Perez-Crisantos v. State Farm Fire & Cas. Co.

CourtWashington Supreme Court
DecidedFebruary 2, 2017
Docket92267-5
StatusPublished

This text of Perez-Crisantos v. State Farm Fire & Cas. Co. (Perez-Crisantos v. State Farm Fire & Cas. Co.) is published on Counsel Stack Legal Research, covering Washington Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Perez-Crisantos v. State Farm Fire & Cas. Co., (Wash. 2017).

Opinion

NOTICE: SLIP OPINION (not the court’s final written decision)

The opinion that begins on the next page is a slip opinion. Slip opinions are the written opinions that are originally filed by the court. A slip opinion is not necessarily the court’s final written decision. Slip opinions can be changed by subsequent court orders. For example, a court may issue an order making substantive changes to a slip opinion or publishing for precedential purposes a previously “unpublished” opinion. Additionally, nonsubstantive edits (for style, grammar, citation, format, punctuation, etc.) are made before the opinions that have precedential value are published in the official reports of court decisions: the Washington Reports 2d and the Washington Appellate Reports. An opinion in the official reports replaces the slip opinion as the official opinion of the court. The slip opinion that begins on the next page is for a published opinion, and it has since been revised for publication in the printed official reports. The official text of the court’s opinion is found in the advance sheets and the bound volumes of the official reports. Also, an electronic version (intended to mirror the language found in the official reports) of the revised opinion can be found, free of charge, at this website: https://www.lexisnexis.com/clients/wareports. For more information about precedential (published) opinions, nonprecedential (unpublished) opinions, slip opinions, and the official reports, see https://www.courts.wa.gov/opinions and the information that is linked there. This opinion was filed for record For the current opinion, go to https://www.lexisnexis.com/clients/wareports/. at ;£:QQ onfih 2)'Dlj Ocro

~~ SUSAN L. CARLSON SUPREME COURT CLERK

IN THE SUPREME COURT OF THE STATE OF WASHINGTON

ISIDORO PEREZ-CRISANTOS, ) a single man, ) ) Appellant, ) No. 92267-5 ) v. ) ) EnBanc STATE FARM FIRE AND ) CASUALTY COMPANY, ) a foreign insurance company, and ) DOE CORPORATIONS I through V, ) ) Respondents. ) Filed FEB 0 2 2017 ___ )

GONZALEZ, J. - In 2007, the legislature passed, and the voters of this

state ratified, the Insurance Fair Conduct Act (IFCA), RCW 48.30.015.

IFCA gives insureds a new cause of action against insurers who

unreasonably deny coverage or benefits. RCW 48.30.015(1). IFCA also

directs courts to grant attorney fees and authorizes courts to award triple

damages if the insurer either acts unreasonably or violates certain insurance

regulations. RCW 48.30.015(2)-(3), (5). These regulations broadly address

unfair practices in insurance, not just unreasonable denials of coverage or For the current opinion, go to https://www.lexisnexis.com/clients/wareports/. Perez-Crisantos v. State Farm, No. 92267-5

benefits. RCW 48.30.015(5). We are asked to decide whether IFCA also

created a new and independent private cause of action for violation of these

regulations in the absence of any unreasonable denial of coverage or

benefits. 1 We conclude it did not and affirm.

FACTS

In November 2010, Isidoro Perez-Crisantos was waiting to turn left

off snowy Wellesley Avenue in Spokane when his car was struck from

behind by Martin Reyes. Clerk's Papers (CP) at 5, 391. Perez-Crisantos

was injured and incurred more than $50,000 in medical bills that he contends

were the result of the accident. Perez-Crisantos had first party personal

injury protection (PIP) and underinsured motorist insurance (UIM) coverage

from State Farm Fire and Casualty Company. State Farm paid the PIP

coverage limits of $10,000 in medical expenses and $400 in lost wages.

Reyes carried $25,000 in liability insurance. Perez-Crisantos settled with

Reyes for his policy limits and made a first party UIM claim to State Farm

for the remaining damages resulting from the accident. State Farm did not

pay benefits under the UIM policy. According to Perez-Crisantos, State

1 The concurrence objects to the way we have framed the issue, suggesting that this caused us to stray from the language and intent of IF CA. But it is the concurrence that strays from RCW 48.30.015. Rather than insert language into the statute that the legislature purposefully omitted, our decision comports with the actual language ofRCW 48.30.015 and is framed consistently with the way the parties have framed the issue.

2 For the current opinion, go to https://www.lexisnexis.com/clients/wareports/. Perez-Crisantos v. State Farm, No. 92267-5

Farm denied his UIM claim after its adjustor, who was not a medical expert,

concluded that Perez-Crisantos was seeking benefits for excessive

chiropractic treatment and an unrelated shoulder surgery. According to State

Farm, it has "not denied underinsured motorist benefits to Mr. Perez-

Crisantos. It does disagree with the valuation [counsel] has placed on his

claim." CP at 386. Either way, after Perez-Crisantos objected to the denial,

State Farm sent the file to a doctor, who concurred with the lay adjustor's

conclusions.

Perez-Crisantos sued on a variety of grounds. Among other things, he

alleged that State Farm had violated IFCA, several of IFCA' s implementing

regulations, and the Consumer Protection Act (CPA), chapter 19.86 RCW.

He also brought bad faith and negligence claims. Most of the claims were

stayed while the UIM claim was sent to arbitration. The arbiter largely

found for Perez-Crisantos. Based on the damages awarded, it appears the

arbiter concluded the shoulder injury was related to the accident, disallowed

some of the chiropractic physical therapy treatments as excessive, and

awarded Perez-Crisantos a gross amount of about $51,000. After adjusting

for Reyes's settlement, PIP benefits, and attorney fees, Perez-Crisantos

received about $24,000 from the UIM arbitration. The court lifted the stay,

and Perez-Crisantos amended his complaint to make clear he was alleging an

3 For the current opinion, go to https://www.lexisnexis.com/clients/wareports/. Perez-Crisantos v. State Farm, No. 92267-5

IFCA claim based on the violation of IFCA regulations relating to unfair

settlement practices. Specifically, he alleged that State Farm forced him to

litigate in order to get payments that were due to him.

Meanwhile, Perez-Crisantos sought discovery about State Farm's

incentive programs and the personnel files of State Farm employees

involved in processing his claim, apparently seeking evidence that State

Farm's incentive program was improperly encouraging its employees to

deny claims or settle them for unreasonably low amounts. While it is not in

the record, it appears State Farm provided discovery on the incentive

programs but resisted release of the personnel files. The trial court allowed

some discovery about the employee compensation and reviewed some

materials under seal. The judge declined to order State Farm to release the

personnel files themselves, finding Perez-Crisantos had not made a

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