Billings v. Union Bankers Insurance Co.

918 P.2d 461, 286 Utah Adv. Rep. 36, 1996 Utah LEXIS 17, 1996 WL 123280
CourtUtah Supreme Court
DecidedMarch 19, 1996
Docket940098
StatusPublished
Cited by75 cases

This text of 918 P.2d 461 (Billings v. Union Bankers Insurance Co.) is published on Counsel Stack Legal Research, covering Utah Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Billings v. Union Bankers Insurance Co., 918 P.2d 461, 286 Utah Adv. Rep. 36, 1996 Utah LEXIS 17, 1996 WL 123280 (Utah 1996).

Opinions

ZIMMERMAN, Chief Justice:

Glen A. Billings brought this action on behalf of his son Stanley D. Billings (“Billings”) against Union Bankers Insurance Company (“Union Bankers”), alleging that Union Bankers breached both the express terms and the implied covenant of good faith and fair dealing contained in a catastrophic [463]*463health insurance contract. The case was tried to a jury, which found a breach of both the express and the implied terms of the contract and returned a $1,800,000 verdict in Billings’ favor. The district court also awarded Billings “reasonable” attorney fees of $110,651 but refused to hold Union Bankers liable for the substantially higher contingency fee which Billings actually incurred. Union Bankers appeals the jury verdict, and Billings cross-appeals the award of attorney fees. We affirm the verdict but vacate the award of attorney fees and remand for recalculation of Billings’ recoverable fees in accordance with his fee agreement.

In June of 1984, Billings entered into a catastrophic health insurance contract with Union Bankers in which Union Bankers agreed to pay certain medical expenses incurred by Billings as a result of injury or sickness. Covered expenses included hospital inpatient services, room, and board; skilled nursing facility services, room, and board; and home health care services. In addition, the policy contained a miscellaneous benefits rider in which Union Bankers agreed to pay, among other things, certain out-of-hospital medical expenses. Throughout the period of the policy, Billings paid the premiums and performed each act required to keep the policy in full force and effect.

On September 22, 1985, Billings was involved in a motorcycle accident in which he sustained serious injuries, including traumatic brain injury. He was hospitalized for several months following the accident, and pursuant to the insurance policy, Union Bankers paid Billings’ hospitalization expenses.

In May of 1986, Dr. Goka, Billings’ treating physician at Holy Cross Hospital, determined that Billings’ recovery would be improved if he were transferred to Tangram Rehabilitation Network in San Marcos, Texas (“Tangram”). Tangram is a transitional treatment center for individuals who are medically stable but who have suffered loss of memory or basic functional skills due to traumatic brain injury. Billings was admitted to Tangram on May 9, 1986. However, Union Bankers denied coverage for Billings’ treatment at Tangram, stating that the insurance policy did not cover such treatment. Although his condition was improving, Billings discontinued his treatment at Tangram on November 25,1986, due to a lack of funds.

Billings commenced this action on May 4, 1988, alleging that Union Bankers breached both the express coverage provision and the implied covenant of good faith and fair dealing contained in the insurance contract. Billings sought reimbursement of the expenses he incurred at Tangram and consequential damages resulting from the premature termination of treatment, which allegedly prevented Billings from ever achieving his full potential for recovery.

On April 10, 1990, Billings moved for partial summary judgment, seeking a ruling that Union Bankers had breached the express coverage provision by refusing to pay for Billings’ treatment at Tangram. The trial judge denied Billings’ motion “for the reason that differing interpretations of the insurance policy create genuine issues of material fact to be tried.” Billings then petitioned this court for interlocutory review. We granted Billings’ petition and affirmed the denial of Billings’ motion because the “record before us ... fail[ed] to adequately demonstrate the nature of the treatment received at Tan-gram.” Billings v. Union Bankers Ins. Co., 819 P.2d 803, 805 (Utah 1991) (“Billings I ”). We remanded, and the case proceeded to trial.

Following closing arguments, Union Bankers moved for a directed verdict on Billings’ claim for breach of the implied covenant of good faith and fair dealing. Union Bankers argued that it could not have breached the implied covenant as a matter of law because its liability under the insurance policy was fairly debatable. The district court denied Union Bankers’ motion but instructed the jury that Union Bankers would not be liable for breaching the implied covenant if its liability under the insurance policy was “fairly debatable [and] a reasonable insurance company in similar circumstances [would have] den[ied] the claim.” The district court also instructed the jury that if it found Union Bankers to have breached the express coverage provision of the insurance contract, it could award Billings the value of the insurance policy benefits to which he was entitled [464]*464and if it found Union Bankers to have breached either the express coverage provision or the implied covenant of good faith and fair dealing, it could award Billings consequential damages for emotional suffering and mental anguish, medical expenses, lost income and earning capacity, and the extent to which Billings had been limited in pursuing and enjoying the ordinary affairs of life. Although Billings also sought to recover his attorney’s contingency fee as consequential damages, the parties agreed to reserve this issue until after the trial.

Following the trial, the jury returned a special verdict finding that Union Bankers had breached both the implied covenant of good faith and fair dealing and the express coverage provision of the insurance contract. It awarded Billings $1,800,000. The district court subsequently addressed the attorney fee issue and awarded Billings what it determined to be a reasonable attorney fee of $110,651.

On appeal, Union Bankers argues that the district court erred in (i) denying Union Bankers’ motion for a directed verdict on Billings’ claim for breach of the implied covenant of good faith and fair dealing, and (ii) instructing the jury that it could award damages for mental anguish caused by Union Bankers’ breach of the insurance contract’s express coverage provision.1 Billings cross-appeals the award of attorney fees. We address Union Bankers’ arguments first and then consider Billings’ cross-appeal.

Union Bankers first argues that the district court should have granted its motion for a directed verdict on Billings’ claim for breach of the implied covenant of good faith and fair dealing. Union Bankers contends that under our decision in Beck v. Farmers Insurance Exchange, 701 P.2d 795 (Utah 1985), a first-party insurer may not be held liable for breaching the implied covenant where the basis for the alleged breach is that it wrongfully denied coverage and where the insured’s claim was fairly debatable. Union Bankers argues that Billings’ claim was fairly debatable as a matter of law and therefore that it could not have breached the implied covenant of good faith and fair dealing. Although we agree that Beck established a “fairly debatable” defense to a claim for breach of the implied covenant of good faith and fair dealing, we do not think that Billings’ claim was fairly debatable as a matter of law.

We first state the applicable standard of review. Whether Beck established a fairly debatable defense to a claim for breach of the implied covenant based on an insurer’s wrongful denial of coverage is a question of law which we review for correctness. See State v.

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918 P.2d 461, 286 Utah Adv. Rep. 36, 1996 Utah LEXIS 17, 1996 WL 123280, Counsel Stack Legal Research, https://law.counselstack.com/opinion/billings-v-union-bankers-insurance-co-utah-1996.