Articles Posted in Insurance & Bad Faith Claims

Mr. O’Donnell recently successfully concluded an insurance “bad faith” case against Allstate Insurance Company. After a two-week trial, the jury found that Allstate had failed to disclose and pay Mr. O’Donnell’s client $100,000 in Underinsured Motorist Coverage that was available from a prior class action settlement. The jury not only awarded Mr. O’Donnell’s client the underlying $100,000, but also awarded an additional $300,000 for financial distress resulting the delayed payment of the claim. The jury further found that Allstate had acted with reckless disregard of its insured’s interests. In Alaska, a jury can only hear evidence of the defendant’s financial condition, and determine the amount of a punitive damage award, after first finding that the plaintiff is entitled to an award of punitive damages. In that situation, the jury reconvenes to hear evidence of the defendant’s financial condition. The case settled here for a confidential amount the morning that the punitive damage phase of the trial was to begin with plaintiff’s CPA expert witness about to testify that Allstate made $2.4 billion last year. Mr. O’Donnell has handled, and continues to handle, numerous insurance “bad faith” cases against Allstate. The attorneys at the Alaska Personal Injury Law Group, including Mr. O’Donnell, have extensive experience with claims against insurance companies for failing to fulfill the special fiduciary duties they owe their insureds.

Over the years we have handled numerous “insurance bad faith” claims against auto insurers. These cases often involve situations where, following a serious auto accident, the insurance company fails to disclose and pay all the insurance coverage that is owed to the injured insured. We have seen that auto insurers often treat insureds as if they are adverse parties. They leave it up to the injured person to figure out which insurance policies apply. They leave it up to the injured insured to figure out what benefits they are entitled to under a 30-page or longer fine print contract. This approach to claims handling is both improper and illegal. Insurance companies owe their insureds an obligation of good faith and fair dealing. Alaska insurance regulations specifically require insurance companies to “fully disclose” to insureds “all relevant benefits and other provisions of coverage under which a claim may be covered.”

Determining what insurance policies and what coverages apply is often a complicated task, particularly in the event of a death or a serious injury. In a recent case, Allstate’s handling of a claim where a woman’s husband died in a head-on collision came to our attention many years after the fact. Our investigation determined that Allstate had denied underinsured motorist (UIM) coverage to the widow under a second household auto policy through a tortured and self-serving “interpretation” of the policy that the Allstate claims managers never disclosed to the widow. Indeed, Allstate never even told the widow (who was not represented by an attorney) about the possibility of coverage under this policy. After Allstate’s conduct came to light and we filed suit, the court granted summary judgment in the widow’s favor ruling that a “coverage determination based on arcane legal doctrine [followed by Allstate] is at odds with Alaska’s reasonable-lay-interpretation doctrine, which expresses clear Alaskan public policy.” The moral of the story is that unfortunately there is a need, in the event of a serious injury or death, to verify that you are actually receiving the “Good Hands” treatment your insurer promised and is required to provide as a matter of Alaska law.

As noted in a recent post here, Allstate has instituted a systematic, nation-wide claims handling system designed to drive down the amount of money it pays on personal injury claims. That system came under review in a recent New Mexico case where five individuals sued Allstate for “low balling” their auto personal injury claims. The Court found that Allstate had violated fair claims handling requirements “by not attempting to effectuate . . . prompt, fair and equitable settlement[s],” “compelling each of the plaintiffs to litigate their claims through a jury trial to final judgment,” and improperly using the judicial system in “an attempt to delay or extort each of the plaintiffs into accepting less than the full value of their benefits under their policy.” The Court found Allstate’s conduct constituted “malicious abuse of process.” Martinez et. al. v. Allstate, Case No. D-0101-CV-200400963, County of Santa Fe, First Judicial District, oral order dated 11/13/09). This case illustrates that injured individuals often receive Allstate’s promised “Good Hands” treatment only if they accept Allstate’s “low ball” settlement offers. Otherwise they are subject to — as an Allstate consultant put it — the “Boxing Gloves” treatment. Be prepared to put on your boxing gloves when dealing with Allstate!

Recent congressional testimony by the Legislative Director of the Consumer Federation of America (CFA) catalogued several major trends in the insurance industry over the past two decades. Most of these trends are extremely adverse to consumers including small businesses. The first trend is the “hollowing out” of the benefits provided in many insurance policies through more restrictive coverage provisions and expanding exclusions that are poorly understood by the insureds who purchase these legally complex documents. The second trend is that many major insurance companies have turned their “claims operations into ‘profit centers’ by using computer programs and other techniques designed to routinely underpay policy holder claims.” As a result, the percentage of each premium dollar that goes to pay claims has fallen dramatically over the past 20 years, producing “unprecedented profits” for insurance company shareholders and insurance company executives at the expense of the insureds. The full report can be found at:
Testimony of Travis V. Plunkett, Legislative Director, Consumer Federation of America, 7/29/08.

The Alaska Personal Injury Law Group has frequently warned injured Alaska consumers about various bad faith tactics used by insurance companies. A new study just released by the American Association for Justice documents many of the bad faith and fraudulent tricks and tactics insurance companies use to evade paying valid claims. Tricks of The Trade: How Insurance Companies Deny, Delay, Confuse and Refuse. All Alaskan consumers, but especially injured Alaskans making claims against an insurance company, need to read this revealing study.

The study details the bad faith tricks and tactics insurance companies use to delay and deny claims the policy requires the insurer to pay. It illustrates its findings with examples of tricks the insurers used against real people to deny their valid claims. These true stories involve outrageous conduct by insurance companies, reminiscent of John Grisham’s novel The Rainmaker. Unfortunately for the poor victims of this insurance company bad faith, the stories are not fiction. They illustrate well the depths to which insurers will stoop to enhance profits at the expense of the insured victims.

These sinister tactics are not limited to liability claims or automobile insurance. The horror stories include insureds who had their health insurance policies revoked in the middle of cancer treatment. The wrongful cancellations resulted in suspension of the critical treatment, delay in resuming crucial treatment, and the burden of unpaid bills totaling hundreds of thousands of dollars. Other true stories involve insureds who had their long term care policies revoked when they finally needed care, after paying premiums for the insurance for many years. In one instance, the family business had to be sold to cover the unpaid bills the insurance company wrongly refused to pay.

These horror stories are not isolated occurrences. Investigating whether an insurer engaged in wrongful post-claim underwriting to cancel health policies, California insurance regulators randomly selected 90 cases where Anthem Blue Cross cancelled policyholders who made a claim. In every single one of those 90 randomly selected cases, the regulators found that Blue Cross had violated state law in cancelling the policy. Study at p. 13.

Insurance companies use these same bad faith tactics to deny claims for damage for many different kinds of insurance. They are used on claims under homeowners’ policies, health insurance policies, long term disability policies, and others. The study names companies that engage in these bad faith schemes and gives specific examples of the bad faith, fraud, and the internal insurance company programs used to implement these tactics. Some of the companies discussed are Farmers Insurance Company, Allstate Insurance Company, State Farm Insurance Company, and AIG Insurance Company.

For example, Farmers Insurance Company had an employee incentive plan called “Quest for Gold” used to reward employees who met goals for low payments.
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