Court Opinion

ID: 9618661
Source: CourtListenerOpinion
Date Created: 2023-08-22 05:15:09.550468+00
Date Added: 2024-06-11T11:33:54.733260
License: Public Domain

McMurbay, Presiding Judge,
concurring in part and dissenting in part.
There are at least two aspects to the defendants’ handling of claims against plaintiff which are the basis of allegations that defendants have failed to perform in conformity with a good faith standard resulting in a financial detriment to plaintiff. First, plaintiff maintains that defendants have overpaid on certain claims. Since plaintiff’s premium obligation on the insurance policies directly corresponds to the actual claims experience, overpayment of claims would add to plaintiffs financial burden for insurance premiums.
Secondly, plaintiff maintained that defendants created excess reserves for claims. When claims were filed a reserve was created by defendants to meet the anticipated costs of the claim. The determination of the amount of the reserve is a subjective decision, more in the nature of an art than science, based on the infinite variables which may affect the value of the claim. Under the policy terms, defendants *336charged and plaintiff was to pay a charge based on a percentage (14 percent) of the reserve established, plus a premium tax also based on the amount of the reserve. There was also provision for upward adjustment of reserves which also incurred the charge and premium tax. If the claim was resolved for less than the amount of the reserve, plaintiff was credited with the balance but there was no rebate of the charges on reserves. It is thus readily apparent that the creation of reserves larger than the final value of claims would be disadvantageous to plaintiff while more profitable to defendants.
While I agree with the majority’s conclusion that defendants satisfied their burden of showing good faith and concur with Division 5 of the majority opinion reversing the grant of summary judgment in favor of defendants as to plaintiff’s breach of contract claim, I cannot join the remainder of the majority opinion. Many additional jury issues are created by the conflicts between defendants’ evidence and the opinions of plaintiff’s experts. Therefore, I respectfully dissent to the partial affirmance of the grant of summary judgment against plaintiff and in favor of defendants.
To support its claims and to oppose defendants’ motion for summary judgment, plaintiff presented the affidavits of two experts who reviewed the records of the claims at issue and opined that they found consistent patterns of overpayment on claims and of creation of excess reserves on claims. Defendants attacked plaintiff’s experts on several fronts, challenging the admissibility of their affidavits by questioning their qualifications, impugning their credibility via depositions showing gaps in their knowledge or in the data they reviewed, and by the presentation of the opposing opinions of other experts. Defendants have reasserted on appeal their arguments against the admissibility of the affidavits of plaintiff’s experts. However, in my view the affidavits were properly considered since the circumstances raised by defendants and adopted by the majority as a basis for refusing to consider the opinions of plaintiff’s experts would affect credibility rather than admissibility. Krause v. Vance, 207 Ga. App. 615, 616 (1) (428 SE2d 595); Morrison v. Koornick, 201 Ga. App. 367, 368 (1), 370 (411 SE2d 105); Southern R. Co. v. Montgomery, 192 Ga. App. 308, 310 (2), 311 (384 SE2d 907).
To the extent that there was some disagreement between the experts as to the reasonableness of the reserve amounts set by defendants or as to other aspects of defendants’ handling of the claims against plaintiff, this alone did not present a genuine issue of material fact in regard to whether defendants had exercised good faith in the handling of the claims. Bad judgment or negligence without more does not amount to bad faith. Bad faith involves actual or constructive fraud, a design to mislead or deceive another, or a neglect or refusal to fulfill some duty, not prompted by honest mistake, but by *337some interested or sinister motive. Michaels v. Gordon, 211 Ga. App. 470, 473 (2) (b) (439 SE2d 722).
Decided March 31, 1995
Reconsideration denied April 27, 1995
Carr, Tabb & Pope, W. Pitts Carr, David H. Pope, for appellant.
Chambers, Mabry, McClelland & Brooks, Genevieve L. Frazier, for appellees.
The primary declaration from plaintiff’s experts suggesting bad faith is their assertion that the claims records show a consistent pattern of conduct by defendants in creating excessive reserves or otherwise mishandling the claims against plaintiff by overpaying. A pattern of conduct of some duration may support inferences which may hot reasonably be drawn from a single incident. Thus, the repetition of a result detrimental to plaintiff and beneficial to defendants might suggest a dishonest purpose or conscious wrongdoing under the circumstances at issue in the case sub judice.
Nonetheless, after having its experts review defendants’ records of many claims during discovery, plaintiff continually reduced the number of claims upon which it relied to support its position in this litigation. This process continued until at the motion hearing, plaintiff’s counsel announced that plaintiff was relying upon only ten or fewer claims from among the hundreds of claims against plaintiff handled by defendants during the relevant period of time. Although this group of claims was not randomly selected and is small in size, I am unable to conclude that it is insufficient as a matter of law to support plaintiff’s position. Thus, I would hold that the state court erred in concluding that plaintiff lacked proof of bad faith on the part of defendants.
I am authorized to state that Presiding Judge Pope and Judge Blackburn join in this opinion.