Oregon Supreme Court Expands Availability of Attorney Fee Awards under ORS 742.061

Oregon Supreme Court Expands Availability of Attorney Fee Awards under ORS 742.061

For years, Oregon’s primary legislative device for compelling prompt settlement of insurance claims has been the availability of an attorney fee award for insureds who recover more than the amount tendered by an insurer within six months of the proof of loss in a lawsuit seeking coverage under ORS 742.061. Prior to the decision in Long v. Farmers Ins. Co. of Oregon, 360 Or 791 (2017), most believed that an insured had to actually obtain a judgment awarding monetary damages in the suit seeking coverage to be entitled attorney fees. However, in Long, the Oregon Supreme Court identified a new way that an insured can obtain an attorney fee award under ORS 742.061, which can apply even if the insured does not prevail in the suit seeking additional coverage.

In Long, the insured submitted a claim under a homeowner’s policy due to a water leak. Farmers promptly paid about $3,000 to the insured for the actual cash value of the claim. Shortly thereafter, the insured submitted estimates indicating that his ACV claim was worth more than $3,000. However, no further payments were made at that time.

About two years later, the insured filed suit against Farmers seeking additional ACV coverage. Farmers subsequently issued two voluntary ACV claim payments following a court-ordered appraisal. On the eve of trial, the insured submitted a proof of loss for his replacement cost claims. Farmers adjusted and paid the RCV claim three days later.

The verdict rendered by the court after trial found that the insured was owed less for his claim than what he received from Farmers before the suit was filed. Accordingly, judgment in favor of Farmers was entered. Nevertheless, the insured filed a petition seeking an award of attorney fees under ORS 742.061. In that petition, the insured argued that he was entitled to an attorney fee award because he “recovered” more than was timely tendered by Farmers based on the voluntary payments issued after the suit was filed. The trial court denied the insured’s petition because it believed that the insured had to obtain a judgment awarding monetary damages to be entitled to attorney fees under ORS 742.061.

On review, the Oregon Supreme Court decided that the “recovery” which must exceed the amount of any timely tenders made by an insurer does not need to be based on a judgment entered in favor of the insured. Accordingly, the Court held that voluntary payments given during litigation can qualify as a “recovery” which triggers entitlement to an attorney fee award under ORS 742.061.

In this case, the Court held that the insured was entitled to an attorney fee award for the work performed by his attorneys up until the time he received the additional ACV claim payments. However, the Court also ruled that the insured was not entitled to any further attorney fees because Farmers paid the RCV claim just days after that claim was submitted and the insured did not recover any more at trial than was timely tendered by Farmers.

The Long case reiterates the importance of determining and paying the full value of a claim within six months of the claim submission because it establishes that subsequent claim payments made during litigation will result in at least some attorney fee exposure. See also Jones v. Nava, 264 Or App 235, 240-241 (2014) (confirming that tenders must be made within six months of proof of loss to avoid attorney fee exposure, even if untimely tender exceeding ultimate recovery is given prior to filing of action). However, the decision is not completely adverse to insurers because it also confirms that the requirements for an attorney fee award must be separately met for each claim submitted, even if claims arise from the same loss.

If you have any questions about this case or how it may affect any of your pending or future claims, do not hesitate to contact our office.

Washington Supreme Court Addresses the Insurance Fair Conduct Act

Washington Supreme Court Addresses the Insurance Fair Conduct Act

Perez-Crisantos v. State Farm et al., Wash. Sup. Ct., No. 92267-5, (February 2, 2017), is perhaps the most favorable ruling for insurers from the Washington Supreme Court in the past several years. The Perez-Crisantos Court was asked to decide whether, in the absence of an unreasonable denial of coverage or benefits, the Insurance Fair Conduct Act (IFCA) creates an independent and private cause of action for an alleged violation of Washington’s Unfair Claims Settlement Practices Regulations. Definitively, the Court held that it does not.

In Perez-Crisantos, the insured was involved in car accident and sustained injuries. The insured was not at-fault and ultimately settled with the at-fault party’s insurance carrier for its policy limits. The insured then tendered a claim for underinsured motorist (UIM) benefits to his insurance carrier, State Farm. State Farm paid its personal injury protection (PIP) limit of $10,000 in medical benefits and $400 in lost wages, but did not pay benefits under the UIM policy, taking the position that the insured had already been made whole. Arguing that State Farm unreasonably denied benefits, the insured sued State Farm alleging violations of IFCA, the Consumer Protection Act (CPA), chapter 19.86 RCW, bad faith and negligence. This lawsuit was stayed while the UIM claim was sent to arbitration.

The arbitrator found that the insured’s damages from the accident totaled $51,000. After adjusting for settlement with the at-fault party, PIP payments, and attorneys’ fees, the insured received $24,000 of new money from State Farm. The stay in the bad faith lawsuit was then lifted. State Farm moved for summary judgment arguing that it had acted reasonably and that the parties had simply had a reasonable disagreement about the value of the claim. The insured moved for partial-summary judgment arguing that State Farm had violated WAC 284-30-330(7)’s prohibition of forcing first party claimants to litigation to recover “amounts due under an insurance policy by offering substantially less than the amounts ultimately recovered in such actions.” The Spokane County Superior Court ruled in State Farm’s favor, finding no evidence that State Farm’s actions were unreasonable, and dismissed the case with prejudice.

The insured appealed directly to the Washington Supreme Court, seeking a determination as to whether IFCA creates an independent and private cause of action for an insurer’s technical violation of the Unfair Claims Settlement Practices Regulations in the absence of an unreasonable denial of coverage or benefits.

Like many of the federal courts before it, the Washington Supreme Court struggled with the interplay of paragraphs 2, 3, and 5 of the statute, and ultimately found that the statute was ambiguous. The Court further admitted that the result of an isolated regulatory violation was not clear.

[G]iven that the trier of fact must find that an insurer acted unreasonably under subsection (1), and that such a finding mandates attorneys’ fees under subsection (3) and gives the trial court discretion to award treble damages under subsection (2), it is not clear what a finding of a regulatory violation accomplishes. (emphasis added).

. . .

IFCA explicitly creates a cause of action for first party insureds who were “unreasonably denied a claim for coverage or payment of benefits.” IFCA does not state it creates a cause of action for first party insureds who were unreasonably denied a claim for coverage or payment of benefits or “whose claims were processed in violation of the insurance regulations listed in (5),” which strongly suggests that IFCA was not meant to create a cause of action for regulatory violations.” (Internal citations omitted) (emphasis added).

In finding IFCA ambiguous, the Court then analyzed IFCA’s official ballot title and determined that it was not the legislature’s intent to create a private cause of action for mere technical violations.

This language does not suggest an intent to create a private cause of action for regulatory violations. Quite the opposite: it suggests that IFCA creates a case of action for unreasonable denials of coverage and also permits treble damages in some circumstances. On balance, we conclude that the legislative history suggests that IFCA does not create a cause of action for regulatory violations. (emphasis added).

The Washington Supreme Court then advised that Washington’s current pattern jury instruction on IFCA is a misstatement of the law. The current pattern instruction concludes that IFCA creates a cause of action if an insurer “unreasonably denied a claim for coverage” or “unreasonably denied payment of benefits,” or “violated a statute or regulation governing the business of insurance claims handling.” Based on the foregoing, this instruction is clearly incorrect.

The Perez-Crisantos decision is a rare win for insurers in what has become a very difficult jurisdiction. This decision should prove extremely important as IFCA claims, and IFCA claims premised solely on technical violations of Washington’s insurance regulations, are becoming more and more prominent. To the extent that you have detailed questions about this case or how it may affect any of your pending or future claims or litigation, do not hesitate to contact our office.

Crowthers v. Travelers: The Federal Court Gets It Right Again on IFCA

Crowthers v. Travelers: The Federal Court Gets It Right Again on IFCA

The Washington State Insurance Fair Conduct Act, commonly referred to as “IFCA”, continues to cause significant concern among insurers conducting business in the State of Washington. The lack of any decisions from the Washington State Appellate Courts interpreting or applying the statute has further compounded the uncertainty relating to IFCA.

The Federal Courts, however, have continued to issue rulings on the application of IFCA in a number of scenarios. The trend of these decisions indicates that the Federal Courts are obtaining a better grasp on how IFCA is to be applied. These decisions provide better direction to all insurers and insureds in regard to these claims.

The most recent decision from the Federal Courts is Crowthers v. The Travelers Indemnity Company, United States District Court for the Western District of Washington, 2:16-cv-00606-RSL. In Crowthers, the Honorable Robert S. Lasnik again held that a technical violation of a regulatory provision under the Washington Administrative does not necessarily constitute an IFCA violation. In issuing this holding, the Court referenced the same result reached by Judge Robart in Schreib v. American Family Mut. Ins. Co., 2015 U.S. Dist. LEXIS 118189 (W.D. Wa.). As a result, it appears that the trend in at least the Western District is that an IFCA violation requires an actual unreasonable denial benefits or of coverage, and not simply a technical violation of the regulations.

Judge Lasnik then went on to address the fact that the Plaintiff in the Crowthers case had failed to establish any “actual damages” under IFCA, as well as a lack of any damage claims asserted as to the remaining extra-contractual claims asserted by Plaintiff. The Court held that a failure to establish actual damages as to these extra-contractual causes of action also warranted dismissal of the claims on a summary judgment motion. This decision again underscores the fact that in order to prosecute an IFCA claim, a party must prove actual damages or injuries. This ruling is again consistent with the ruling in Schreib.

The Crowthers case provides excellent legal precedent for insurers to utilize in defending IFCA claims. In fact, at least one court in King County, Washington (Seattle) utilized the Crowthers decision in dismissing an IFCA claim in a separate, highly contested consent judgment case arising from an underlying commercial construction defect matter.

Lether & Associates proudly represented Travelers in the Crowthers matter. If you have any questions in regard to this case, please let us know. In the meantime, a copy of this decision is attached.

On a different note, Lether & Associates is proud to add three new attorneys to the office. Congratulations to Nicole Morrow, Matt Erickson and Ben Miller. Each of our new rising stars brings a great attitude and experience to our team. This includes adjusting experience and defense experience. Our recent growth also means we have added an attorney licensed in the State of California to better service our California client base. Welcome aboard, everyone.

Construction in Seattle – An All Time High

As most insurers and lawyers in the Northwest know, construction in the Northwest region of the United States is at a record level. What many people do not understand, however, is just how dramatic this increase is. If you are not from the Northwest, you may not realize that at this time there is more high-rise and commercial construction in the Seattle market than arguably anywhere else in the United States.

According to the attached link, there are currently 58 active projects utilizing construction cranes in the Seattle area. Most of these are high-rise developments. As set forth in the attached article, this puts Seattle at the top of all cities in the United States with ongoing construction cranes in place. This also represents a 38% increase in construction crane activity in the last year in Seattle. New York City, who has traditionally had the largest number of construction towers in operation at any given time, has only 28 cranes currently in operation. In fact, Seattle has twice as many construction cranes as any other city in the United States except Los Angeles which only has 40 operating cranes.

Obviously, this level of construction brings with it tremendous problems – traffic issues, congestion, increases in cost of living, etc. It also forecasts a potential for a significant increase in construction defect claims in the next 3 – 7 years in the Seattle market. Good news potentially for lawyers, but not so good news for insurers.

Lether & Associates is involved in a number of construction projects around the United States and particularly in the Northwest region. If you have questions in regard to the status of any construction related issues on the west coast, please contact our office.

http://www.seattletimes.com/business/real-estate/seattle-skyline-is-tops-in-construction-cranes-more-than-any-other-us-city/

Fraudulent Water Damage Claims “Arson In The 21st Century”

Since 1988, Tom Lether has represented national and local insurers in first-party arson claims. Utilizing examinations under oath, requests for information, forensic experts, and other investigatory tools, Lether & Associates has been involved in some of the largest commercial and residential arson cases in the Northwest – the most notorious of these being the tragic 1995 Mary Pang Food Warehouse Fire where four Seattle firefighters tragically lost their lives.

Over the past 30 years, the methodology of criminals who are involved in fraudulent insurance schemes has become more sophisticated. Insureds have developed new ways of recovering from insurers on intentionally caused losses. A growing trend involves fraudulent water damage claims. Similar to fire loss claims, water damage claims can be intentionally caused. Moreover, legitimate water damage events can lead to inflated or overstated claims. The similarities with arson cases are striking. However, the tactics in regard to investigating these claims are not nearly as developed. For example, in arson losses there are dozens of experts who are available to testify as to cause and origin. Moreover, there is often physical evidence, such as a liquid pour pattern, that can determine the cause and origin of a fire. There are not nearly as many water damage cause and origin experts. In a water damage event it may be more difficult to prove the insured intentionally caused the loss. For example, it is more difficult to establish that an insured allowed their pipes to become frozen and burst. It may be difficult to establish through forensic evidence that a supply line to a washing machine or dishwasher did not accidentally fail.

Moreover, the magnitude of these property losses is sometimes as significant as in a fire loss. A home or business can suffer a total loss from a water damage claim just as if they were damaged by a fire.

Finally, the risk to an insured in a water damage claim can be less than in fire damage claims. It is unlikely that anyone is going to be killed in a water damage event. It is also less likely that someone is going to be criminally prosecuted. Knowing the risk versus reward of water damage claims leads insureds to intentionally cause a water loss for the exact same financial reasons they would normally burn down their home or business. A failed kitchen supply line is a great way to remodel a kitchen.

As Lether & Associates continues to see an increase of significant water damage claims, we have used traditional and new methods to contest these claims. These tools include requests for examinations under oath, recorded statements, public records, NICB referrals, site inspections, etc. Working with SIU groups and insurers, Lether & Associates is continuously developing new means of investigating these types of claims.

If you believe you are facing a suspicious water damage loss, feel free to contact Lether & Associates to discuss our ability to assist you.