Nager v. Allstate Ins. Co.

99 Cal. Rptr. 2d 348, 83 Cal. App. 4th 284
CourtCalifornia Court of Appeal
DecidedAugust 23, 2000
DocketG024720
StatusPublished
Cited by19 cases

This text of 99 Cal. Rptr. 2d 348 (Nager v. Allstate Ins. Co.) 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
Nager v. Allstate Ins. Co., 99 Cal. Rptr. 2d 348, 83 Cal. App. 4th 284 (Cal. Ct. App. 2000).

Opinion

99 Cal.Rptr.2d 348 (2000)
83 Cal.App.4th 284

Bram NAGER, Plaintiff and Appellant,
v.
ALLSTATE INSURANCE COMPANY, Defendant and Respondent.

No. G024720.

Court of Appeal, Fourth District, Division Three.

July 31, 2000.
As Modified August 23, 2000.

*349 Glickman & Glickman and Steven C. Glickman, Beverly Hills, for Plaintiff and Appellant.

Luce, Forward, Hamilton & Scripps, Charles A. Bird, Peter H. Klee and Ronald D. Getchey, San Diego, for Defendant and Respondent.

OPINION

CROSBY, J.

The trial court properly granted an insurer's summary judgment motion in an insured's bad faith claim arising out of $2,000 in disputed no-fault medical payment benefits to a chiropractor lien claimant. The insurer promptly paid what appeared to be the chiropractor's reasonable and necessary bills, and the remainder of *350 the lien was satisfied from the proceeds of the insured's settlement with the drunk driver.

I

Plaintiff Bram Nager was the named insured under an automobile policy with defendant Allstate Insurance Company for his 1984 500 SEC Mercedes Benz. In addition to third party liability coverage, the policy provided no-fault medical payments (med-pay) coverage for up to $10,000 for expenses "actually incurred" by an insured for "necessary" medical treatment for bodily injury arising out of an automobile accident.[1] The drunk driver was insured by Farmers Insurance Company (Farmers). Nager sued the driver and an adjacent property owner for damages arising out of the accident.

While Nager did not seek medical treatment at the accident scene, he went to Michael Weinstein, an orthopedist, three days later, complaining of stiffness and pain in his neck, stabbing pains in his low back and numbness in his right leg. Weinstein suggested physical therapy and chiropractic treatment. Nager was first seen by a chiropractor, John Vostmyer, in late October 1994.

Vostmyer frequently testified as an expert in personal injury matters, having done so in over 100 cases. Nager signed a contractual lien against the proceeds of any settlement, judgment or verdict he might obtain. In November 1994, Vostmyer prepared an initial evaluation report for Nager's trial counsel.

Allstate initially paid some $470 to Vostmyer for his services. In January 1995, he billed Allstate an additional $705. Allstate cut this charge by $400 because the treatments "exceed[ed] frequency guidelines from the initial date of service" and because "physical therapy exceed[ed] expected duration for the diagnosis indicated."

In April 1995, Allstate paid $500 of a new bill for $775, declining to pay for the attorney report. Vostmyer sent Allstate new statements for an additional $1,400 for treatments from January through May 1995, which the carrier did not pay. The combined contested balance totaled approximately $2,000.

Nager sued Allstate for bad faith in September 1995. His expert, Frank Orma, an insurance claims consultant, opined that Allstate's claims handling practices were unreasonable because it relied upon standardized expectations of the duration of treatment, based on a diagnosis code. He criticized Allstate for not obtaining "an independent medical (or in this case, chiropractic) review of the bills and records."

In February 1996, Vostmyer was paid in full from the proceeds of Nager's settlement with Farmers, acting on the other motorist's behalf. Farmers paid a total of $21,000 to settle Nager's personal injury claim and had earlier entered into a settlement of $20,000 for the property damage claim.

II

We consider the totality of the circumstances involving Allstate's handling of Nager's med-pay claim. Not every first party insurance claim is transmogrified into a bad faith suit simply because an insurer questions the amount of a bill before paying it. To give rise to tort liability for bad faith, the insurer's conduct not only must be erroneous but "unreasonable" or "without proper cause" as well (Dalrymple v. United Services Auto. Assn. (1995) 40 Cal.App.4th 497, 513-514, 46 Cal. Rptr .2d 845 [affirming summary judgment for insurer which raised legitimate third party coverage dispute]; Opsal v. United Services Auto. Assn. (1991) 2 Cal.App.4th 1197, 1205, 10 Cal.Rptr.2d 352 [reversing *351 bad faith verdict of over $1.7 million in compensatory and punitive against homeowner's insurer which declined to pay property damage claim based on "genuine" policy dispute].)

The reasonableness of an insurer's claims handling conduct in a first-party coverage case becomes a question of law, properly determined on summary judgment, where the evidence is undisputed and but one inference can be drawn. (Lee v. Crusader Ins. Co. (1996) 49 Cal.App.4th 1750, 57 Cal.Rptr.2d 550 [summary judgment affirmed]; Carlton v. St. Paul Mercury Ins. Co. (1994) 30 Cal.App.4th 1450, 1459, 36 Cal.Rptr.2d 229 [same]; Globe Indemnity Co. v. Superior Court (1992) 6 Cal.App.4th 725, 8 Cal.Rptr.2d 251 [writ issued to compel summary judgment].)

In Lee v. Crusader Ins. Co., supra, 49 Cal.App.4th 1750, 57 Cal.Rptr.2d 550, the court affirmed a summary judgment for an insurer in a first-party bad faith claim arising out of an arson fire that destroyed the insured's liquor store during the Los Angeles riots. Although the insurer strongly doubted the validity of the arson charges, it conducted no independent investigation, choosing to wait until the insureds were acquitted in a criminal prosecution. Lee held the insurer had a "reasonable basis for deferring action on the [insureds'] claim." (Id. at p. 1759, 57 Cal.Rptr.2d 550.)

In like fashion, in Carlton v. St. Paul Mercury Ins. Co., supra, 30 Cal.App.4th 1450, 36 Cal.Rptr.2d 229, the court affirmed an automobile insurer's summary judgment in a bad faith case alleging unreasonable delays in the payment of the insured's collision claim for damages to an antique car. The court noted that the insurer promptly paid the initial cost estimates for repairing the car, and then reopened its file once the insured reported that the costs would be greater than anticipated. While agreeing that the insurer might have handled the claim more "expeditiously in the period after ... [the insurer] indicated it would reinspect the car," Carlton held the delay was not so unreasonable as to give rise to bad faith liability, particularly since the insured himself delayed in submitting the requested paperwork. (Id. at p. 1459, 36 Cal.Rptr.2d 229.)

In Globe Indemnity Co. v. Superior Court, supra, 6 Cal.App.4th 725, 8 Cal. Rptr.2d 251, the court directed that summary judgment be granted to an automobile insurer which delayed paying any first-party benefits until the insured submitted to an examination under oath and agreed to a medical examination. (The insured had been injured while riding as a passenger on a stolen motorcycle.) According to the court, "There can be no `unreasonable delay' until the insurer receives adequate information to process the claim and reach an agreement with the insureds." (Id. at pp. 730-731, 8 Cal. Rptr.2d 251.)

Finally, in Waters v. United Services Auto. Assn. (1996) 41 Cal.App.4th 1063, 48 Cal.Rptr.2d 910, the court reversed a judgment of $1.3 million in emotional distress damages for insureds who became embroiled in a protracted dispute with their homeowner's insurer regarding rebuilding costs for their fire-damaged home. The insureds never put on any evidence that they "spent a penny of their own" as a result of the insurer's delayed payments. (

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99 Cal. Rptr. 2d 348, 83 Cal. App. 4th 284, Counsel Stack Legal Research, https://law.counselstack.com/opinion/nager-v-allstate-ins-co-calctapp-2000.