Amica Mutual Insurance Company v. Ullaine Sanders

Court of Appeals of Georgia·Decided November 16, 2015·No. A15A0917·Published

Opinion

SECOND DIVISION

ANDREWS, P. J.,

MILLER and BRANCH, JJ.

NOTICE: Motions for reconsideration must be physically received in our clerk’s office within ten days of the date of decision to be deemed timely filed.

http://www.gaappeals.us/rules

November 16, 2015

In the Court of Appeals of Georgia A15A0917. AMICA MUTUAL INSURANCE COMPANY v.

SANDERS et al.

BRANCH, Judge.

We granted the application of Amica Mutual Insurance Company (“Amica”)

to determine whether a trial court erred in denying Amica partial summary judgment as to Ullaine and Stephanie Sanders (“plaintiffs”)’ bad-faith claim arising from Amica’s offer of $716.25 to settle the diminished value of their car after it was hit by Amica’s insured. Amica argues that its adjuster’s application of a formula established in the wake of the Georgia Supreme Court’s decision in State Farm Mut. Auto. Ins. Co. v. Mabry, 274 Ga. 498 (556 SE2d 114) (2001), cannot, in the absence of any other evidence of bad faith, justify such a claim. We agree and therefore reverse.

“Summary judgment is proper when there is no genuine issue of material fact and the movant is entitled to judgment as a matter of law. We apply a de novo standard of review and view the evidence in the light most favorable to the non- movant.” (Citations and punctuation omitted.) Lawyers Title Ins. Corp. v. Griffin, 302 Ga. App. 726, 727 (691 SE2d 633) (2010).

Although we would view the record in favor of plaintiffs as the non-movants, the relevant facts are not in dispute. In Mabry, supra, our Supreme Court held that insurers were contractually bound to compensate their insureds for both the cost of repair and the vehicle’s lost value. The Court reasoned that because “value, not condition, is the baseline for the measure of damages in a claim under an automobile insurance policy in which the insurer undertakes to pay for the insured’s loss from a covered event,” an insurance contract affording the insurer an option to repair “serves only to abate, not eliminate, the insurer’s liability for the difference between pre-loss value and post-loss value.” 274 Ga. at 506 (4). The Court thus concluded that

the policies issued by [the insurer] obligate it to compensate its policyholders for that loss of value, notwithstanding repairs that return the vehicle to pre-loss condition in terms of appearance and function, if the repairs do not return the vehicle to its pre-loss value; and [the insurer] is obligated to assess that element of loss along with the

elements of physical damage when a policyholder makes a general claim of loss.

Id. at 509 (4). Accordingly, on December 7, 2001, the Insurance Commissioner of Georgia issued a directive to all property and casualty insurers licensed in the state that they were now required to adjust claims by including “assessment and payment of diminution of value relative to physical damage.” Officer of Insurance Commissioner, Directive 01-P&C-1.

The so-called “17 (c)” formula is named after paragraph 17 (c) of the second injunction issued in the class action styled Myron G. Walker, Individually and On Behalf of All Others Similarly Situated v. American National General Insurance Company, Individually and On Behalf of All Similarly Situated Insurers in the State of Georgia (Muscogee County Superior Court Civil Action No. SU-03-CV-2058). The 17 (c) formula specifies that the application of a so-called “damage severity modifier” was a “subjective decision, which must be made by the adjuster,” and that the modifier “can be adjusted as necessary to fit the damage[].” The formula also notes that while it provided “a good figure on which to base a loss of value claim, there are many circumstances that will require additional consideration in determining the loss of value,” including prior damage to and dealer ownership of the car at issue.

In a settlement order dated July 14, 2004, the Walker class action terminated those plaintiffs’ claims on conditions including that the defendant insurers, including Amica, “shall continue the use of the 17 (c) formula . . . in their assessment of diminished value in physical damage losses reported by these insurer[s’] policyholders subsequent to June 30, 2003[.]” The Walker settlement order also provided that 17 (c), “applied appropriately and uniformly, would provide a basis for the negotiation of [a] diminished value loss,” and that insurers using 17 (c) “cannot be found to have acted in bad faith by virtue of using the formula to assess diminished value claims.”

On December 2, 2008, the Insurance Commissioner issued a second directive attempting “to clarify the Department’s position” on diminished value claims. The Commissioner observed that the Department “ha[d] never indicated that the diminished value result obtained by a carrier’s use of a particular formula or method constitutes the definitive determination of the carrier’s liability to its insured,” and that “[t]he nature of each claim demands that carriers must take into consideration all relevant information in the evaluation of diminished value claims including but no limited to, relevant information provided by an insured regarding diminution of value.” But the Commissioner also noted that

defining the amount of loss associated with diminution of value is a subjective process where even experts can have a difference of opinion.

For this reason, the Department has not endorsed a particular formula or method. Each claim is unique and should be evaluated as such. Every carrier has the obligation to evaluate the vehicle prior to loss and after the loss to determine the amount of diminution in value in accordance with Georgia law and applicable contractual language. Total reliance on one particular formula or method in making that evaluation may not be appropriate given the subjective nature of the claim.

Office of Insurance Commissioner, Directive 08-P&C-2 (December 2, 2008) (emphasis supplied). The same directive mandated that insurers should

cease using any language which implies that the Department has endorsed a particular formula or method to determine diminution of value. Specifically, any insurer disseminating information and/or appraisals to their insureds shall cease using any language which implies that the Mabry decision or any other requirement of the Department supports the proposition that the diminished value result obtained by a carrier’s use of a particular formula or method constitutes the definitive determination of the carrier’s liability to its insured.

Id.

These rulings and directives were in effect on March 7, 2009, when a vehicle driven by defendant Robert Miller crossed over the center line and struck plaintiffs’

2008 Nissan Sentra, forcing it into a third vehicle. At the time of the accident, Miller was insured by Amica, which assigned Mike Frazier, an adjuster, to perform both the repair estimate and the diminished value estimate for plaintiffs’ car. Frazier first estimated the car’s repair costs at $4,104.60. Using the 17 (c) formula, Frazier also estimated diminished value at zero because the car did not appear to have suffered any “structural damage.” On disassembly of the car, however, Frazier saw frame damage that required what he estimated to be an additional $3,307.47 in repairs, for a total repair cost estimate of $7,412.07. In light of the discovered frame damage, but continuing to apply 17 (c), Frazier also revised his estimate of diminished value upward from zero to $716.25.

In light of Frazier’s revised estimates, Amica offered plaintiffs $716.25 for the diminished value of their car, which they rejected. Plaintiffs’ own appraiser later estimated the car’s diminished value at approximately $3000. In February 2010, plaintiffs made a written demand on Amica for $3000 in diminished value as well as $22,000 in punitive damages and attorney fees on grounds including that Miller had been driving under the influence at the time of the accident. Amica rejected this demand, but offered $1000 to settle the claim.

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