State Farm Fire and Casualty Company, Cross-Appellant v. George Balmer and Margaret Balmer, Cross-Appellees

891 F.2d 874, 1990 U.S. App. LEXIS 343, 1990 WL 4
CourtCourt of Appeals for the Eleventh Circuit
DecidedJanuary 11, 1990
Docket87-7699
StatusPublished
Cited by20 cases

This text of 891 F.2d 874 (State Farm Fire and Casualty Company, Cross-Appellant v. George Balmer and Margaret Balmer, Cross-Appellees) is published on Counsel Stack Legal Research, covering Court of Appeals for the Eleventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
State Farm Fire and Casualty Company, Cross-Appellant v. George Balmer and Margaret Balmer, Cross-Appellees, 891 F.2d 874, 1990 U.S. App. LEXIS 343, 1990 WL 4 (11th Cir. 1990).

Opinion

VANCE, Circuit Judge:

George and Margaret Balmer appeal from the grant of judgment notwithstanding the verdict in favor of State Farm Fire and Casualty Company, (“State Farm”), on the Balmers’ bad faith failure to pay claim. For the reasons stated below, we affirm.

I.

On Sunday, April 13, 1986, a fire demolished the farm house of George and Margaret Balmer located near China Grove, Alabama. The house was insured by a policy of insurance with State Farm which was scheduled to expire the next day. After investigating the claim, State Farm paid the dwelling coverage to the mortgagee, denied contents coverage, and brought this declaratory judgment action, alleging that it was not obligated to pay for the loss of the structure or personal property because the Balmers had intentionally concealed material facts from State Farm by misrepresenting the value of the contents destroyed in the fire and procured or set the fire. The Balmers counterclaimed for bad faith failure to pay.

After a trial lasting several days the jury concluded that State Farm was guilty of bad faith in denying the Balmers’ claim and awarded punitive damages of $1.5 million, $45,650.00 for breach of contract, and $265,000.00 in compensatory damages. The trial court granted State Farm’s motion for judgment notwithstanding the verdict, concluding that it had been error to submit the bad faith claim to the jury because State Farm had an arguable basis for denying the claim. Accordingly, the court reduced the award of damages to $48,-404.90. State Farm Fire & Casualty Co. v. Balmer, 672 F.Supp. 1395 (M.D.Ala.1987).

II.

This is a diversity case involving Alabama law. The tort of bad faith failure to pay an insurance claim was first recognized in Alabama in Chavers v. National Sec. Fire & Casualty Co., 405 So.2d 1 (Ala.1981). The prima facie showing which must be met in order to submit a bad faith claim to the jury was originally stated as “either ‘(1) no lawful basis for the refusal coupled with actual knowledge of that fact or (2) intentional failure to determine whether or not there was any lawful basis for such refusal.’ ” Id. at 7 (citation omitted). In cases decided after Chavers, the supreme court has interpreted the second tier as a method of proving the first.

The second tier of the test is an elaboration on the first. The trier of fact, by finding, on the part of the insurer, an “intentional failure to determine whether or not there was any lawful basis for-refusal,” may use that fact as an element of proof that no lawful basis for refusal ever existed. The relevant question before the trier of fact would be whether a claim was properly investigated and whether the results of the investigation were subjected to a cognitive evaluation and review. Implicit in that test is the conclusion that the knowledge or reckless disregard of the lack of a legitimate or reasonable basis may be inferred and imputed to an insurance company when there is a reckless indifference to facts or to proof submitted by the insured. Of course, if a lawful basis for denial actually exists, the insurer, as a matter of law, cannot be held liable in an action based upon the tort of bad faith.

Gulf Atlantic Life Ins. Co. v. Barnes, 405 So.2d 916, 924 (Ala.1981). Accordingly, however recklessly an insurer conducts its investigation, a bad faith claim cannot succeed where the insurer had an arguably lawful basis for denying the claim. “When *876 a claim is ‘fairly debatable,’ the insurer is entitled to debate it, whether the debate concerns a matter of fact or law.” National Sec. Fire & Casualty Co. v. Bowen, 417 So.2d 179, 183 (Ala.1982) (citation omitted). A debatable reason for denying a claim is “an arguable reason, one that is open to dispute or question.” Id. If the evidence offered by the insured “fails to eliminate any arguable reason for denying payment, any fairly debatable reason on a matter of fact or a matter of law, he cannot recover under the tort of ‘bad faith refusal.’ ” Id. at 185. Whether the insurer had such an arguable basis for denial is judged as of the time the decision to deny is made. See National Savings Life Ins. Co. v. Dutton, 419 So.2d 1357, 1362 (Ala.1982).

To apply this standard, the supreme court has developed a “directed verdict on the contract claim” test which must be met in normal cases before a bad faith claim can be submitted to the jury. Under this test the insured must offer proof that he or she is entitled to recover on the contract claim as a matter of law. “Ordinarily, if the evidence produced by either side creates a fact issue with regard to the validity of the claim and, thus, the legitimacy of the denial thereof, the tort claim must fail and should not be submitted to the jury.” Id.

The supreme court has recognized several “extraordinary” cases in which the directed verdict standard does not apply. In these cases, an insured may be able to submit a bad faith claim to the jury even though the proof would not satisfy the directed verdict on the contract claim requirement. In his concurrence in Safeco Ins. Co. of America v. Sims, 435 So.2d 1219 (Ala.1983), Justice Jones discussed when such an extraordinary case might arise.

Exceptions to the “directed verdict” rule will undoubtedly arise. Take the case where the insurer insists that its refusal of payment was grounded solely on a particular entry in a hospital record, and plaintiff denies the very existence of such an entry. Merely because the insurer may be able to withstand a directed verdict motion — the existence vel non of the record entry itself being a issue of fact — would not, as a matter of law, bar the plaintiff’s tort claim. This extreme example is to be distinguished from the more normal situation in which the factual dispute centers around the reasonable, but conflicting, inferences which may be drawn from a hospital record entry.

Id. at 1225. See also Continental Assurance Co. v. Kountz, 461 So.2d 802, 807 (Ala.1984) (exceptional circumstance where insurer intentionally failed to determine the existence of a valid reason for denying the claim); Aetna Life & Casualty Ins. Co. v. Lavoie, 470 So.2d 1060 (Ala.1984), vacated 475 U.S. 813, 106 S.Ct. 1580, 89 L.Ed.2d 823 (1986), on remand, 505 So.2d 1050 (Ala.1987) (same); Jones v. Alabama Farm Bureau Mut. Casualty Co., 507 So.2d 396, 401 (Ala.1986) (exceptional circumstance where basis for denial was itself a disputed issue of fact).

After considering these standards, the district court determined that this was not a “special” case to which the directed verdict standard does not apply. The court also determined that evidence of possible arson and misrepresentation of contents gave State Farm an arguable basis for denying the claim. Accordingly, the court granted State Farm’s motion for judgment notwithstanding the verdict.

A.

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891 F.2d 874, 1990 U.S. App. LEXIS 343, 1990 WL 4, Counsel Stack Legal Research, https://law.counselstack.com/opinion/state-farm-fire-and-casualty-company-cross-appellant-v-george-balmer-and-ca11-1990.