Employers Equitable Life Insurance v. Williams

665 S.W.2d 873, 282 Ark. 29, 1984 Ark. LEXIS 1576
CourtSupreme Court of Arkansas
DecidedMarch 12, 1984
Docket83-280
StatusPublished
Cited by31 cases

This text of 665 S.W.2d 873 (Employers Equitable Life Insurance v. Williams) 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
Employers Equitable Life Insurance v. Williams, 665 S.W.2d 873, 282 Ark. 29, 1984 Ark. LEXIS 1576 (Ark. 1984).

Opinions

Robert H. Dudley, Justice.

This appeal involves the first party tort of bad faith committed by an insurance company against its insured. The jury found that the appellant, Employers Equitable Life Insurance Company, breached its contract by failing to pay benefits to appellee, J. C. Williams, in the amount of $2,050.00. The jury also found that appellant committed the first party tort of bad faith by declaring appellee’s health and accident policy had lapsed and could not be reinstated. The jury awarded $25,000 for compensatory damages and $75,000 for punitive damages. The two points of appeal address only the tort cause of action. We affirm. Jurisdiction is in this Court under Rules 29 (l)(c) and 29(l)(o).

Appellant’s first point of appeal is that the tort of bad faith against an insurance company has been pre-empted by the statute allowing penalty, interest, and attorney’s fees, Ark. Stat. Ann. § 66-3238 (Repl. 1980), and by the comprehensive statutory scheme for regulation of the insurance business, Ark. Stat. Ann. Title 66, Chapter 30 (Repl. 1980). We have rejected this express argument. Aetna Casualty and Surety Company v. Broadway Arms Corporation, 281 Ark. 128, 664 S.W.2d 463 (1984). We decline to overrule Aetna.

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. Aetna Casualty and Surety Company v. Broadway Arms Corporation, supra. The third party tort of bad faith is the negligent failure of an insurer to settle a third party claim within the policy limits. See Members Mutual Ins. Co. v. Blissett, 254 Ark. 211, 492 S.W.2d 429 (1973); Findley v. Time Ins. Co., 264 Ark. 647, 573 S.W.2d 908 (1978); and M.B.M. Co., Inc. v. Counce, 268 Ark. 269, 596 S.W.2d 681 (1980). The cause of action on appeal in this case is for the intentional tort of altering insurance records so that it appeared that the insurance policy on a bad risk had lapsed when, in truth, it had not. Compensatory damages for bad faith in an occasional lawsuit would not deter the wrongdoing insurance company, or others, from seeking a wrongful gain by similarly victimizing hundreds of other policyholders. Punitive damages will have a deterrent effect in a case of this type. See Ray Dodge, Inc. v. Moore, 251 Ark. 1036, 479 S.W.2d 518 (1972). The proof in this case overwhelmingly justifies the exaction of punitive damages.

Appellant, an insurance company, generated much of its business by mail. In 1980, it mailed appellee two fliers advertising its health and accident policy as well as its prompt claim service. On July 1,1980, appellee purchased a policy for a one month term, renewable monthly, with a thirty-one day grace period. The policy provided that if the premium was late, the acceptance of the late premium without a request for reapplication would result in a reinstatement of the policy, but the insurer could issue a conditional receipt and the insured could submit a reapplication for approval or rejection by the company within 45 days. If not rejected within that 45 day period the policy would be automatically reinstated.

The appellee paid the monthly premiums and on November 1, 1981, suffered a heart attack. On December 19, 1981, the appellee signed his claim for $1,708.22 in benefits. The appellant admits receiving the claim on December 30, 1981. On February 11, 1982, appellee called appellant to ask why he had not been paid. He was told it was being processed. He called again on February 12 and a third time on February 22. Both times he was again told his claim was being processed. On February 17 appellant wrote a letter to appellee stating that his claim was in the final steps of processing.

While appellee’s claim was lying on the desk of appellant’s claims underwriter the Arkansas Insurance Department began a market conduct survey of appellant for the months of February and March, 1982. The investigators discovered that appellant was not paying claims when they were calculated and due but was paying them only when the cash flow of the company would allow. The average time for paying calculated claims was 52.87 days. The investigators found that the company used a rubber stamp to show the date claims were received but that dates on the stamp were changed to correspond with dates desired by appellant and, in addition, liquid paper was used for alterations on forms. One investigator testified that as he physically took control of a large stack of claim files the company secretary tried to destroy a note from the president of appellant which read: “work this one to death. Best regards, p.s. throw this note away now.” Another claim form had a note: “wait 90 days, may lapse.” The Insurance Department found such voluminous violations of the insurance code that it took 68 paragraphs of a consent order to state them. Ultimately the appellant was fined $50,500.00, the largest insurance penalty in the history of the State. In addition, appellant’s license to operate was twice suspended. A claims underwriter for appellant testified that the president of appellant offered her a bonus if she would deny claims and that he also instructed her to refuse to pay claims in the hope that the policies would lapse.

Appellant’s underwriter admitted that people who had suffered a heart attack, like appellee, were not acceptable insurance risks because they were more likely to have another heart attack. In fact, appellee had his second attack on May 21, 1982. The appellee testified that on March 22 he finally received his benefit check along with a form from the secretary of appellant which stated: “Due to the fact that we did not receive your premiuim payment until after your 31-day grace period expired, it will be necessary for you to sign and return the enclosed form to me for our files, in order that we may continue your coverage.” Appellee signed the form and returned it to appellant. Then, on May 7, 1982, appellant wrote to appellee “Enclosed please find your check number 4269 in the amount of $52.00 and your check number 4273 in the amount of $52.00. Your application for reinstatement of the above listed policy has been declined by the underwriting department.”

At trial, the appellant claimed appellee’s insurance policy was cancelled because the February 1 premium was not paid until March 15. Appellant produced a record of monthly receipts in which payments were entered by hand. It shows no premium payments for February and March. Appellant’s claims worksheet, also maintained by hand, reflects that the policy lapsed February 1. However, the computer cards, maintained by appellant, reflect payment of the February 1 premium and reflect payment of the March 1 premium on March 15. The March 1 computer card is altered to change the “3” month to the “2” month. An employee of appellant admitted altering the payment card to “correct” it. She stated that the policy was paid only to February 1 and that is the reason she changed the “3” month to “2”.

The appellee testified that he made his payments within the grace period.

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Bluebook (online)
665 S.W.2d 873, 282 Ark. 29, 1984 Ark. LEXIS 1576, Counsel Stack Legal Research, https://law.counselstack.com/opinion/employers-equitable-life-insurance-v-williams-ark-1984.