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
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.
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.
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.
Yesterday, the Oregon Supreme Court issued a decision clarifying the statute of limitation for negligent construction claims. In Goodwin v. Kingsmen Plastering Inc., 359 Or. 694 (June 16, 2016), the Court was asked to identify the period of limitations for a negligent construction claim. Plaintiffs in the case filed a claim for negligence and negligence per se, alleging construction defects that led to water intrusion at a single family residence built in 2001. Plaintiffs argued that the six-year statute of limitation set forth in ORS 12.080(3), which applies to actions “for interference with or injury to any interest of another real property,” governed their claims.
Defendant, a siding subcontractor, argued that the action was not for injury to an “interest” in real property, but rather for damage to the property itself, and should be governed by a two-year statute of limitations set for in ORS 12.110(1). That statute applies to tort actions in general.
The Oregon Supreme Court determined conclusively that the two-year statute of limitations set forth in ORS 12.110(1) applied. The Court found that ORS 12.080(3) applied only to an injury to an “interest” in real property, such as trespass or waste. It did not apply to actions arising from damage to the property itself. The Court further held that the Plaintiff’s discovery of the damage to the property initiates the two year period of limitation. As a result, the Supreme Court remanded the case back to the Court of Appeals for determination of whether or not the action was brought within two years of when the Plaintiffs knew or should have known about the damage.
This case provides clarity as to the appropriate statute of limitations in Oregon for negligent construction claims. Previously there had been some confusion over what statute should apply. The arguments presented in theGoodwin case were common. Parties often argued whether the six-year or two-year period was appropriate for actions involving construction defects. The Court has now clarified that a party has two years from which to bring a claim for negligent construction. Moreover, the Court clarified that this two-year period of limitations allows for discovery of the claim. As a result, the operative date for any statute of limitations defense will be when the claimant knew or should have known about the damage to the property.
Lether & Associates regularly represents insurers in a number of construction matters and other insurance claims in the State of Oregon. This includes some of the most significant construction defect claims in that jurisdiction. A number of our attorneys are licensed to practice in Oregon. We are always happy to discuss representation of clients in that jurisdiction.