California Insurance Bad Faith Litigation

Dude, Where’s the Insurance Company’s Claims Manual?

Posted in Bad Faith, Civil Procedure, Discovery, Litigation, Motions

In most California Insurance Bad Faith lawsuits, the most important document to obtain in discovery is the insurance company’s claims manual. The insurance defense attorney knows how damaging the claims manual can be, and will do everything possible to keep you from getting it. Fortunately, California law is clear that the insurance company’s claims manual is discoverable in an insurance bad faith lawsuit.

Glenfed Develop. Corp. v. Superior Court is the case you’ll need to support your position that you have the right to obtain the insurance company’s claims manual. The Glenfed Court held that claims manuals are clearly discoverable in coverage dispute litigation.

Here’s how your attempt to get the insurance company’s claims manual will likely play out:

  • You send a request for production of the claims manual to the insurance company’s attorney.
  • The defense attorney will request an extension of the 35-day deadline to respond. You should grant the extension to show the court you are reasonable if and when you bring your motion to compel. Usually the defense attorney will ask for at least two extensions, perhaps three—you should give them at least two, and possibly three depending on the excuses offered.
  • 90 to 120 days after you requested the claims manual, you will receive the insurance company’s response objecting that the claims manual constitutes a trade secret and will not be produced.
  • You should send a meet and confer letter immediately to the defense attorney outlining the holding in Glenfed and offer to stipulate to a protective order. Make clear that you will file a motion to compel, along with a request for monetary sanctions by X date, if the defense attorney refuses to produce the claims manual.
  • You may or may not hear back from the defense attorney. Either way, it is very unlikely that you’ll get an agreement that the claims manual will be produced.
  • File your motion to compel. Make sure to follow all the procedures for your motion. You don’t want to lose on a procedural defect when you have very good substantive grounds for winning the motion.
  • The better defense attorneys will contact you about a week before the motion is heard and will agree to produce the claims manual if you withdraw your motion to compel. As painful as it is to withdraw the hard work you put into your motion to compel, you should do so, as long as you actually get an agreement that the claims manual will be produced. Keep in mind that your goal is to get the claims manual—not win the motion to compel.
  • The less stellar defense attorneys will fall on their sword in front of the Court at the motion hearing. The Court will likely order the claims manual produced subject to a protective order. Depending on the Court, you may or may not get monetary sanctions—but who cares; you’re going to get the claims manual.

This entire process can take as much as 120 to 150 days, so get started on it as soon as your right to discovery opens.

Once you have the claims manual, the fun begins. You find all kinds of useful information in the claims manual for your PMK and Insurance Company Employee depositions. I’ll go into further detail in a future blog on how to dissect the claims manual helping you to create devastating deposition outlines.

10 Lessons I Learned About Being a California Trial Attorney in 2011

Posted in Civil Procedure, Discovery, Litigation, Motions

After making the decision to take all of my cases to trial in 2011, here are the important lessons I learned as a California plaintiff’s trial attorney:

1.    Taking each of your cases to trial generally works in your client’s favor.

Defense attorneys (and their clients) will offer your clients pennies on the dollar for your client’s harms and losses, until the defendant is fully convinced you will take a case to a jury of your client’s peers. Even then, most defense attorneys (and their clients) require you to show up and begin trial (whether you get to voir dire, opening statement, witness testimony, or closing argument) before offering a reasonable settlement amount. I think they do this because they know most attorneys are not willing to go to trial.

Even though I attempted to take every case to trial in 2011, only three cases actually made it, with one settling right before voir dire, and the other two going all the way to a verdict. All other cases I had in 2011 settled generally between 30 days out to the day before trial.

This is an important lesson. It is very likely the only way you will obtain a fair settlement for your client is to be prepared to take your case to trial—and then take them to trial if the defendant refuses to offer a reasonable settlement.

2.    Jury instructions and element outlines are mandatory.

When I first became an attorney I remember hearing the better attorneys say you have to know the jury instructions and create an elements outline. I had no idea what they were talking about. I do now. Before taking a case, spend time looking over the jury instructions applicable to the case you’re considering taking on. What facts do you have that satisfy each of the jury instructions? Make an elements outline of each jury instruction, including a brief description of the facts you have (or need to have) to satisfy each instruction.

This takes some work early on, but it’s worth it. It helps you focus on what facts you have, and what facts you need to obtain in the discovery process. If you learn new and needed facts during discovery, be sure to update the elements outline.

3.    Hire experts early on.

Experts are expensive—but worth every penny. There were several cases we looked at taking in 2011, but had to decline after experts told us the potential case had no chance of winning. It’s always difficult to have a conversation with a potential client letting them know they don’t have a case, but better to do this early on before putting them through the hell of several years of litigation, and then having the same conversation.

Experts are also great because they focus you in on the facts you need to obtain in the discovery process.

4.    Don’t be afraid of motions for summary judgment.

I used to be terrified of getting motions for summary judgment. I then changed the way I viewed these motions. First, I now expect that a motion for summary judgment will be filed in every case—and that takes the surprise and fear element out of the equation. Second, because I’ve done my homework with the jury instructions, created an elements outline, and hired experts early on, I am able to file an opposition that will likely be granted. It actually makes it fun (okay, not exactly fun) to put your opposition together.

Motions for summary judgment also alert you to the arguments and facts the defense attorney will use at trial. This gives you additional time to contemplate how you plan to respond to these arguments and facts at trial. We really should be welcoming motions for summary judgment. I’m not there yet—but hope to be sometime in 2012.

5.     Bring motions to compel during the discovery process.

Defense attorneys know that many (if not most) plaintiff’s attorneys will not take the substantial time required to bring motions to compel during the discovery process. Don’t make this mistake. Defense attorneys will always give you garbage responses in the first go around of written discovery. When this occurred in 2011, I brought motions to compel immediately (of course after my meet and confer letter was ignored). It not only let the defense attorney know I wasn’t going to allow him/her to play games, it made future responses from the defense attorney so much better.

6.    Spend less time objecting at deposition and more time on motions in limine.

I used to treat depositions as an “objection” exercise. Now I don’t do that (unless absolutely necessary). If the defense attorney is questioning my client and I’m uncomfortable with the questions, I simply mark these down in my notes and indicate in my notes that I need to bring a motion in limine to keep this evidence out at trial. In most cases, these uncomfortable questions are either (1) not relevant, (2) lack foundation, (3) are inadmissible hearsay, or (4) can be kept out as “unduly” prejudicial under California Evidence Code section 352.

When you don’t object, it’s amazing how much information a defense attorney is willing to provide in a deposition that you can identify for future motions in limine. Let the defense attorney “win” the deposition—You “win” when it matters at trial when the court grants your motion in limine and keeps the bad facts out.

Worst-case scenario—the Court denies your motion in limine. At least you have the first opportunity to address these bad facts in your opening statement, which will likely remove the sting the defense attorney is hoping for.

7.    Practice, practice, practice for voir dire and opening statement.

My poor legal assistant. I make her listen to my voir dire questions and my opening statement, over and over again. I want her to poke holes in my questions and opening statement. I also ask anyone else who will listen about these issues. The more you practice the more comfortable you become. I don’t think many defense attorneys spend time doing this—and it shows.

8.    Send defense attorneys all trial documents 30 days out from trial.

Don’t worry about showing your hand too early. Defense attorneys are extremely busy with all the cases they’re required to handle, and likely won’t have time to spend much time with your trial documents in any event. Sending defense attorneys proposed joint exhibit lists, witness lists, a statement of the case, jury instructions, and your trial brief will surprise them. Most plaintiff’s attorneys don’t do it—you should.

9.    Don’t be nice to defense attorneys.

I’m tired of hearing that we need to be civil with the defense bar. I would agree with being nice if the defense bar felt the same way—but they don’t. It’s been my experience that defense attorneys will do anything required to make your client’s case go away. It still amazes me (although it shouldn’t) that defense attorneys are willing to demonize and attack individuals who have suffered substantial harms and losses due to their client’s irresponsible actions. The purpose is to stress the plaintiff so he/she will take a small settlement or dismiss a case in its entirety.

In one of my recent cases, the defense attorney, in deposition, wanted to know how many times my client had sex with her husband in the year prior to his death, which was caused by the intoxicated defendant. Apparently this was to somehow show they did not have a good sex life, which leads to them somehow having a bad relationship, which in turn leads to somehow my client hating her husband and glad that he’s actually dead. I know it takes huge leaps of logic to get there, but defense attorneys don’t care about the logic, they care about stressing your client and making litigation more miserable than it already is.

In another case, a large defendant corporation that manufactures surgical mesh that destroyed my client’s vagina wanted to know in deposition if my client had attempted sexual intercourse after the mesh destroyed her vagina. My client answered “yes” she attempted to one time but could not due to the substantial pain she felt. The defense attorney then wanted to know whom she attempted to have sex with. I directed my client not to answer that question based on her right to privacy. The defense attorney threatened to bring a motion to compel. I told the defense attorney to bring the motion. I couldn’t wait for the court to hear that one. Of course the defense attorney already had the information she was seeking as she previously heard two treating physicians of my client testify at deposition that it was very unlikely she would ever have pain-free intercourse for the rest of her life due to the substantial scarring. But that wasn’t enough, the defense attorney wanted to know whom she tried to have sex with.

Finally, in a recent sexual harassment case, the defense attorney wanted to know how many sexual partners my client (a female) had during her lifetime. Then he wanted to know how many sexual partners in the past 10 years, then 5 years. I did not allow my client to answer these ridiculous, invasive, and despicable questions.

Am I still supposed to be nice to defense attorneys after this type of behavior? I say no. Let’s stop being nice to defense attorneys who choose to act inappropriately.

10.    Never give up.

Never giving up may be the best trait of a trial attorney. No matter how bad things seem, don’t give up.  Everyone will tell you that your client won’t win or doesn’t have a case. You’ll hear this multiple times from the defense attorney; you’ll hear it from the mediator; you’ll hear it from a judge at the mandatory settlement conference; you’ll hear it from the doubt that creeps into your thought process when you’re attempting to fall asleep at night. Don’t give in to these doubts.

The good news is that most defense attorneys advise their clients to offer almost nothing before trial to settle the harms and losses they’ve created. These insignificant settlement amounts make it easy to go to trial—after all, you won’t do much worse if you get defensed at trial. That makes it easier for me to handle the doubt that I will inevitably feel going to trial. Chances are, if you don’t give up, the defendant will come up with a reasonable settlement amount a few weeks out from trial. But if they don’t, take them to trial. There’s no reason not to.

What is Insurance Bad Faith?

Posted in Bad Faith, Breach of Contract, Litigation, Prosecuting bad faith

Insurance Bad Faith:

Insurance Bad Faith occurs when an insurance company treats its customers unfairly. For example, an insurance company may deny a valid claim, or the insurance company may try to pay less than full and fair value of a valid claim. When an insurance company attempts to do either—deny a valid claim or pay less than fair value—it is said to be breaching its implied promise of good faith and fair dealing.

Insurance Bad Faith can be divided into two categories: (1) first party coverage claims and (2) third party coverage claims.

First Party Insurance Coverage Claims:

First party bad faith arises when an insurance company denies insurance benefits for one of its customer’s personal losses. For example, a customer’s home burns to the ground, and the insurance company refuses to accept responsibility to pay for a new home. This results in a first party insurance bad faith lawsuit.

First Party coverage claims generally fall into a single category, specifically, an insurance company’s unreasonable withholding of benefits due under an insurance policy, i.e. to pay for its customer’s home if it burns to the ground.

Third Party Insurance Coverage Claims:

Whereas, Third Party bad faith arises when an insurance company refuses to protect the interests of one of its customers from liability to some other person. For example, a customer is involved in an automobile accident causing serious personal injury to another person. If the customer is at fault and the insurance company refuses to pay a reasonable settlement to person who was seriously injured (or refuses to defend its customer in a lawsuit related to the accident), then the insurance company is not protecting the interests of its customer. This results in a third party insurance bad faith lawsuit.

Third Party coverage claims generally fall into two categories: (1) An insurance company’s unreasonable failure to settle a lawsuit against one of its customers, and (2) An insurance company’s failure to defend one of its customers in a lawsuit covered by the insurance policy.

In a future blog post, I’ll discuss the statute of limitations applicable to bad faith insurance lawsuits, as well as the factors that give rise to bad faith claims.

Top 10 Books Every Trial Attorney Should Read

Posted in Litigation

1. Rules of the Road, Second Edition, by Rick Friedman & Patrick Malone

This is likely the most influential book I’ve come across in my time as a lawyer. Read it, and then read it again. I use the “rules” concept in my depositions as well as at trial. It is amazing how effective the “Rules of the Road” approach works.

2. Reptile, by David Ball & Don C. Keenan

I can’t figure out whether I like Reptile or Rules of the Road better. Both are the two most important books a trial attorney can read in my opinion. My suggestion is to read Rules of the Road first, then Reptile. Then Reptile first, and Rules of the Road Second. Did I say I like these two books?

3. David Ball on Damages, by David Ball (Third Edition)

A great book that attorneys wanting to do trials—and do them well—need to read. The voir dire chapter is worth the price alone.

4. Polarizing the Case, by Rick Friedman

Is the defense calling your client a liar, cheat, and a fraud? You will thank the defense after reading this gem of a book. I come across this defense tactic in almost every case. This book teaches you how to embrace the defense’s accusations and make them look foolish. My favorite is, “Dr. Jones, when did my client start lying about her physical suffering?” I still haven’t heard a good answer from Dr. Jones to that question.

5. Rick Friedman on Becoming a Trial Lawyer, by Rick Friedman

Perhaps I should have read this book first. My recommendation to all trial attorneys is to read this book. It will change the way you view your role as an attorney helping people who have been harmed by other peoples/entities’ irresponsible actions.

6. Cross-Examination: Science and Techniques, by Larry S. Pozner and Roger Dodd

Want to know how to effectively cross-examine at deposition and trial? This is the only book you will ever need for that purpose.

7. Win Your Case, by Gerry Spence

A very easy read with insightful advice from one of the best trail attorneys. You just feel good reading this book.

8. Recovering for Psychological Injuries, Third Edition, by William A. Barton

I have not finished reading this book yet, but it is full of great ideas that you can use for all types of cases. You will need a copy of the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) as well.

9. The Evidence Wheel, by Robert S. Arns

This book is for California attorneys. I was always confused on evidence before I read The Evidence Wheel. Now I have quick trial reflexes to handle the introduction of evidence I need for my case, and how to keep the opponent’s evidence out. You can also get The Trial Wheel by Robert S. Arns, which is a companion to The Evidence Wheel. Both books help you to be quick on your feet at trail, and right most of the time.

10. All books by Bryan A. Garner. The book I like the most is “The Winning Brief”. You will become a better writer after reading, digesting and then implementing Mr. Garner’s advice. (Please do not hold anything against Mr. Garner for my current writing abilities, as they were much worse before reading his books.)

11. I know, I said the top 10 books, but I have to throw in one more book. Logic For Lawyers, by Ruggero J. Aldisert. A tough read, but it definitely sharpens your legal reasoning—and helps you find your opponent’s lack thereof.

 

Welcome to the California Insurance Bad Faith Blog

Posted in Bad Faith

I’m frustrated that insurance companies regularly and wrongfully deny their customer’s valid claims. Or perhaps they don’t outright deny a claim, but do their best to pay significantly less than required. Most insurance customers, rather than deal with the insurance company’s wrongful denial or underpayment of a claim, move on with their lives believing they are helpless to challenge an insurance company’s bad faith denial or under payment on an insurance claim.

But that is not the case. California law requires that insurance companies pay all valid claims on a timely basis. Sadly, most insurance companies flat out ignore the law and wrongfully deny their customers’ valid insurance claims.

When an insurance company wrongfully denies its customer’s insurance claim, it is said to be acting in “bad faith”. When an insurance company acts in bad faith, its customer can sue the insurance company not only for the insurance proceeds that should have been paid, but also for an extra amount (i.e., punitive damages) that represents the insurance company’s bad faith in refusing to pay the full claim amount in the first place. If a jury determines the insurance company breached its policy, and was in bad faith, significant damages can be awarded against the insurance company to punish it for its wrongful denial of a customer’s valid claim.

The purpose of the Bad Faith Blog is to discuss insurance companies acting in bad faith and what their customers can do if a valid claim is denied. After all, when we buy insurance, we are buying peace of mind—at least that is the goal. Most of us don’t know that in most cases we will have to aggressively fight with our insurance company to get our valid claims covered. These issues, and more, will be discussed in this blog. With that, welcome to the Bad Faith Blog. I hope our posts are helpful to you in understanding insurance bad faith in California.

Insurance Bad Faith Forecast: Cloudy with a Chance of Increased Bad Faith Due to Worsening Economic Environment

Posted in Bad Faith, Breach of Contract

Insurance companies acting badly by either (1) denying valid claims or (2) not paying the full value of claims will likely increase during the next several years due to three recent impacts on insurance companies’ bottom lines: First, the economic environment may be worsening, leading to a reduction in the premiums insurance companies receive from their customers. Second, insurance companies rely heavily on investment income, which in a sliding economy results in declining investment income. Finally, insurance companies continue to take significant hits due to the record catastrophic activity in 2011, including floods, tornados, and Hurricane Irene.

The worsening economy, declining returns on investment income, and the record catastrophic events of 2011 create a perfect storm leading to an increase in insurance companies denying valid claims or not paying the full value of claims.

Most states laws, including California, provide protection to their residents from insurance companies acting badly. These laws do not stop insurance companies from denying valid claims, but they do allow customers to sue the insurance companies for breach of contract and bad faith. These types of suits will likely increase, as the economic pressures on insurance companies worsen. Ironically, it is during tough times that having insurance coverage is most sought after. This leaves consumers of insurance even further exposed to the economic elements beyond their control.

Expect more stormy skies ahead for insurance companies and a dark cloud of increasing bad faith.

Bad Faith Insurance Companies (i.e. most of them) Love Employer Provided Health Insurance

Posted in Bad Faith, Breach of Contract

Insurance companies are good at taking money—but not so good at paying money out to their customers for valid claims. Most, if not all, insurance companies actively look for ways not to pay valid claims. When an insurance company wrongfully denies a valid insurance claim, the insurance company is said to be acting in “bad faith.” If an insurance customer’s valid claim is denied in bad faith, the customer can sue his/her insurance company for breach of the insurance policy contract and for bad faith. If a jury determines at trial that the company did breach its insurance policy contract, and was in bad faith, significant damages, including punitive damages will likely be awarded against the insurance company as a way to punish the insurance company for wrongfully denying a customer’s valid insurance claim. And this makes sense as it alerts insurance companies that they better pay valid claims or risk being punished for bad faith claim denials.

But that is not the case with employer provided health insurance, which falls under the protection of federal law, namely the Employee Retirement Income Security Act of 1974 (ERISA). If you have health insurance provided by your employer, you give up significant rights due to ERISA. If that insurance company wrongfully denies your health insurance claim you can only sue them for the actual cost of your medical bills—not for bad faith.

An example may be helpful: If your employer provided health insurance company wrongfully denies your valid claim for life saving medical care, you would have to pay for the medical care yourself—or die. With those options you would likely choose to raid your retirement account, sell your car, sell your kidney, etc., to pay for the life saving medical care. Think of all the emotional stress and turmoil this causes. Say you pay $75,000 for the life saving medical care out of your own pocket and happen to survive. You now sue your employer provided health insurance company for wrongful denial of a valid insurance claim. Bad news for you. After you pay an attorney $100,000 to get to trial, and if you’re lucky enough to have a jury find in your favor, the most you can get is… $75,000. You cannot get “bad faith” damages, otherwise known as punitive damages, to punish the insurance company for wrongfully denying your claim.

Think about that for a second. There is no incentive for an employer provided health insurance company to pay for your life saving treatment that is covered under your employer provided health plan. The insurance company’s view of it is it can pay the $75,000 now, or it can wait to see what happens, deny your claim, and know that two to three years down the road the most it will be required to pay to you (or your family if you die) is $75,000.

Take the same example above, but change the facts a bit to you buying your own health insurance (most likely more expensive than your employer provided plan) coverage. Now, you are not precluded by federal law (ERISA) from suing your health plan (i.e. health insurance company) for wrongful denial of a valid medical claim. Now, you can get “bad faith”, or punitive damages, against your personal health plan for bad faith denial of a valid claim.

Tort reform tries to teach us that punitive damages are bad for society and should not be allowed. After reading the above two examples, I’ll let you decide if punitive damages are appropriate to alert insurance companies they could be punished for wrongful denial of valid insurance claims. After all, if punitive damages are not allowed, why would an employer provided health insurance plan pay for your covered life saving medical care? Something to think about.

Egan v. Mutual of Omaha: The Birth of Bad Faith in California

Posted in Bad Faith, Breach of Contract, Prosecuting bad faith

Insurance companies in California fear Egan v. Mutual of Omaha Insurance Company, and appellate court decision decided in 1979. Egan involved an insurance company selling an insurance policy to one of its customers. That customer later made a valid claim, which the insurance company wrongfully denied. In Egan, the California Supreme Court held that an insurance company may breach the covenant of good faith and fair dealing when it fails to properly investigate its customer’s claims before the claim is denied.

Egan has fantastic language that should be used in every lawsuit against an insurance company that wrongfully denies one of its customer’s valid claims under the insurance policy. Here are some of the best rules established by Egan:

  • The insurance policy contract includes an implied covenant of good faith and fair dealing. The implied promise requires the insurance company to refrain from doing anything to injure the right of its customers to receive the benefits of the insurance policy contract.
  • An insurance company must give at least as much consideration to the welfare of its customers as it gives to its own interests.
  • When an insurance company unreasonably and in bad faith withholds payment of its customer’s insurance claim, it is subject to being sued in civil court in front of a jury.
  • Because customers buy insurance coverage for peace of mind and protection against calamity, insurance companies are required to look fully into all possible bases that might support the customer’s insurance claim.
  • An insurance company cannot reasonably and in good faith deny payments to its customers without thoroughly investigating the foundation for its denial.
  • These five phrases alone cause fear in insurance companies in California. I’ve found just mentioning Egan in phone calls, letters, and depositions of insurance claim adjusters causes substantial discomfort. Why? Because the claim adjusters know what’s coming next: “Ms. Claims Adjuster, I have four simple questions for you:”
  • First, you agree with me that an insurance company owes an implied covenant of good faith and fair dealing to its customers? (I don’t care which way she answers—either way hurts).
  • Second, you agree with me that an insurance company must give at least as much consideration to the welfare of its customers as it gives to its own interests. (Again, I don’t care which way she answers—either way hurts).
  • Third, you agree with me that insurance companies are required to look fully into all possible bases that might support the customer’s insurance claim. (Then follow up with the question: Can you tell me all the ways you looked at to support my client’s claim?)
  • Fourth, you agree with me that insurance companies cannot reasonably and in good faith deny payments to their customers without thoroughly investigating the foundation for its denial.

Egan is just the first stop in evaluating an insurance bad faith case in California. I’ll be writing future blog posts on other sources to refer to when evaluating or prosecuting a bad faith claim.