Randall G. Dueringer, Plaintiff Appellee, v. General American Life Insurance Company, Defendant Appellant, 853 F.2d 283 (5th Cir. 1988)

Randall Dueringer petitions this court for rehearing of Dueringer v. General American Life Insurance Company, 842 F.2d 127 (5th Cir. 1988). We upheld Dueringer's jury award of $5,852.18 in actual damages but denied $360,000 in punitive damages awarded by the jury for bad faith denial of an insurance claim.

Dueringer strenuously objects to our reversal of his punitive damages award. He contends that this court has usurped the role of the jury in contravention of Boeing v. Shipman, 411 F.2d 365, 374 (5th Cir. 1979). He asserts that this court cannot reweigh the evidence of punitive damages or substitute its judgment for that of the jury. In addition he contends that the present case is replete with the same kind of evidence cited by the Mississippi Supreme Court in Bankers Life & Casualty Co. v. Crenshaw, as proof of bad faith, 483 So. 2d 254 (Miss.1985). In particular, Dueringer argues that General American conducted an inadequate investigation and gave an improper and illegal excuse for denying Dueringer's claim.

Although Dueringer's arguments are made with force and fervor, we find them resistible. First, we acknowledge that the Boeing v. Shipman standard of review is applicable to the issue of punitive damages in this case since our court has held that we apply federal procedural law in determining whether a motion for directed verdict should be granted on this question. Tutor v. Ranger Ins. Co., 804 F.2d 1395, 1398 (5th Cir. 1986).¹ 

Boeing provides:

On motions for directed verdict and for judgment notwithstanding the verdict the Court should consider all of the evidence--not just that evidence which supports the non-mover's case--but in the light and with all reasonable inferences most favorable to the party opposed to the motion. If the facts and inferences point so strongly and overwhelmingly in favor of one party that the Court believes that reasonable men could not arrive at a contrary verdict, granting of the motions is proper.

411 F.2d. at 374-75. Application of federal procedural law does not allow us to ignore Mississippi substantive law, however. Rather, we follow the accepted rule that absent a federal constitutional or statutory question, a federal court sitting in diversity should employ the substantive law of the applicable state. Erie R. Co. v. Tompkins, 304 U.S. 64, 78, 58 S. Ct. 817, 822, 82 L. Ed. 1188 (1938). Thus, while we use the Boeing standard to review the evidence, we must look at Mississippi law "to determine the type of evidence ..." that should be considered. Tutor v. Ranger Ins. Co., 804 F.2d at 1398. In applying Mississippi law, we note that the Mississippi Supreme Court has said time and again that "it is the function and responsibility of the trial court to determine whether the insurance carrier had a reasonably arguable basis, either in fact or in law, to deny the claim." Bankers Life & Cas. Co. v. Crenshaw, 483 So. 2d at 269 (quoting Blue Cross and Blue Shield of Miss. v. Campbell, 466 So. 2d 833, 842 (Miss.1984)); Pioneer Life v. Moss, 513 So. 2d 927 (Miss.1987). See also Life & Casualty Ins. Co. v. Bristow, 529 So. 2d 620 (1988, Miss.). Therefore, we direct our inquiry to the question whether, under the Boeing standard, General American had a reasonably arguable basis for denying Dueringer's insurance claim.

Dueringer contends that in addressing punitive damages we ignored the case of Bankers Life, 483 So. 2d 254. He asserts: " [M]embers of this panel cannot read Bankers Life & Cas. Co. v. Crenshaw, and conclude that the case at bar was rightly decided. The record in this case is replete with the same kind of evidence recited by the Mississippi Supreme Court in Bankers Life as proof of bad faith under Mississippi law." (Citations omitted). Dueringer maintains that, like Bankers Life, General American obtained little information regarding the claim, did not interview Dueringer or obtain his medical records, and presented a different reason at trial for denying his claim. See Bankers Life, 483 So. 2d at 270-73. Dueringer contends that we disregarded his evidence of bad faith, including, inter alia: (1) no investigation was conducted before his first denial; (2) the investigation consisted of two written requests made to Dueringer's former employer and his physician; (3) General American did not solicit any information from Dueringer; (4) General American ignored Dueringer's offer to supply additional information;²  and (5) General American gave one reason for denial of benefits initially, and another reason at trial.³  Dueringer thus contends that this evidence constitutes bad faith and the district court properly submitted the issue of punitive damages to the jury.⁴ 

Although Dueringer intensely argues the similarities between his case and Bankers Life, Bankers Life must be read objectively as a whole and in context with its precedents. These Mississippi cases have emphasized that each case is fact specific. See, e.g., Blue Cross & Blue Shield of Miss. v. Campbell, 466 So. 2d 833 (Miss.1984); Reserve Life Ins. Co. v. McGee, 444 So. 2d 803 (Miss.1983). As Bankers Life and its precedents reiterate, it is the responsibility of the trial court in each case to determine whether the issue of bad faith should be submitted to the jury. Life & Casualty Ins. Co. v. Bristow, 529 So. 2d 620 (1988, Miss.); Bankers Life, 483 So. 2d at 269. This determination is made by addressing whether there is a "reasonably arguable basis, either in fact or in law, to deny the claim." Id. (citations omitted).⁵  In answering this question,⁶  the court in Bankers Life conducted a fact-specific inquiry into the handling of the claim, the reason given for denying the claim, and the reason given during trial. After reviewing the evidence, the court held that the insurer had acted in bad faith in denying the insurance claim. Id. at 271.

In reviewing whether there was a jury question in this case, we similarly examined the evidence to determine if a reasonably arguable basis existed for General American's denial of the claim when it finally did so on September 11, 1984. The evidence showed that in May 1984 General American contacted Richardson, Dueringer's former employer, and Dr. Nix, Dueringer's attending physician at the time of the accident. Richardson informed the company that its records did not indicate that Dueringer was "totally disabled." Dr. Nix responded that Dueringer was probably able to return to work by June 23, 1983. Dueringer did not supply any contrary or additional information to the company. "It is well settled that an insurance company is entitled to rely upon information from an insured's doctor in making its decisions about benefits." Bristow, 529 So. 2d 623-24 (1988, Miss.). The information before General American thus clearly indicated that Dueringer was not disabled.⁷  The company then informed Dueringer in writing that because their investigation showed that he had terminated his insurance policy upon termination of his employment, the only possible avenue of coverage was the extended medical benefits provision. With respect to this provision, the company wrote, he was not covered because he was not "totally disabled." General American enclosed a copy of the policy's provisions, and a copy of the definition of "disabled." The term "disabled" was defined as "unable to perform regular work." Neither Dueringer nor his lawyer contested whether he was disabled within the meaning of the policy, but instead filed suit. On the basis of the evidence before General American at the time it finally denied the claim, it is certain to us that, when construed in the most favorable light to Dueringer, no reasonable juror could have concluded that General American did not have a reasonably arguable basis for denying the claim.⁸ 

Nevertheless, Dueringer contends that General American acted in bad faith because it investigated and denied his claim under an erroneous standard. He notes that the extended medical benefits provision does not contain the term "totally disabled," but only requires the insured to be disabled, i.e., unable to perform regular work. Thus Dueringer asks how there can be a reasonably arguable basis to deny the claim when the denial was based upon an erroneous premise, i.e., a requirement that he be totally disabled. We answer this question by determining whether there was evidence of bad faith on the part of General American when it asserted that he was not totally disabled and denied his claim. See Bankers Life, 483 So. 2d at 269. No evidence suggests that General American deliberately or intentionally applied a stricter policy term than was required under the contract. No evidence indicates that the use of the term "totally disabled" by General American was anything more than negligence.⁹  More serious and egregious conduct than this sort of negligence is required to establish an independent tort against the insured, State Farm Fire & Casualty Co. v. Simpson, 477 So. 2d 242, 248 (Miss.1985). The evidence here simply does not show that General American's applying the erroneous standard of "totally disabled" was conduct that can be described as gross or callous or wanton or accompanied by fraud or deceit. See Simpson, 477 So. 2d at 250. As earlier noted, General American specifically provided Dueringer with a copy of the extended medical benefits provision and a copy of the definition of "disabled." Consequently, both Dueringer and his lawyer were apprised of the reason for General American's denial of his claim. We can only conclude that under these circumstances General American's use of the term "totally disabled" cannot be classified as "bad-faith."

For these reasons, the petition for rehearing is DENIED.