Major v. Western Home Insurance

169 Cal. App. 4th 1197
CourtCalifornia Court of Appeal
DecidedJanuary 30, 2009
DocketD050479
StatusPublished
Cited by92 cases

This text of 169 Cal. App. 4th 1197 (Major v. Western Home Insurance) is published on Counsel Stack Legal Research, covering California Court of Appeal primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Major v. Western Home Insurance, 169 Cal. App. 4th 1197 (Cal. Ct. App. 2009).

Opinion

Opinion

NARES, J.

In this insurance bad faith action arising out of the destruction of Patrick A. and Elsa L. Major’s (together the Majors) home in the Cedar Fire in October 2003, their insurer, Western Home Insurance Company (Western), appeals from a jury verdict against it totaling approximately $1.3 million, consisting of $31,359.55 in economic damages, $450,000 in noneconomic damages, $189,000 in attorney fees, and $646,471.53 in punitive damages. On appeal, Western asserts the verdict must be reversed because (1) it had no legal duty to pay the insurance benefits the Majors claim were withheld because they were “courtesy benefits” over and above the coverage limits in their policy; (2) no substantial evidence supports the amount of compensatory damages awarded by the jury; (3) the award of noneconomic damages is excessive; (4) the emotional distress award is the result of prejudicial instructional error; (5) the amount of the attorney fees award is not supported by substantial evidence; (6) the punitive damages award is not supported by substantial evidence that a “managing agent” of Western committed the alleged bad faith; (7) a new trial on the amount of punitive damages is necessary if this court reduces or eliminates the compensatory damages award; and (8) the punitive damages verdict is inconsistent on the findings on malice and oppression. We affirm.

FACTUAL AND PROCEDURAL BACKGROUND 1

A. The Insurance Policy

In 2001 the Majors obtained a homeowners policy from Western for their house in El Cajon, California. At the time of the fire, the policy provided coverage of $193,000 for their dwelling (coverage A), $19,300 for other structures (coverage B), $135,100 for personal property (coverage C), $38,600 for living expenses (coverage D), and $18,000 for mortgage disaster protection.

*1204 The policy was an “extended replacement cost” policy. Under this coverage, “In the event of any covered loss” to the Majors’ home, Western agreed to repair or replace their home “up to specified percentage over the policy’s limits of liability” as specified in the declarations page of the policy. The declarations page specified that the extended replacement cost was 25 percent over the policy limits, meaning the coverage under the policy, as written, called for coverage A limits of $241,250, coverage B of $24,125, coverage C of $168,875, and coverage D of $48,250.

As a condition to recovering extended replacement cost coverage, Western required that the dwelling coverage limits be equal to the cost to replace the home. In order to ensure the proper amount of coverage was granted, the policy required that the Majors “must permit an inspection of the dwelling by the insurance company” and required a physical inspection of the home be made and a report issued identifying the replacement cost. However, Western did not send an inspector until after the policy was issued and the coverage limits set. The inspection report identified the replacement cost as $235,578, approximately $43,000 more than the coverage for the dwelling listed in the policy. Based on this valuation, the extended replacement cost coverage for coverage A should have been $305,216, for coverage B $30,522, for coverage C $213,651, and coverage D $61,043.

As will be discussed, post, once the discrepancy was discovered after the Majors retained counsel, Western, by a letter dated February 23, 2005, increased the coverage limits to match these amounts. This was based upon Western’s policy that required a modification of the coverage amount if the inspection number was not equal to the coverage in the policy.

The policy allowed for modifications, but required that in order to be valid they must be in a writing prepared by Western.

B. The Cedar Fire and Western’s Claims Handling

In October 2003 the Cedar Fire burned the Majors’ home and all of their personal belongings in the house. The only things that survived were “a few pieces of porcelain . . . [and] a couple jars of pennies that were kind of fused together.”

Western used a company named Cambridge Integrated Services (Cambridge) to administer their claims. Cambridge regional manager/supervisor/claims representative Linda Dare supervised the Majors’ file and agreed that “[t]ime was of the essence” because their home was gone. In October 2003 Dare assigned the file to claims adjuster Richard Fleming. Western did not make its first payment on the dwelling until February 2004. Western failed to make a *1205 mortgage payment on time that month. Fleming also refused to provide the Majors with a copy of the policy, despite several requests.

In May 2004 Dare reassigned the claim to Andrew Anderson. At that time, Anderson had not received training required by California law in fair claims settlement practice. 2 Moreover, although Dare knew that requiring an adjuster to process anything more than 75 to 100 claims was “way too many to handle,” over the time the Majors’ claim was assigned to Anderson, he handled over 200 other claims.

At the time Anderson took over the file, Western was two months behind on payment of mortgage benefits and behind in payments for the trailer the Majors were living in on their property. The Majors received complaints from their lender and had to use their savings to pay their mortgage. In May 2004 Patrick Major sent a letter to Western regarding unresolved issues regarding their claim. They submitted invoices for $25,315 to replace their pool, inquired about replacing a spa destroyed by the fire, and told Anderson they would be providing an inventory of personal property lost in the fire. Shortly thereafter, the Majors sent Western a 77-page inventory of personal property for payment.

Anderson did not respond and the Majors followed up with phone calls on May 25, 28 and June 1, 2004. On June 2, Anderson called back and told the Majors he had not reviewed the claims file and would call them back on June 7. He did not do so and the Majors called him on June 9. At that time, Anderson again said he had not reviewed the file and told them their claim was “third in his stack.” He told the Majors on at least three occasions their claim was not his top priority.

On June 15, 2004, the Majors contacted Anderson again because the issues raised in their May 14 letter had still not been addressed. Anderson told the Majors that two adjusters had quit, he had been given additional files to manage, and he had not yet read the claims file. On June 25, 2004, the Majors again contacted Western regarding the issues raised in the May 14 letter. Anderson said he had “glanced over [the letter] but ha[d]n’t had time to go over it yet.”

Anderson reviewed the May 14 letter on or about July 12. Anderson thereafter told the Majors they were not entitled to recover the cost of replacing their pool because it fell within the coverage for the dwelling, and *1206 the policy limit for the dwelling had already been met. Anderson also stated he did not know what coverage the spa fell under.

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Cite This Page — Counsel Stack

Bluebook (online)
169 Cal. App. 4th 1197, Counsel Stack Legal Research, https://law.counselstack.com/opinion/major-v-western-home-insurance-calctapp-2009.