Cato v. Arkansas Municipal League Municipal Health Benefit Fund

688 S.W.2d 720, 285 Ark. 419, 1985 Ark. LEXIS 1936
CourtSupreme Court of Arkansas
DecidedApril 22, 1985
Docket84-315
StatusPublished
Cited by18 cases

This text of 688 S.W.2d 720 (Cato v. Arkansas Municipal League Municipal Health Benefit Fund) is published on Counsel Stack Legal Research, covering Supreme Court of Arkansas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Cato v. Arkansas Municipal League Municipal Health Benefit Fund, 688 S.W.2d 720, 285 Ark. 419, 1985 Ark. LEXIS 1936 (Ark. 1985).

Opinion

Robert H. Dudley, Justice.

Appellants, Chester Cato and Verna Cato, were participants in the health insurance program of appellee, the Arkansas Municipal League. Verna Cato suffered a self-inflicted gunshot wound to the head which required that she be hospitalized. Her hospital charges were $26,206.89. Appellants both signed a standard form which authorized the Municipal League’s insurance carrier to pay benefits directly to the hospital. Appellants later filed a claim for the hospital expenses which was denied on the basis that an intentional self-inflicted injury was excluded from coverage. Appellants then retained attorneys on a 40% contingent fee basis. The attorneys filed suit for appellants. After service of process and a denial of liability, appellee settled directly with the hospital for $13,103.45, or 50 cents on the dollar. Neither appellants nor their attorneys were notified of the settlement until after it had been completed. Appellants then amended their complaint to allege that appellee owed them an attorney’s fee equal to 40% of the hospital bill, before settlement, under the attorney’s fee lien statute, Ark. Stat. Ann. § 25-301 (Repl. 1962), and also the 12% penalty plus attorney’s fees as set out in Ark. Stat. Ann. § 66-3238 (Repl. 1980). Additionally, appellants amended their complaint to allege that the refusal to pay hospital expenses directly to appellants constituted the tort of bad faith. Both parties filed motions for summary judgment. The trial court awarded to appellants an attorney’s fee of $10,407.76, or 40% of the $26,206.89 originally billed by the hospital; denied appellants’ claim for the 12% penalty and attorney’s fees; and denied appellants’ claim based upon the tort of bad faith. We reverse and remand on the amount of attorney’s fees, but affirm on all other parts. Jurisdiction to interpret the statutes at issue is in this Court. Rule 29(l)(c).

Appellants first argue that the trial court erred in refusing to award the 12% penalty plus attorney’s fee. Where an insured loss occurs and an insurance company fails to pay the loss within the time specified in the policy, the insurance company is required to pay, in addition to the loss, a 12% penalty plus a reasonable attorney’s fee. Ark. Stat. Ann. § 66-3238 (Repl. 1980). Since this statute is penal in nature, it is to be strictly construed. Callum v. Farmers Union Mutual Ins. Co., 256 Ark. 376, 508 S.W.2d 316 (1974). The plaintiff must recover the exact amount claimed in order to collect the penalty and attorney’s fees. Farm Bureau Ins. Co. v. Paladino, 264 Ark. 311, 571 S.W.2d 86 (1978). In this case, appellants’ complaint and amended complaint asked for a greater amount than was finally recovered. It was only after appellee confessed judgment and tendered $916.83 into the registry of the court that the appellants reduced their claim to the correct sum, the amount which had already been tendered. Even so, appellants argue that they are entitled to penalty and attorney’s fee because they recovered the exact amount finally claimed. The argument is without merit because the insurance company confessed judgment for the correct amount before appellant filed claim for the correct amount. See Broadway v. The Home Ins. Co., 203 Ark. 126, 155 S.W.2d 889(1941).

Appellants next contend that the trial court erred in not awarding punitive damages based upon the first party tort of bad faith. In an unusual proceeding, the appellants filed a motion for summary judgment following a similar motion by appellee, but neither party contended below, nor contends on appeal, that there is any issue of material fact. The trial judge decided the question on the affidavits. We affirm as the decision is not clearly erroneous.

An insurance company may incur liability for the first party tort of bad faith when it affirmatively engages in dishonest, malicious, or oppressive conduct in order to avoid a just obligation to its insured. Employers Equitable Life Ins. Co. v. Williams, 282 Ark. 29, 665 S.W.2d 873 (1984). However, mere refusal to pay a claim does not constitute the first party tort of bad faith when a valid controversy exists with respect to liability on the policy. Findley v. Time Ins. Co., 264 Ark. 647, 573 S.W.2d 908 (1978).

The only provision in appellants’ affidavit which can be construed as a fact showing affirmative conduct designed to avoid a just obligation is the statement that appellee settled the hospital claim directly with the hospital rather than with the appellants. However, in response the appellee, in its affidavit, stated:

5. It is undisputed that Mrs. Verna Cato, Plaintiff herein, suffered a gunshot wound to the head on or about March 12, 1982. From the claim forms, medical reports from doctors at the Corning hospital and the Baptist Memorial hospital, and two investigative reports from Equifax Services Inc., the claim was initially denied based on the exclusion contained in our benefits excluding coverage for self-inflicted wounds. Copy of the above mentioned documents have previously been filed herein.
6. The claim was ultimately appealed to the Municipal Health Benefit Fund’s Board of Trustees who upheld the decision to deny the claim. This lawsuit followed.
7. After commencement of this suit, further investigation undertaken by trial counsel, and research of the applicable Arkansas law, trial counsel advised that the Municipal Health Benefit Fund faced a difficult burden of proof in maintaining that Mrs. Cato suffered an intentional self-inflicted wound. Whereupon a decision was reached to settle this claim.
8. A settlement has been arrived at with the Baptist Memorial hospital and a full release of claims obtained therefor. We have submitted sums in the registry of the court representing payment for claims received by us and for which we provide benefits, up to the limits of our policy. We continue to deny liability for any nursing home or disability income benefits since these claims are not covered by our benefits. In addition, we are due a setoff in the sum of $75.00 which represents the remainder of the deductible provision under the terms of our benefit program.

Upon this evidence we cannot say the trial court’s ruling was clearly erroneous.

The appellee has filed a cross-appeal. The trial court found that when the appellee settled the $26,206.89 debt directly with the hospital for $13,103.45 after suit had been commenced, the appellants’ attorneys held a lien against appellee for 40% of $26,206.89, or a lien for an attorney’s fee in the amount of $10,482.76. We modify and remand for further evidence on this point.

The cross-appellant insurer argues that the crossappellees, the Catos, assigned their medical benefits to the hospital, and therefore, there is nothing to which the lien could attach.

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Bluebook (online)
688 S.W.2d 720, 285 Ark. 419, 1985 Ark. LEXIS 1936, Counsel Stack Legal Research, https://law.counselstack.com/opinion/cato-v-arkansas-municipal-league-municipal-health-benefit-fund-ark-1985.