Notrica v. State Compensation Insurance Fund

83 Cal. Rptr. 2d 89, 70 Cal. App. 4th 911, 64 Cal. Comp. Cases 378, 99 Daily Journal DAR 2503, 1999 Cal. App. LEXIS 210
CourtCalifornia Court of Appeal
DecidedMarch 17, 1999
DocketB097529
StatusPublished
Cited by51 cases

This text of 83 Cal. Rptr. 2d 89 (Notrica v. State Compensation Insurance Fund) 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
Notrica v. State Compensation Insurance Fund, 83 Cal. Rptr. 2d 89, 70 Cal. App. 4th 911, 64 Cal. Comp. Cases 378, 99 Daily Journal DAR 2503, 1999 Cal. App. LEXIS 210 (Cal. Ct. App. 1999).

Opinion

Opinion

HASTINGS, J.

Introduction

Joe Notrica, doing business as Notrica’s 32nd Street Market (Notrica), sued his workers’ compensation insurer, State Compensation Insurance Fund (SCIF, sometimes State Fund or Fund), to recover in tort and for unfair business practices, based on allegations relating to SCIF’s case reserve and claims handling policies and practices. In a bifurcated proceeding, the jury awarded Notrica $478,606 in compensatory damages and $20 million in punitive damages; the trial court enjoined SCIF from various business practices and awarded $333,319.65 in attorney fees. SCIF appeals from the judgment. We conclude that the punitive damages award must be reduced to $5 million and otherwise affirm.

Procedural Background

In its complaint against SCIF, Notrica asserted two causes of action here pertinent: tortious breach of the implied covenant of good faith and fair dealing, to be determined by the jury; and unfair, unlawful, or fraudulent business practices (Bus. & Prof. Code, § 17200), to be determined by the trial court.

The implied covenant cause of action alleged the following pertinent facts.

SCIF is the state’s largest workers’ compensation carrier, created in 1914 as a public enterprise fund and subject to the jurisdiction and control of the state Insurance Commissioner. SCIF has issued policies to more than 250,000 California employers and has held itself out to the public as the most experienced carrier in California. SCIF, required by Insurance Code section 11775 to be neither more nor less than self-supporting, owns or controls assets exceeding $2.5 billion and “enjoyed a net investment gain on investment income of over $370 Million for the year ending December 31, 1989. Premiums earned for that year exceed[ed] $1.8 Billion.” SCIF *919 conducts its business in the same manner as a private carrier, can and does compete with private carriers, and is subject to the same standard of liability. SCIF may be sued in all actions arising out of any act or omission in connection with its business affairs, whether in tort or contract, pursuant to Insurance Code section 11783. 1

SCIF issued a workers’ compensation policy (Policy) to Notrica for the period June 1988 through June 1989, which obligated it to investigate, defend, and settle claims reasonably and to estimate reasonable claim reserve levels. SCIF failed to meet these obligations, resulting in its breach of the implied duty of good faith and fair dealing. SCIF breached this duty for the purposes of either receiving higher premiums or paying less dividends, and increasing its revenues and surpluses while impairing Notrica’s financial interests. As a proximate result, Notrica paid higher premiums to workers’ compensation carriers, failed to receive sufficient dividends, and was forced to hire professionals to assist it in reviewing SCIF’s conduct and to prosecute this action.

SCIF’s conduct had been intentional and constituted fraud, oppression, or malice, justifying imposition of punitive damages under Civil Code section 3294.

Under the unfair competition cause of action (Bus. & Prof. Code § 17200 et seq.), which requested restitution, punitive damages, and injunctive relief, Notrica included the following additional allegations. SCIF failed to disclose certain internal policies in order to induce Notrica to enter into the Policy agreement. Notrica reasonably relied upon the inducements and incurred damages as a result. SCIF intentionally, wrongfully and with fraud, oppression, or malice, refused to deal directly with Commercial Benefits, Notrica’s authorized representative for workers’ compensation insurance concerns, thereby interfering with the contractual relationship between Notrica and Commercial Benefits. SCIF represented that denials of reviews of claims files was to protect the privacy interests of individuals; however, its motives were to perpetrate a fraud upon Notrica and other insureds, to destroy the third party risk manager industry, to compete unfairly with private insurers, to inhibit or prevent discovery of SCIF’s fraudulent and negligent conduct, to gain and maintain an unfair advantage over its insureds and the industry, *920 to enable it to collect exorbitant premium payments, all of which acts constitute dishonest, deceptive, oppressive, fraudulent, unfair, and destructive conduct. SCIF’s interference resulted in Notrica’s overpaying premiums.

The jury rendered several findings by special verdict. It found by a preponderance of the evidence that SCIF had breached the duty of good faith and fair dealing and that such breach had resulted in Notrica’s suffering damages totaling $478,606. 2 The jury found by clear and convincing evidence that SCIF had acted with fraud, awarding $20 million in punitive damages.

The trial court, sitting in equity, found SCIF had engaged in unfair business practices (Bus. & Prof. Code, § 17200). It issued an injunction requiring SCIF to delete the term “maximum probable potential” from its claims estimating manual and to return to a previous standard. It further enjoined SCIF from denying insureds access to claims files as relevant to the employer’s premium, from refusing to communicate with an insured’s authorized representative, and from refusing to allow such representative to conduct an appropriate claim file review (Lab. Code, § 3762).

The trial court found that Notrica was the prevailing party on its cause of action for breach of the implied covenant of good faith and fair dealing, and on that ground it awarded costs and reserved jurisdiction to determine entitlement to reasonable attorney fees. At a postjudgment hearing, the trial court awarded some $300,000 in attorney fees.

SCIF asserts the following contentions on appeal:

I. An insured employer should be prohibited from recovering tort damages where the only damage claimed is the impact on future premiums.

II. The bad faith judgment must be reversed because it is not supported by SCIF’s reserving practices, claims handling, or claims review policies, including those governing its relationship to the insured’s agents.

III. The compensatory damage award must be reversed for new trial.

IV. The injunction is not supported by the law or the facts.

V. The punitive damages award must be reversed and any new trial on this issue requires retrial of all issues.

VI. The award of attorney fees should be reversed or at least limited.

*921 Discussion

I. Basis for Tort Damages

The “particular risk presented by the insured’s experience or insurance history” is one of the factors that an insurer is permitted to consider in setting premiums for its insureds. (P. W. Stephens, Inc. v. State Compensation Ins. Fund

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Bluebook (online)
83 Cal. Rptr. 2d 89, 70 Cal. App. 4th 911, 64 Cal. Comp. Cases 378, 99 Daily Journal DAR 2503, 1999 Cal. App. LEXIS 210, Counsel Stack Legal Research, https://law.counselstack.com/opinion/notrica-v-state-compensation-insurance-fund-calctapp-1999.