Darlow v. Farmers Ins. Exchange
Annotate this Case
Darlow v. Farmers Ins. Exchange
1991 WY 157
822 P.2d 820
Case Number: 91-76
Decided: 12/09/1991
Supreme Court of Wyoming
CANDELARIA V. DARLOW AND DANIEL L. DARLOW, APPELLANTS (PLAINTIFFS),
v.
FARMERS INSURANCE
EXCHANGE, A CALIFORNIA CORPORATION, APPELLEE (DEFENDANT).
Appeal from the District
Court, AlbanyCounty, Arthur T. Hanscum,
J.
C.M. Aron of Aron and
Henning, Laramie, for appellants.
George E. Powers, Jr. and
Rachel Recker Rouse of Godfrey & Sundahl, Cheyenne, for appellee.
Before URBIGKIT, C.J.,
and THOMAS, CARDINE, MACY and GOLDEN, JJ.
URBIGKIT, Chief
Justice.
[¶1.] The issue to be decided
by this appeal is whether the conduct of an insurer with its insured constituted
bad faith under the rule this court announced in McCullough v. Golden Rule Ins.
Co., 789 P.2d 855 (Wyo. 1990). The policyholders, appellants Candelaria V.
Darlow and Daniel L. Darlow, appeal from a summary judgment entered in favor of
appellee, Farmers Insurance Exchange. Appellants claim appellee acted in bad
faith by unreasonably delaying or denying auto insurance policy medical payment
benefits owed following a two-car collision where both vehicles were insured by
the same insurance carrier.
[¶2.] We affirm.
I.
ISSUES
[¶3.] Appellants present
three issues for review:
[1.] Whether the
insurer's delay in payment of first-party medical-payment benefits was
unreasonable.
[2.] Whether the trial
court erred in holding that insurer bad faith in a first-party case is cured by
later payment of the claim.
[3.] In a double-insured
auto accident case - that is, the same company insures both drivers - whether an
insurer acts in bad faith when it negotiates the insured's third-party claim
without informing her of the rights to which she is entitled under her own
policy, and without clearly disclosing that the insurer is acting not on behalf
of the insured but instead on behalf of the other driver.
[¶4.] Appellee's formulation
of the relevant issues on appeal differs:
[1.] In an action for bad
faith under McCullough v. Golden Rule Insurance Company, can an insurance
company be liable where it has paid its insured's claim promptly and in
full?
[2.] Is a claimant
seeking recovery under a liability policy entitled to special treatment simply
because she is also insured by the same company under a separate policy of
insurance?
II.
FACTS
[¶5.] The innocuous beginning
of this litigation occurred on October 1, 1988. Misty Jackson, a juvenile, drove
a 1979 Mustang out of a parking lot in Laramie, Wyoming and struck broadside
Candelaria Darlow's 1977 Buick. Jackson accepted liability for the accident.
Mrs. Darlow's whiplash injuries required emergency room treatment and subsequent
physical therapy.1
[¶6.] Candelaria Darlow and
her husband Daniel Darlow (Darlows) purchased their automobile insurance policy
from Farmers Insurance Exchange (Farmers) in Ogden, Utah.
The Darlows had moved to Wyoming only two months before the accident so
Mr. Darlow could begin law school. Their Wyoming E-Z-Reader Car Policy, in
effect at the time of the accident, was actually issued October 28, 1988, but
effective on September 23, 1988. The policy was signed by the Laramie agent of Farmers,
T.F. Thone. This policy included first-party medical claims coverage. "We will
pay reasonable costs for necessary medical services furnished within two
years from the date of the accident, because of bodily injury
sustained by an insured person." (Emphasis in original.)
[¶7.] The Mustang driven by
Jackson was also
insured by Farmers. The policyholders were Ms. Jackson's parents, Marvin and
Kathryn Browning of Laramie. Thone had sold the Brownings their
policy. This policy provided liability coverage for third-party property damage
and bodily injury claims.
[¶8.] Mr. Darlow reported the
accident to Thone on Monday, October 3, 1988, after obtaining his name from
Jackson's
mother. Mr. Darlow completed a form titled "Statement of Facts of Accidents" at
Thone's office. This insurance form identified the parties to the accident and
indicated that both parties were insured by "FIG" or Farmers Insurance Group.
The form reported damage to the Darlows' Buick and the injury to Mrs. Darlow.
Farmers processed this form as a third-party liability claim by the Darlows
against the Browning policy.
[¶9.] During the meeting, Mr.
Darlow did not ask Thone any questions about coverage under the Darlows' policy
and no requests for payment of medical bills were made. Thone said that
Jackson had admitted liability and that Charles
Robert Inman, a Farmers claims representative from Cheyenne, Wyoming, would be the adjuster for their
claim. Thone clearly indicated that he was the agent for both parties in this
accident, since both were covered by the same company, and his job would be to
forward the paperwork. Mr. Darlow informed Thone that his policy was "full
coverage" including comprehensive, collision, medical and liability
coverage.
[¶10.] Farmers opened a property damage claim
file on October 4 and a bodily injury claim file on October 5, 1988. Inman, the
claims representative, contacted the Darlows on October 5 by telephone and
scheduled an appointment to meet with the Darlows at their home on October 12,
1988.
[¶11.] At the October 12 meeting, Inman informed
the Darlows that he represented Jackson and the Brownings in reaching a
settlement. The Darlows do not recall such a specific statement. However, the
Darlows acknowledge that Inman immediately settled the property damage claim on
their vehicle by paying $470.
[¶12.] During the meeting, Inman offered, after
discussing Mrs. Darlow's condition, to settle the bodily injury claim for a
total of $3,000. However, Inman discouraged the Darlows from settling their
claim so soon after the accident. Inman informed the Darlows that until they
settled, any medical bills would be paid by their insurance policy. Mr. Darlow
acknowledged he had medical coverage since he had reviewed the terms of his
insurance policy prior to the meeting.
[¶13.] Inman's next meeting with the Darlows
occurred on November 4, 1988. Inman offered the Darlows a revised settlement of
$3,500 which the Darlows rejected. The Darlows requested a $5,000 to $10,000
settlement.
[¶14.] At the November meeting, the Darlows gave
Inman medical bills to be paid from the Darlows' medical payments coverage.
After this meeting, Farmers opened a first-party medical claim file under the
Darlows' policy. On November 8, 1988, Farmers requested a proof of loss form be
completed by Mrs. Darlow. She completed the form on November 17, 1988 and
Farmers received it on November 22. The initial payment of $770.55 for medical
bills was made by Farmers on December 16, 1988. Subsequent installment payments
were made to total the sum for all medical bills submitted by the
Darlows.
[¶15.] Mrs. Darlow sought legal assistance on
December 2, 1988 which resulted in a negligence lawsuit against Jackson filed on December
21, 1988. Mrs. Darlow accepted, on May 30, 1989, an offer of judgment under
W.R.C.P. 68. On June 12, 1989, Mrs. Darlow filed a satisfaction of judgment
acknowledging receipt of $15,035 for settlement of her claims against Jackson. As a result, no
third-party claims are at issue in the present action.
[¶16.] The Darlows filed this action on November
21, 1989 alleging bad faith, deceit and duress, and intentional infliction of
emotional distress in Farmers' handling of the first-party claims. After more
than one year of discovery, Farmers filed a motion in the district court for
summary judgment on all claims. The Darlows responded with a cross motion for
partial summary judgment on the bad faith claim. The district court granted
Farmers' motion and denied the Darlows' motion. The Darlows appeal only from the
portion of the summary judgment which denied their bad faith claim.
Consequently, we now consider the duty of the insurer under its first-party
automobile insurance medical payment benefit coverage when that carrier also had
the liability coverage on the other driver involved in the two-car
accident.
III.
DISCUSSION
A.
[¶17.] This appeal contemplates a grant of
summary judgment in favor of Farmers which is only proper if there are no
genuine issues of material fact and the insurer as the prevailing party is
entitled to judgment as a matter of law. St. Paul Fire and Marine Ins. Co. v.
Albany County School Dist. No. 1, 763 P.2d 1255 (Wyo. 1988); Teton Plumbing and
Heating, Inc. v. Board of Trustees, Laramie County School Dist. No. One, 763 P.2d 843 (Wyo.
1988). Where, as in this case, the facts are not in dispute and the questions
presented are strictly ones of law, the appellate court accords no special
deference to and is not bound by the district court's decision. Albany County
School Dist. No. 1, 763 P.2d at 1257-58; Teton Plumbing and Heating, Inc., 763 P.2d at 847.
"[W]e review the judgment
in the same light as the district court, using the same information. A party
moving for summary judgment has the burden of proving the nonexistence of a
genuine issue of material fact. Material fact has been defined as one which, if
proved, would have the effect of establishing or refuting an essential element
of the cause of action or defense asserted by the parties. Upon examination of a
summary judgment, we view the record from the vantage point most favorable to
the party opposing the motion, giving him all favorable inferences which may be
drawn from the facts."
Doud v. First Interstate
Bank of Gillette, 769 P.2d 927, 928 (Wyo. 1989)
(quoting Garner v. Hickman, 709 P.2d 407, 410 (Wyo. 1985)).
[¶18.] Wyoming announced the rule that an insurance
company owes a duty of good faith to its policyholders not to unreasonably deny
a claim for benefits under the policy in McCullough, 789 P.2d 855. The breach of
the duty of good faith and fair dealing gives rise to an independent tort action
for bad faith. Id. at 858. The appropriate standard of care
to determine bad faith is the objective standard of whether or not the validity
of the denied claim was fairly debatable. Id. at 860.
"To show a claim for
bad faith, a plaintiff must show the absence of a reasonable basis for denying
benefits of the policy and the defendant's knowledge or reckless disregard of
the lack of a reasonable basis for denying the claim. It is apparent, then, that
the tort of bad faith is an intentional one."
Id. at 860 (quoting
Anderson v.
Continental Ins. Co., 85 Wis.2d 675, 271 N.W.2d 368, 376-77 (1978)).
[¶19.] The test announced in McCullough, as
adopted from Anderson, contains two essential components.
Reuter v. State Farm Mut. Auto. Ins. Co., Inc., 469 N.W.2d 250 (Iowa 1991); Fehring v.
Republic Ins. Co., 118 Wis.2d 299, 347 N.W.2d 595 (1984). First, the insured
must show the absence of a reasonable basis for the insurer to deny the benefits
of the policy. Stated another way, the insured must show that a reasonable
insurer under the circumstances would not have acted as they did by denying or
delaying payment of the claim. McCullough, 789 P.2d at 860; Anderson, 271 N.W.2d
at 377. Second, knowledge or reckless disregard of the lack of a reasonable
basis for denying the claim must be proven. The Anderson court recognized that:
[T]he knowledge of the
lack of a reasonable basis may be inferred and imputed to an insurance company
where there is a reckless disregard of a lack of a reasonable basis for denial
or a reckless indifference to facts or to proofs submitted by the
insured.
Anderson, 271 N.W.2d at
377.
[¶20.] he Darlows' foundational premise asserts
that Farmers' delay in payment of the first-party medical payment benefits was
unreasonable. The principal support the Darlows provide for the premise comes
from three contentions. First, the Darlows were denied medical payment benefits
for ten weeks after reporting the accident to the local Farmers agent. Second,
the lack of payment allegedly caused Mrs. Darlow to decline medical treatment.
Third, Farmers used the offer of medical payment benefits as a negotiation tool
in settlement of the Darlows' third-party claim against the Browning
policy.
[¶21.] The first contention fails since no
medical payments were in fact denied for a period of ten weeks. It is undisputed
that the Darlows made no claim for medical payments in their initial report to
Farmers on October 3, 1988. At the October 12, 1988 meeting, Mr. Darlow claimed
he gave Inman medical bills to "get them taken care of" from the ambulance
service, hospital, and X-ray technician. Inman did not recall receiving medical
bills during this meeting. The submitted hospital statement contained in the
record for $432.55 was dated November 3, 1988.
[¶22.] The November 4, 1988 meeting marked the
first time the Darlows sought to make a claim for benefits under terms of their
first-party medical payments coverage. Inman accepted the medical bills and
provided them to the Cheyenne office of Farmers to process. Four
days later, November 8, Farmers requested a proof of loss form be completed by
Mrs. Darlow. The form carries a stamped notation that "[n]o medical bills can be
paid until this form is completed, signed & returned." After Mrs. Darlow
completed the form on November 17, 1988, it arrived in Cheyenne on November 22,
1988. Farmers then took twenty-four days after receiving the completed proof of
loss form and the associated medical bills to process the claim and make an
initial payment on December 16, 1988. This twenty-four day period is just over
one-half of the statutory forty-five day period established under Wyoming law. "Claims for
benefits under a life, accident or health insurance policy shall be rejected or
accepted and paid by the insurer or its agent designated to receive the claims
within forty-five (45) days after receipt of the proofs of loss and supporting
evidence." W.S. 26-15-124(a) (1991). The statutory period for the first-party
insurance benefit payments begins when the insurer receives the proofs of loss
and the supporting evidence. Hart v. Allstate Ins. Co., 437 So. 2d 823
(La.
1983).
[¶23.] The contention that Mrs. Darlow declined
necessary medical treatment also fails to demonstrate unreasonableness on
Farmers' part. Mrs. Darlow sought treatment from Dr. W.F. Hankins, III on
October 20, 1988. The doctor's records indicate Mrs. Darlow was examined and had
six additional office visits for chiropractic adjustments during the period from
October 20, 1988 through November 23, 1988. In deposition testimony, Mrs. Darlow
stated she suspended these visits after the doctor demanded payment. Mr. Darlow
admitted that at the time his wife elected to suspend treatment, no claim for
the $190 medical bill had been submitted to Farmers, although other claims were
being processed. In fact, the doctor's statement establishes that when Mrs.
Darlow suspended treatment on November 23, no balance was owed since the Darlows
had paid for the visits. Farmers cannot reasonably be expected to anticipate the
need for payment of a chiropractic treatment billing that has not been presented
to them. Farmers did reimburse the Darlows for the money they paid to Dr.
Hankins after a claim was made.2 Mrs. Darlow resumed treatment with
the doctor on December 30, 1988.
[¶24.] The third argument advanced by the
Darlows in support of their unreasonable delay theory is that Farmers used the
offer of medical payment benefits as a negotiation tool in settlement of their
third-party claim against the Browning policy. This contention is unsupported by
the record. During the initial report of the accident, the Darlows never
inquired of the rights under their policy and made no requests for payment of
medical bills. During the October 12 meeting, Inman discouraged a premature
bodily injury claim settlement and advised the Darlows that medical claims would
be paid by their insurance policy. After rejecting a second settlement offer at
the November 4, 1988 meeting, the Darlows presented Inman with medical bills for
payment as a first-party claim under the Darlows' policy. These bills were paid
without unreasonable delay. At no time did Farmers withhold medical payments
with the intent to coerce a settlement of the third-party liability
claims.
[¶25.] The Darlows' argument fails to satisfy
even the first portion of the McCullough test requiring proof of the absence of
a reasonable basis to deny the benefits under the policy. The Darlows receive no
support for their position from other authority. Our attention is directed to
Chavez v. Chenoweth, 89 N.M. 423, 553 P.2d 703 (App. 1976), where the court
merely found that allegations of delay in paying first-party medical expenses
under an insurance contract were sufficiently pleaded to state a claim for
relief. The plaintiff contended that the bad faith dealings had occurred from
April until December of 1972, a period of nine months. Id., 553 P.2d at 709. In
Neal v. Farmers Ins. Exchange, 21 Cal. 3d 910, 148 Cal. Rptr. 389, 389-95, 582 P.2d 980, 983-86, (1978), the California Supreme Court determined that a delay
of two-years and eight-months for payment of an uninsured motorist claim was
sufficient support for a jury finding of a breach of good faith and fair
dealing. Delays in claims payments of nine or more months created a breach of
good faith and fair dealing in Kanne v. Connecticut General Life Ins. Co., 607 F. Supp. 899 (D.Cal. 1985), aff'd in part, rev'd in part, 819 F.2d 204,
withdrawn, 823 F.2d 284 (9th Cir. 1987), reh'g, 859 F.2d 96, superseded, 867 F.2d 489 (9th Cir. 1988), cert. denied, 492 U.S. 906, 109 S. Ct. 3216, 106 L. Ed. 2d 566 (1989). Unreasonable attempts to "starve out" an insured were found
in Chester v. State Farm Ins. Co., 117 Idaho 538, 789 P.2d 534 (App. 1990) when
the court found claim forms had been repeatedly rejected by the insurer in a
prolonged and confused seven-month-long process.
[¶26.] In the present case, Farmers received an
initial claim for third-party liability coverage by the Darlows against the
Browning policy. Farmers reacted properly by investigating the accident,
determining liability and offering property and bodily injury settlements. The
Darlows accepted the property settlement, but refused the bodily injury
settlement, partly on the well-considered advice of the Farmers' claims
representative. Later, the same claims representative instituted the processing
of first-party medical claims at the Darlows' request. The fact the Darlows
declined two Farmers settlement offers and eventually received a larger sum
after instituting proceedings on the third-party claim is immaterial. We hold
Farmers did not act unreasonably, in a fashion calculated to achieve delay for
delay's sake, in paying the first-party medical claims. Greene v. Truck Ins.
Exchange, 114 Idaho 63, 753 P.2d 274 (1988). Once submitted,
the medical claims were fully and promptly paid.
B.
[¶27.] The Darlows also contend, in essence,
that Farmers had a duty to deal in good faith, and, if it did not do so, it is
not absolved as a matter of law by eventual payment of the first-party medical
claims. Farmers counters that its duty was fulfilled as there was absolutely no
denial or delay of benefits under the terms of the Darlow policy. Farmers argues
absent denial or unreasonable delay that bad faith cannot exist as a matter of
law. The difficulty with both arguments originates with the failure to
comprehend that bad faith requires objective review of whether or not the
validity of the denied claim was fairly debatable. McCullough, 789 P.2d at
860.
[¶28.] The Darlows rely primarily upon the
Arizona Supreme Court's decision in Rawlings v. Apodaca, 151 Ariz. 149, 726 P.2d 565
(1986) for support. That court determined that the implied covenant of good
faith and fair dealing in an insurance contract can be breached, even if a
company performs its express covenants under the insurance contract by paying
the claim demanded. Id., 726 P.2d at 573. The express covenant was
a $10,000 coverage provision in a homeowners policy for the loss by fire of a
hay barn valued at $40,000. Id. 726 P.2d at 568, 576. Farmers Insurance
Company of Arizona (Farmers of Arizona) paid the claim a
month after the fire. Id., 726 P.2d at 568. The first-party bad
faith arose when the insurer failed to disclose to the insured an investigator's
report that determined the fire was started negligently by a neighbor, who
carried a $100,000 liability policy also with Farmers of Arizona. Id. The court found that
Farmers of Arizona had acted improperly to impede its insured's recovery of the
uninsured portion of the loss. Id., 726 P.2d at 569, 579.
[¶29.] What the Darlows conveniently ignored was
the Rawlings court rationale. First, the court determined that the insurer's
conduct was unreasonable by delaying the insured's claim against the
tort-feasor. Id., 726 P.2d at 573. The court then
determined that the insurer acted intentionally without fairly debatable grounds
using deceit, nondisclosure, reneging on promises, violation of industry custom
and deliberate attempts to obfuscate. Id., 726 P.2d at 576-77. Rawlings clearly
followed the two-step test outlined in McCullough and Anderson for first-party
liability. Clearwater v. State Farm Mut. Auto. Ins. Co.,
164 Ariz. 256,
792 P.2d 719 (1990); accord, White v. Unigard Mut. Ins. Co., 112 Idaho 94, 730 P.2d 1014
(1986).
[¶30.] A number of courts have found, as the
Rawlings court determined, that "only a showing of an initial bad faith refusal
to pay a claim - not a showing of its ultimate nonpayment - is a required
element of a bad faith tort cause of action." 1 J. McCarthy, Recovery of Damages
for Bad Faith § 1.11 (5th ed. 1990). See Robinson v. North Carolina Farm Bureau
Ins. Co., 86 N.C. App. 44, 356 S.E.2d 392 (1987). The Eleventh Circuit Court of
Appeals concluded that refusal to pay a valid insurance claim is a tortious act
that cannot be erased by subsequent payment. Berry v. United of Omaha, 719 F.2d 1127 (11th
Cir. 1983). See also Schlauch v. Hartford Acc. and Indem. Co., 146 Cal. App. 3d 926, 194 Cal. Rptr. 658 (1983). The
affirmative act of nonpayment, rather than the condition of nonpayment, is the
focus of the courts' inquiries. Berry, 719 F.2d at 1129.
[¶31.] For the Darlows, the case law reveals no
hidden treasure. We agree that subsequent payment of a denied or unreasonably
delayed claim does not absolve a tort-feasor; however, no claims of the Darlows
for medical payments were denied after submission. No claims for medical
payments were unreasonably delayed after submission. No affirmative act of
nonpayment sufficient to constitute a tort occurred. Therefore, the payment of
the medical claims could not absolve Farmers of tort liability since, as a
matter of law, none existed. Coleman v. Gulf Life Ins. Co., 514 So. 2d 944
(Ala.
1987).
C.
[¶32.] The Darlows argue Farmers acted with
knowledge or reckless disregard of the lack of a reasonable basis for denying
the claim in one of two alternatives. First, it is claimed that Farmers violated
its duty of good faith and fair dealing by intentional failure to inform the
insured of available policy benefits, and second, Farmers violated its duty of
good faith and fair dealing by intentional misrepresentations concerning the
insured's rights under the policy. The Darlows' argument is prefaced upon the
nature of the legal duty owed to an insured particularly in a situation in which
both parties to an incident are insured by the same company, the so called
double-insured situation. Farmers defends its actions by saying that the Darlows
never asked for an explanation of coverage or benefits and no misrepresentations
occurred.
[¶33.] The duty owed to an insured is often
characterized by the nature of the claim. When the benefit derives from the
insurer's duty to defend the insured against third-party actions, that
relationship is characterized as a third-party claim. Farmers Group, Inc. v.
Williams, 805 P.2d 419 (Colo. 1991). A first-party claim results when
the insured makes a claim against his insurer for benefits accruing directly
from the insurance contract. Id. In Western Casualty and Surety Co. v.
Fowler, 390 P.2d 602 (Wyo. 1964), this court previously defined the
duty of an insurer to an insured in a third-party claim. The insurer's duty is
to "exercise intelligence, good faith, and honest and conscientious fidelity to
the common interest" of the insured as well as the insurer and give at least
equal consideration to the interest of the insured, and, if it fails to do so,
the insurer acts in bad faith. Id. at 606.
[¶34.] The duty of good faith and fair dealing
announced in McCullough applies to first-party claims. McCullough, 789 P.2d at
855. In an issue of first impression in Wyoming, the Darlows argue that inherent
in this duty is the requirement that the insurer inform the insured of the
extent of the coverage afforded under their policy before negotiating a
settlement, especially when it is apparent that the insured did not know the
coverage. MFA Mut. Ins. Co. v. Flint, 574 S.W.2d 718 (Tenn.
1978). In Flint,
the court specifically found it was apparent to the adjuster that the insured
did not know the extent of their coverage. Id. The adjuster took advantage of the
insured's ignorance to negotiate a settlement that was grossly inadequate.
Id.
[¶35.] While Flint specifically dealt with uninsured
motorist provisions of a first-party claim, the Tennessee Supreme Court applied
the duty to inform to similar policy provisions involved in a double-insured
situation. Gatlin v. Tennessee Farmers Mut. Ins. Co., 741 S.W.2d 324 (Tenn.
1987). The court reasoned the duty of good faith and fair dealing includes
"informing an insured as to coverage and policy requirements when (1) it is
apparent to the insurer that there is a strong likelihood that its insured only
can be compensated fully under her own policy and (2) that the insured has no
basis to believe that she must rely upon her policy for coverage" (hereinafter
"Tennessee Rule"). Id. at 326. Gatlin involved a two-car accident
in which both parties had liability coverage with the same insurer. Id. at 325. The driver
who was clearly at fault had only minimum coverage. Id. at 326. The insurer
failed to disclose the restricted coverage of the party at fault and failed to
disclose that the injured party would have greater coverage under her own
policy. Id.
[¶36.] The court in Dercoli v. Pennsylvania Nat.
Mut. Ins. Co., 520 Pa. 471, 554 A.2d 906 (1989) gave the most
expansive reading to the Tennessee Rule. The duty to deal fairly and in good
faith includes the duty of full and complete disclosure as to all of the
benefits and every coverage that is provided by the applicable policy or
policies along with all requirements, including any time limitations for making
a claim, when the insurer's agents undertake to provide assistance and advice
and advise against retaining independent legal counsel. Id. A more restrictive
reading came from the Utah Supreme Court which adopted the philosophy of the
Tennessee Rule, in explaining the duty of good faith, without expressly adopting
the entire statement. Beck v. Farmers Ins. Exchange, 701 P.2d 795 (Utah 1985). One
commentator expresses the view that there must be some bounds on the insurer's
duty to inform; otherwise, the claims adjustment process would grind to a halt
if the insured could avoid the force of any provision of his choosing simply by
alleging that the insurer did not explain it to him. S. Ashley, Bad Faith
Actions § 5:15 (1984-1990).
[¶37.] California's Supreme Court also recognized the
benefit of an obligation to inform an insured of policy provisions. In Davis v.
Blue Cross of Northern California, 25 Cal. 3d 418, 158 Cal. Rptr. 828, 600 P.2d 1060 (1979), the court reasoned that the implied duty of good faith and fair
dealing requires the insurer to give at least as much consideration to the
insured's interest as it does to its own. See Egan v. Mutual Of Omaha Ins. Co.,
24 Cal. 3d 809, 169 Cal. Rptr. 691, 620 P.2d 141 (1979). The Davis court determined the
insurer has a duty reasonably to inform an insured of the insured's rights and
obligations under the insurance policy. Davis, 158 Cal. Rptr. at 833, 600 P.2d at 1065.
The court found a particular need for information existed when the insured's
lack of knowledge may potentially result in a loss of benefits or a forfeiture
of rights. Id., 158 Cal. Rptr. at 833-34, 600 P.2d at
1065-66.
[¶38.] Farmers offers no alternative
construction for the duty of good faith and fair dealing. Instead, Farmers views
the situation as a double-insured in which the insured party was automatically
treated as a third-party claimant to be dealt with at arm's length. See Chavez,
553 P.2d at 708-09, bad faith claim allowed for unreasonable delay in
first-party medical payments; however, the bad faith claim not allowed when
alleged misrepresentations concerned third-party claims; Pixton v. State Farm
Mut. Auto. Ins. Co. of Bloomington, Ill., 809 P.2d 746 (Utah App. 1991), insurance
company did not owe insured a duty to deal fairly and in good faith in her
capacity as a third-party claimant. However, third-party issues are not in
dispute in this case - the Darlows finitely settled those issues in separate
litigation. The law has clearly advanced beyond arm's length dealings when
considering first-party obligations such as medical payment provisions. To this
date, neither party directs this court's attention to any existing Wyoming cases on
point.
[¶39.] We believe the Tennessee Rule
appropriately states the obligations of the insurer. Under this formulation, the
duty of good faith and fair dealing includes informing an insured as to coverage
and policy requirements when it is apparent to the insurer that (1) there is a
strong likelihood that its insured only can be compensated fully under her own
policy and (2) the insured has no basis to believe that they must rely upon
their policy for coverage. Gatlin, 741 S.W.2d at 326.
[¶40.] Measured against this standard, Farmers'
handling of the Darlows' claim, as a matter of law, did not demonstrate
knowledge or reckless disregard of the lack of a reasonable basis for denying
the claim. The Farmers' claims representative clearly stated at both the October
12 and November 4, 1988 meetings that until a settlement was reached, Mrs.
Darlow's medical bills would be paid under the terms of the Darlows' insurance
policy. The insured was placed on notice that she could secure payment from her
own policy. Such payment would probably have been made earlier than when
third-party negligence litigation would have been resolved. The adjuster did not
act in a manner calculated to take advantage of the insured's ignorance.
Flint, 574 S.W.2d at 722.
[¶41.] In sharp contrast to the case precedents
upon which the Darlows depend, they knew and understood the terms of their
policy, fulfilling their duty to read. Security Ins. Co. of Hartford v. Wilson, 800 F.2d 232 (10th Cir. 1986). In
making the accident report, Mr. Darlow informed Farmers' agent that his policy
was "full coverage" which he understood to include medical payments. Mr. Darlow
also reviewed the policy prior to the October 12, 1988 meeting with the Farmers'
claims representative. The Darlows contend that Farmers remained obligated to
explain the medical payment benefits of the Darlows' policy. The Darlows never
requested this explanation. Therefore, there was no occasion to advise the
Darlows of their rights under the policy and no violation of any obligation to
inform them. Twaite v. Allstate Ins. Co., 216 Cal. App. 3d 239, 264 Cal. Rptr. 598
(1989). Nothing is provided as evidence by this record to reveal first to the
trial court or now to this court that the Darlows as the insured did not
understand the concept of first-party medical payment benefit coverage which
they had acquired in their automobile insurance as provided with the full
coverage policy. Certainly it is unquestioned that they knew the coverage
existed. No violation of the Tennessee Rule was demonstrable by documentation
submitted which would justify the trial court's denial of the insurer's motion
for summary judgment.
IV.
CONCLUSION
[¶42.] No disputed extrinsic facts exist in the
present case, so the issue before this court is whether the conduct of Farmers
constituted first-party bad faith as defined by Wyoming law. The Darlows have failed to show
that Farmers denied or unreasonably delayed payment of their claim. The decision
of the district court in granting summary judgment in favor of Farmers is
affirmed.
FOOTNOTES
1 The medical expenses
incurred by Mrs. Darlow apparently totalled $1,540.55, including Ivinson
Memorial Hospital emergency room - $279.55, ambulance - $153, radiology - $40,
physical therapy - $240, medical doctor - $173 and the balance of $655 for
chiropractic treatments.
2 The district court may
have viewed with some suspicion any suggestion that the chiropractic treatment
provider refused to treat when the insured was well aware and could have advised
that first-party medical payment benefit insurance of a sufficient amount was in
effect.
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