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

389 P.3d 476, 187 Wash. 2d 669
CourtWashington Supreme Court
DecidedFebruary 2, 2017
DocketNo. 92267-5
StatusPublished
Cited by101 cases

This text of 389 P.3d 476 (Perez-Crisantos v. State Farm Fire & Casualty 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 & Casualty Co., 389 P.3d 476, 187 Wash. 2d 669 (Wash. 2017).

Opinions

González, J.

¶1 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 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.

[673]*673Facts

¶2 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 under-insured 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 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.

¶3 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 [674]*674excessive, 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 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.

¶4 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 sufficient showing.

¶5 State Farm moved for summary judgment dismissal, largely on the merits. It argued that there was no genuine dispute that it had acted reasonably and in good faith throughout the claims process, that Perez-Crisantos had not alleged a cognizable claim, and that the parties merely had a reasonable disagreement about the value of the claim. Unfortunately, the record does not reveal State Farm’s valuation of the UIM claim. Relying largely on unreported cases out of federal court, State Farm argued that a delay in payment of UIM benefits until after arbitration is not a denial of payment under IFCA. CP at 56-57 (citing Beasley v. State Farm Mut. Auto. Ins. Co., No. C13-1106RSL, 2014 WL 1494030, at *6, 2014 U.S. Dist. LEXIS 53205, at *10 (W.D. Wash. Apr. 16, 2014) (court order); Countiy Preferred Ins. Co. v. Hurless, No. C11-1349RSM, [675]*6752012 WL 2367073, at *4, 2012 U.S. Dist. LEXIS 86334, at *8 (W.D. Wash. June 21, 2012) (court order)). Perez-Crisantos moved for partial summary judgment, contending that State Farm had violated WAC 284-30-330(7)’s prohibition on making a first party claimant litigate to recover “ ‘amounts due under an insurance policy by offering substantially less than the amounts ultimately recovered in such actions.’ ” CP at 104 (quoting WAC 284-30-330(7)). He also argued that State Farm’s summary judgment motion was premature because discovery on State Farm’s employee incentive program was not complete.

¶6 At the summary judgment hearing, the trial judge took issue with Perez-Crisantos’s characterizing State Farm as having “made a zero offer” on the UIM claim. Verbatim Report of Proceedings (VRP) at 10-11. In the judge’s view, “it verges on being misleading in terms of trying to evaluate whether or not you have a basis for a summary judgment.” Id. at 11. Instead, the judge characterized State Farm as arguing that Perez-Crisantos had been fully compensated for his injuries from Reyes’s policy limits and State Farm’s PIP payment. She concluded that “[t]here has never been one scintilla of evidence” that State Farm’s actions were “unreasonable and there must have been some ulterior motive” for them, such as “some sort of incentive program to ‘lowball claims.’ ” Id. at 27. She dismissed the case with prejudice on the merits. Perez-Crisantos sought direct review, which we granted.

Analysis

¶7 This case is before us on appeal from summary judgment and asks us to interpret a statute. Our review of both is de novo. Auto. United Trades Org. v. State, 183 Wn.2d 842, 853-54, 357 P.3d 615 (2015) (citing Freeman v. State, 178 Wn.2d 387, 393, 309 P.3d 437 (2013); Lummi Indian Nation v. State, 170 Wn.2d 247, 257-58, 241 P.3d [676]*6761220 (2010)). Summary judgment “may be granted if the pleadings, affidavits, and depositions before the trial court establish that there is no genuine issue of material fact and that as a matter of law the moving party is entitled to judgment.” Ruff v. County of King, 125 Wn.2d 697, 703,

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Cite This Page — Counsel Stack

Bluebook (online)
389 P.3d 476, 187 Wash. 2d 669, Counsel Stack Legal Research, https://law.counselstack.com/opinion/perez-crisantos-v-state-farm-fire-casualty-co-wash-2017.