of their structure before ever reporting the claim to Allstate. While O’Neill thought there were minimally sufficient allegations to allow the breach of contract claim to proceed past the motion for judgment on pleadings stage, he did not feel so inclined concerning the bad faith claim.
In the wake of Iqbal, insurers may be more likely to obtain motions for dismissal under Federal Rule 12(b)(6) and/or motions for judgment on the pleadings by invoking scrutiny for the factual nature, or lack thereof, of a plaintiff’s allegations of bad faith.
Charles E. Haddick Jr. is a partner with Dickie McCamey & Chilcote. He welcomes feedback from readers, along with any suggestions for topics you would like to see discussed in this space. He can be reached at chaddick@dmclaw.com.
The Pennsylvania Superior Court has ruled in Herd Chiropractic Clinic v. State Farm Mutual that an insurer who followed the peer review process to deny payment of medical expenses under the state Motor Vehicle Financial Responsibility Law (MVFRL) was nevertheless required to reimburse the challenging provider for its attorney fees after the court also found the treatment at issue was determined to be reasonable and necessary.
In the unanimous opinion authored by Superior Court Judge Anne E. Lazarus, the court examined the interplay between the peer review statute portion of the MVFRL and case law which holds that an insurer cannot be liable for treble damages or bad faith if it follows the peer review process. Lazarus recognized that protection, but also pointed out that the mechanism for an award of attorney fees to a health care provider challenging a peer review organization decision were embedded into the peer review process itself. She wrote "there is nothing in the language of the statute that specifically precludes attorney fees where a peer review decision is challenged and the court finds the treatment reasonable and necessary."
Insurers should be aware that when they elect to employ a peer review of medical bills, one of the consequences of an appeal by a provider from a PRO decision denying reimbursement may well be that an insurer must pay not only disputed medical charges, but the challenger's cost of the PRO appeal including, as seen in this case, attorney fees. The Herd Chiropractic decision is not, in its purest sense, a bad-faith opinion. It is, however, a warning to insurers that it can deploy the peer review process in good faith and still be liable to pay opposing party's attorney fees arising out of a PRO appeal.
Several months ago, Senior U.S. District Judge Robert F. Kelly of the Eastern District of Pennsylvania provided some insight and important analysis of bad-faith delay claims. In the case, Tomer v. Allstate, plaintiff Nancy Tomer filed a bad-faith claim against Allstate arising out of Allstate's handling of her UIM claim. The claim included cognitive brain injury claims and some additional injury claims, including a claim of three fractured teeth made almost three full years following the accident. In addition, Tomer made claims of psychiatric injury as well.
In ruling that Allstate did not commit bad faith in investigation of the claim, Kelly detailed the long course of history in which medical authorizations and request for medical information was exchanged between the parties. Kelly pointed out that the long period of delay between the demand and settlement does not on its own necessarily constitute bad faith on the part of the insurer. He also pointed out that for the plaintiff to made a valid case for bad-faith delay, the plaintiff not only had to establish 1) delay on the part of the insurer but also 2) that the delay was unreasonable and unreasonably delayed payment.
The court noted that not only did the plaintiff wait three years after the accident to bring a UIM claim, essentially wiping out any delay attributable to those three full years, but much of the subsequent delay was attributable to either the insured or her counsel in failing to respond to request for medical records, etc.
It used to be in certain jurisdictions in Pennsylvania over the past number of years that some practitioners assumed bad faith when they could establish delay alone. Kelly's opinion in the Tomer case, however, reinforces the principle that delay alone is not the proper analysis, and that the reasonableness or unreasonableness of the delay is the determinative factor in bad-faith analysis.
On July 21, Chief Judge J. Curtis Joyner of the U.S. District Court for the Eastern District of Pennsylvania granted State Farm Mutual Automobile Insurance Company's Rule 12(b)(6) motion seeking dismissal of a bad faith claim in a class action complaint arising out of the denial of first-party medical benefits.
In McWalters v. State Farm Mutual Automobile Insurance Company, Joyner took up the question of whether the plaintiff class was precluded from pursuing a bad faith claim arising out of the non-payment of benefits under the Pennsylvania Motor Vehicle Financial Responsibility Law, specifically 75 Pa.C.S.A. §1797.
Joyner noted that Section 1797, under statutory construction rules, was more specific than the bad faith statute, and the specific provisions should prevail and be construed as an exception for the general provision. The judge also noted that under several federal decisions, the prevailing view was that Section 1797 pre-empts Section 8371, but also pointed out that "where an insurer’s malfeasance goes beyond the scope of Section 1797, courts have reconciled the two statutes and found bad faith claims to supplement claims under Section 1797," citing Hickey v. Allstate Property and Casualty.
Joyner examined the allegations in the class action complaint carefully and determined, "We surmise that the gravamen of Plaintiffs' bad faith claim is the denial of first party medical benefits and nothing more.
Indeed, there are no allegations that Defendant did not properly invoke or follow the PRO process, denied or refused coverage, improperly invoked a coverage exclusion or otherwise misinterpreted or misapplied the insurance contract."
The judge felt, based on that analysis, that the plaintiff's bad faith claim fell within the scope of Section 1797 and dismissed the bad faith claim on pre-emption grounds.
It is unclear as to how far this decision will reach, in light of the judge's correct observation that Section 8371 and 1797 claims often accompany one another. The biggest lesson practitioners can take from the ruling is that special attention should be paid to the pleading requirements when pleading parallel 8371 and 1797 claims.
Can an insured file concurrent bad faith and UM/UIM suit when the suit is the first notice to the insurer of a UM/UIM claim? Under Koken v. Insurance Federation of Pennsylvania, the answer, at least in theory, is "yes."
In practice, however, where the first notice to an insurer of a UM/UIM claim is a civil complaint, which also contains a bad faith count, it is rather like a patient handing his surgeon a medical malpractice complaint while he is being wheeled into the OR. The practical problems created by this animal are the subject of today’s post.
Perhaps the best place to begin is Pa.R.C.P. 1023.1, which states that an attorney's signature on the pleading certifies that the claim is not being presented for an improper purpose; the claims defenses and legal contentions are warranted by existing law; and the factual allegations have evidentiary support or they specifically identify or likely to have evidentiary support after a reasonable opportunity for further investigation or discovery.
By its very nature, a bad faith claim is a statement by an insured that the his or her claim has not been handled by the insurer in a reasonable manner. How can such a statement be made, however, when the insurance claim that is the subject of the bad faith action has not yet been made?
Until now, courts have dealt with thorny issues around the periphery of this question, such as the discoverability of an insurer's claims activity logs in a bad faith case while at the same time such would be not discoverable in a concurrent UM/UIM proceeding. One example is Wutz v. Smith, from the Court of Common Pleas of Allegheny County. Bifurcation and severance address issues like discovery problems, but to my knowledge no court has ever addressed whether or not a bad faith claim concerning a UIM claim can properly be stated under Pa.R.C.P. 1023.1 requiring there to be an evidentiary basis for the allegations. This is something to certainly keep an eye on going forward.
In finding that American Commerce committed bad faith by failing to inform its insured of the correct policy limits (American Commerce, it turns out, did inform the plaintiff of the correct limits of $50,000; just not that the limits were stacked for total applicable coverage of $100,000), the court cited with approval Hollock vs. Erie Insurance Exchange Company. In so doing, the court found, "Erie Insurance intentionally mislead its insured for over a year regarding coverage available."
This is correct insofar as it goes. However, the court in Wisinski may have attempted to apply a case involving intentional conduct to a case in which the court had already recognized it was aware of no evidence of intentional conduct with respect to disclosure of policy limits.
Allow me to respectfully suggest two difficulties with this patch. First, the court's analysis appears to dismiss out of hand the possibility of mistake or inadvertence in Wisinski in favor of intentional or reckless conduct so as to make Hollock the right size. In truth, the court conceded it had no more evidence of one possibility than the other when it came to the policy limits issue.
Second, this patch blurs to the point of indistinguishable that which makes bad faith bad faith: the element of state of mind -- intentional or reckless disregard for the rights of the insured. The difference in the established degrees of conduct in Wisinski and Hollock -- evidence of intentional misrepresentation v. no direct evidence of intentional misrepresentation -- is the very difference under Pennsylvania law between negligence and actionable conduct under the bad faith statute. The court recognized the disparity as the essence of the difference between bad faith conduct and negligence, and yet it transmuted one into the other.
Finally, the court held that American Commerce was guilty of bad faith conduct because it violated its own claims guidelines regarding prompt confirmation of policy limits and the state Unfair Insurance Practices Act, which prohibits insurers from portraying to insureds a "policy of appealing from awards."
As with claims underwriting guidelines, courts have previously held that failure to follow state insurance practices regulations is "equally consistent with a mistake as with bad faith," according to Employers Mutual v. Loos and Pittas v. Hartford Life Ins. Co. See also Oehlmann v. Met Life Ins.Co.
Moreover, even if this were an appropriate bad faith standard, the Unfair Practices Act section upon which the court relied, on its face, would not impose bad faith conduct on American Commerce in the case. The statute precludes insurers from having a policy of appealing from awards. Yet, in the Wisinski opinion, the court referred only to evidence that American Commerce wanted to convey to the claimant that it was contemplating an appeal of the single possible arbitration award in the case. The statute is aimed at a pattern and practice of portraying a conduct policy to insureds. The court cited to no pattern or practice evidence, and no multiple awards from which appeals were to have been taken by ACI.
Over the last several posts, I have subjected the Wisinski opinion to a lot of scrutiny and criticism. In fairness, American Commerce could have been more precise in its claims handling to avoid the outcome that befell it, and Cohill did put together a comprehensive and factually rich opinion.
There is no question, however, that the opinion in Wisinski stands out, somewhat, against the backdrop of the last five to seven years of bad faith opinions at both the state and federal level. Whether it will prove to be a temporary departure from the general trend, or a sign of the change in direction of judicial bad faith opinions, is not yet known.
Charles E. Haddick Jr. is a partner with Dickie McCamey & Chilcote. I welcome feedback from readers, along with any suggestions for topics you would like to see discussed in this space. Please e-mail me at chaddick@dmclaw.com.
In this post, we continue our analysis of a recent bad faith ruling in Wisinski vs. American Commerce Group Inc. and American Commerce Insurance Company. Here, we will discuss the court’s finding that settlement negotiations included “lowball” settlement offers by the insurer, and constituted bad faith.
Specifically, the court found, in light of seeing American Commerce ultimately settle for policy limits ($100,000), that two earlier offers, each less than $15,000, were “lowball” in nature and constituted bad faith on the part of the insurer.
Before examining whether Pennsylvania law allows for such a retrospective, results-backward analysis of settlement offers, we might first examine an assumption underlying the court’s opinion: that American Commerce had any duty to participate in settlement negotiations at all, in light of the limits demand.
Under Pennsylvania law, an insurance company does not have an obligation to participate in settlement talks where the insured has demonstrated no interest in resolution of the claim. Under Zappile vs. Amex Insurance (2007), the Superior Court held that where a plaintiff insured maintains a policy limits demand, such a position is not indicative of willingness to compromise, and thus the insurer has no obligation to enter into settlement discussions. Zappile, then, invites the conclusion that a policy limits demand by an insured signifies no more interest in compromise than a zero-dollar offer from the insurer: both represent 100 percent victories for the respective proponents.
Here, despite the plaintiff’s adherence to a policy limits demand throughout the course of the claim, American Commerce did make settlement offers, where arguably under Zappile it had no obligation to do so. And if an insurer has no obligation to make any settlement offers, how is it possible to consider those offers “lowball” or made in bad faith?
Beyond that question, we turn our attention to whether there was a reasonable basis for the initial offers the insurer made. American Commerce questioned causation in the case and viewed the claim as, if anything, a potential exacerbation of a pre-existing condition. The insurer also obtained an independent medical report that indicated the automobile accident did nothing to change the preordained course of the plaintiff’s degenerative knee arthritis.
The court nonetheless felt that because late in the claim the insurer came to the realization that the plaintiff was likely to win policy limits of $100,000, this made earlier offers of less than $15,000 “lowball”and bad faith in nature. This is a dangerous way to look at settlement offers.
The court’s analysis of the nature of the original offers can be questioned on at least two grounds. First, the quality of the offers should be objectively measured as of the time they are made and not retroactively against other offers when the case has materially developed and changed, as seen in the Middle District of Pennsylvania’s 2007 decision in Oehlmann v. Met Life Ins. Co.
Secondly, the court took great pains to analyze the initial lower offers in terms of what the insurer subjectively knew. Under Pennsylvania law, bad faith is not to be judged on a subject of standard, but rather, an objective one; any justification for an insurer’s position on a claim, whether the insurer was aware of the justification or not, is a valid defense to a Section 8371 claim, as seen in the Eastern District’s 2007 decision in Wedemeyer v. The United States Life Insurance Company In The City Of New York, et al.
Even if the subjective of standard were the correct one, the court claimed the insurer made the early low offers in bad faith because they were made at a time when it did not have the benefit of the insurer’s IME findings attacking causation. While true, the court apparently overlooked the fact that the insurer did have information at the time of the offers from the insured’s own attorney indicating prior degenerative joint disease in the plaintiff’s knees. Under either standard, therefore, it is respectfully suggested that analysis of the prior offers as “lowball” is suspect.
Medical causation, when in question, can be an all-or-nothing proposition when decided by a panel of arbitrators. It is not necessarily unreasonable, therefore, that settlement discussions might approximate this model as well. We will continue our look at Wisinski in our next post.
In my last post, I introduced a bad faith ruling from the Western District of Pennsylvania that has received considerable attention since it was published on Jan. 4. Now, we continue our look at the Wisinski case, beginning with an in-depth analysis of the ruling.
To the extent an over-arching observation can be made, the ruling, in large part, appears to place heavy burdens and obligations on the insurer to safeguard the rights of the insured even though Pennsylvania law clearly holds that a UM/UIM proceeding is adversarial in nature, according to Condio vs. Erie, and that an insurer need not subvert it’s own rights in such a proceeding to the rights of the insured.
Moreover, even though the insured in Wisinski was represented by counsel throughout the duration of her UM claim, the court did not appear to find this highly significant and appeared to impose greater responsibility for safeguarding the insured’s rights on the insurer than Wisinski’s own lawyer.
Starting off with a change in assumption of such high magnitude -- the precise duty owed by an insurer to an insured in a UM/UIM context -- was sufficiently fundamental to then cause the remainder of the opinion to lean the way it did, contrary to existing bad faith law and highly in favor of the insured. In fairness to the ruling, we will examine each feature of the opinion individually.
The first casualty of the above assumption was the falling of another: the long-held belief in Pennsylvania that negligence and bad faith do not describe legally equivalent conduct. Nonetheless, in Wisinski, the court may have interpreted conduct on the part of the insurer that may have been no more than negligence as satisfying the liability standard under the bad faith statute.
The court here appeared to overlook two fairly significant facts. First, the insured had a copy of her policy and her own lawyer. Wouldn’t that, especially in the adversarial setting of a UM/UIM claim, put the insurer in at least as good a position to make a determination what her limits were? Second, why doesn’t the court here at least allow for the possibility of mistake or inadvertence on the part of the insurer, especially at the summary judgment stage where disagreement over the “limit” was actually whether a recognized $50,000 limit was stacked to provide an aggregate of $100,000 in coverage? To ignore such a possibility is to wrongly equate negligence and bad faith, and controlling Pennsylvania law does not permit such an equation, as we shall see in an upcoming post.
So, despite acknowledging the need for the plaintiff to produce clear and convincing evidence of bad faith, and that such evidence must include proof of ill will or improper motive, and despite acknowledging it was aware of no direct evidence of intentional misrepresentation concerning the policy limits, the Wisinski court nevertheless made an assumption at the summary judgment stage that ACIC could not have simply made a mistake, or been negligent, but ruled that because the insurer had the same information the insured and her lawyer had, it either knew or should have known the correct policy limits, and intentionally or recklessly misrepresented them to its insured.
Charles Haddick is a partner with Dickie McCamey & Chilote. I welcome feedback from readers, along with any suggestions for topics you would like to see discussed in this space. Please e-mail me at chaddick@dmclaw.com.
On Jan. 4, Judge Maurice Cohill of the U.S. District Court for the Western District of Pennsylvania issued a ruling in the insurance bad faith case of Wisinski vs. American Commerce Group Inc. and American Commerce Insurance Company. The court entered summary judgment in favor of the insured relative to bad faith and breach of contract claims arising out of an uninsured motorist claim.
While the court also granted summary judgment in favor of the insurer with respect to the plaintiff’s first party benefits claim, it is the portion of Cohill’s opinion that found bad faith in the handling of the UM/UIM claim that is drawing the most attention.
It is unclear whether or not American Commerce will seek an appeal of the ruling at the conclusion of the litigation.
The opinion spans 32 pages and is such a rich discussion of so many facets of bad faith claims handling that it cannot be broken down and analyzed in a single post. Over the next several blog posts, then, we will look at the Wisinski decision in some detail and analyze why some of the assumptions underlying the opinion may be a departure from existing bad faith precedent in Pennsylvania on both the state and federal levels. While it is far too early to determine whether the opinion is a brief departure from the trend to narrow the footprint cast by Section 8371, or perhaps a sign of something more, it is worth an immediate look.
The court’s discussion of the factual history of the first party and UM/UIM insurance claims alone comprises nearly half of the 32-page opinion. We will discuss specific facts as they lend themselves to the specific issues we will be examining. It is sufficient for current purposes to know that the case arises out of an auto accident Wisinski reported to ACIC on Dec. 21, 2001. The first party claim was pursued initially, and Wisinski, who was represented by counsel throughout the claim, did not place American Commerce on notice of a UM claim until Dec. 18, 2003. The parties disputed whether or not the policy between them provided for arbitration of the UM claims. ACIC originally informed Wisinski that the policy was a single $50,000 limit policy, when in reality the limit was stacked twice in the aggregate to $100,000.
Several settlement offers were made by ACIC after learning that Wisinski, who sought compensation for knee injury, had made a prior SSI claim, and was diagnosed by her own doctor with degenerative arthritis. Settlement in principal for the policy limit of $100,000 was reached in late 2006 and an acceptable release agreement was finalized in February 2007 under which $100,000 policy limits were paid.
A bad faith claim was subsequently filed on behalf of Wisinski. The three chief claims against American Commerce relative to handling the UIM claim concerning bad faith were the company’s failure to advise its insured of the correct policy limits; its failure to proceed to arbitration; and its initial offer of a release agreement which sought release of any and all claims, including bad faith claims.
In our next post, we will start to tackle analysis of Cohill’s ruling.

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