Hale v. Farmers Insurance Exchange

42 Cal. App. 3d 681, 117 Cal. Rptr. 146, 1974 Cal. App. LEXIS 1258
California Court of Appeal·Decided October 25, 1974·No. Civ. 13033·Published·Cited by 52 cases

Opinions

[686] Opinion

WHYTE, J.*

Plaintiff Arthur L. Hale brought suit against his insurance company Farmers Insurance Exchange, its attorney-in-fact, Farmers Underwriters Association (hereafter Farmers), their Orange County claims supervisor, defendant Eugene J. Penasa, and their claims examiner, defendant Sally Lawrence, for bad faith refusal to pay medical benefits due plaintiff under his automobile insurance policy.

A jury verdict was returned October 27, 1972, in favor of plaintiff and against the defendants in the total sum of $212,659.03. Judgment on the verdict was entered and included the following individual verdicts:

1. $2,557.97 plus accrued interest of $601.06 against Farmers for breach of contract;
2. $5,000 compensatory damages against all defendants for bad faith;
3. $200,000 punitive damages assessed against defendant Farmers;
4. $3,000 punitive damages assessed against defendant Penasa;
5. $1,500 punitive damages assessed against defendant Lawrence.

Defendants moved for a new trial and for judgment notwithstanding the verdict.

The trial court granted the motion for judgment notwithstanding the verdict assessing $200,000 punitive damages against defendant Farmers, but denied the motion for judgment n.o.v. as to defendants Lawrence and Penasa.

The trial court’s order on the motion for new trial was entered as follows:

1. Granted the motion as to the verdict for $200,000 punitive damages assessed against defendant Farmers on the ground of insufficiency of the evidence;
2. Granted the motion as to the verdict for $2,557.97 breach of contract damages plus $601.06 interest against defendant Farmers on the ground of insufficiency of the evidence unless plaintiff remitted $650;
3. Granted the motion as to the verdict for $5,000 compensatory damages against all defendants on the ground of insufficiency of the evidence unless plaintiff remitted $4,350;
[687]*6874. Denied the motion as to the verdict for $3,000 punitive damages against defendant Penasa and $1,500 punitive damages assessed against defendant Lawrence.

Plaintiff filed a remittitur of $650 damages for breach of contract and, accordingly, the motion for new trial was deemed denied as to that portion of the verdict, leaving judgment against defendant Farmers for breach of contract in the sum of $1,907.97, plus interest of $601.06. No party has appealed from that portion of the judgment.

Plaintiff refused to remit any portion of the $5,000 compensatory damages award.

Plaintiff appeals from the order granting Farmers judgment notwithstanding the verdict. He also appeals from the order granting a new trial to defendant Farmers on the punitive damages issue and from the order granting all defendants a new trial on the issue of $5,000 compensatory damages.

Defendants appeal from the judgment as originally entered except from that portion against Farmers for damages for breach of contract in the net sum (after plaintiff’s remittitur) of $1,907.97, plus accumulated interest of $601.06.

A brief summary of the facts indicate that on December 3, 1967, plaintiff and his wife were injured in an automobile collision. At the time of the accident, plaintiff was insured under an automobile liability policy with Farmers Insurance Exchange, an interinsurance exchange (hereinafter Farmers). Included in the benefits of said policy was reimbursement up to $2,000 per person for necessary medical expenses arising out of an automobile accident.

Plaintiff filed his proof of claim with the Orange County claims office of Farmers on the day of the collision. On December 13, 1967, the claims office received a first medical report together with an authorization executed on the company form giving Farmers complete access to any and all medical, hospital and doctors’ records pertaining to treatment and medical care to plaintiff and his wife.

Following emergency examination and treatment, Mr. and Mrs. Hale began a course of treatment with Dr. Zinkan, which lasted several months.

As treatment progressed, Farmers paid certain benefits amounting to approximately $92. However, after learning the treating doctor had referred plaintiff to an orthopedist, Dr. Merlin C. Smith, Farmers refused to pay further benefits.

[688] Although Dr. Zinkan’s first medical report did not reflect any injury to plaintiff’s lumbar spine, and estimated his disability as one month, symptoms developed within two weeks of the accident and followed the clinical pattern of a traumatic herniated disc: positive electromyogram three weeks following the collision; pain radiating down the inside of plaintiff’s legs, persistent and increasing radiation pain in leg.

On February 20, 1968, Dr. Smith’s examination revealed a positive sciatic stretch, and a lumbar myelogram confirmed the injury to the disc. Surgery was performed on February 23, 1968.

Defendant Sally Lawrence handled the processing of plaintiff’s claim for medical benefits. She had three years’ experience in handling claims and six years’ experience in reading medical reports. Her superior was defendant Eugene J. Penasa, who was claims supervisor of the Santa Ana claims office of Farmers. He had been with the company since 1957, and claimed experience and understanding of traumatic ruptured disc injuries.

Defendant Lawrence talked to Dr. Zinkan’s office on February 13, 1968. She was advised plaintiff required additional treatment and, in fact, was • being referred to an orthopedic doctor, Dr. Merlin C. Smith.

An appointment was set up with an orthopedic surgeon selected by defendant insurance company for an independent medical examination. When informed of the appointment plaintiff’s wife called defendant Lawrence and advised her that plaintiff was unable to keep it because he was then hospitalized, recuperating from back, surgery. No other independent examination of plaintiff was requested by the company.

In March 1968, an investigator for Allstate Insurance examined plaintiff’s file at Farmers in connection with a claim by plaintiff against the adverse driver in the accident, who was insured by Allstate. He made a detailed report of this examination of Farmers’ file including therein an itemization of expenses for hospital and medical bills for surgery. He also specified the names and addresses of the doctors and the hospital, and the general nature of the surgery performed on Mr. Hale.

Defendants claimed they never received any bills from plaintiff until December 12, 1968, and had no medical report in their file relating the disc injury to the accident of December 3, 1967. They continued to refuse payment.

Failing to obtain payment, plaintiff turned the matter over to his attorney, who received a letter dated March 3, 1969, from defendant Penasa indicating payment would be forthcoming if plaintiff would furnish a medi[689] cal report giving them sufficient information to substantiate that the injury was related to the accident.

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Hale v. Farmers Insurance Exchange, 42 Cal. App. 3d 681, 117 Cal. Rptr. 146, 1974 Cal. App. LEXIS 1258 (Cal. Ct. App. 1974).

42 Cal. App. 3d 681 (Hale v. Farmers Insurance Exchange) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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