Tornai v. CSAA Insurance Exchange CA1/2

CourtCalifornia Court of Appeal
DecidedDecember 18, 2023
DocketA167666
StatusUnpublished

This text of Tornai v. CSAA Insurance Exchange CA1/2 (Tornai v. CSAA Insurance Exchange CA1/2) 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
Tornai v. CSAA Insurance Exchange CA1/2, (Cal. Ct. App. 2023).

Opinion

Filed 12/18/23 Tornai v. CSAA Insurance Exchange CA1/2

NOT TO BE PUBLISHED IN OFFICIAL REPORTS

California Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or relying on opinions not certified for publication or ordered published, except as specified by rule 8.1115(b). This opinion has not been certified for publication or ordered published for purposes of rule 8.1115.

IN THE COURT OF APPEAL OF THE STATE OF CALIFORNIA

FIRST APPELLATE DISTRICT

DIVISION TWO

KATHRYN TORNAI, Plaintiff and Respondent, A167666 v. CSAA INSURANCE EXCHANGE, (Sonoma County Super. Ct. No. SCV271737) Defendant and Appellant.

After plaintiff Kathryn Tornai filed a lawsuit against her insurance company for breach of contract and bad faith, defendant insurance company filed a motion to compel arbitration of her underinsured motorist claim. The motion was made pursuant to a provision in plaintiff’s automobile policy, which, as mandated by Insurance Code1 section 11580.2, subdivision (f), requires the parties to arbitrate any dispute over entitlement to recover damages caused by an uninsured or underinsured motorist2 or the amount of

1 Undesignated statutory references are to the Insurance Code unless

otherwise specified. 2 Section 11580.2 governs both uninsured motorist (UM) and

underinsured motorist (UIM) coverage, and the policy here defines “ ‘Uninsured motor vehicle’ ” to include “underinsured motor vehicle[s].” For purposes of this opinion, the terms are used interchangeably.

1 damages. The trial court denied the motion, and defendant appeals. We conclude that the denial was error, and we reverse. BACKGROUND The Parties and the General Setting In August 2021, plaintiff Kathryn Tornai (plaintiff) entered into a contract with defendant CSAA Insurance Exchange (defendant) to provide automobile insurance for her vehicle (policy). The policy had a clause in the UM/UIM coverage endorsement, which read: “We will pay damages, other than punitive or exemplary damages, for bodily injury to an insured person, which an insured person is legally entitled to recover from the owner or operator of an uninsured motor vehicle. The bodily injury must be caused by accident and arise out of the ownership, maintenance or use of the uninsured motor vehicle. [¶] Determination whether an insured person is legally entitled to recover damages or the amount of damages shall be made by agreement between the insured person and us. If no agreement is reached, the decision will be made by arbitration.” Several paragraphs later, the policy reads: “ARBITRATION [¶] If an insured person makes a claim under this Part and we do not agree that such person is legally entitled to recover damages from the owner or operator of an uninsured motor vehicle because of bodily injury to such insured person, or, if so entitled, do not agree as to the amount, then either party, on written demand of the other, shall institute arbitration proceedings as provided in Section 11580.2 and the following sections of the Insurance Code . . . .” According to the complaint that plaintiff would come to file, on February 2, 2022, she was injured in a traffic accident with another driver. In September, plaintiff settled with the driver’s insurance carrier for $25,000,

2 his policy limits. Plaintiff’s policy provided UM/UIM coverage of up to $300,000 per accident. Plaintiff made a written demand to defendant under the policy for $275,000—the policy limits of $300,000, less the $25,000 she had already received from the settlement with the UIM. Defendant refused to tender the $275,000 demanded. The Proceedings Below On October 3, 2022, plaintiff filed her complaint against defendant alleging breach of written contract and breach of the implied covenant of good faith and fair dealing. The allegations in support of both causes of action were the same and included the following: defendant failed to settle or make any offer “when Plaintiff’s damages clearly exceed the policy limit with numerous surgeries having been undergone”; defendant failed to “promptly respond to Plaintiff’s communications with respect to the claim” and “ignor[ed] time limited settlement demands”; defendant “[w]ithh[eld] benefits due to Plaintiff when [defendant] knew, or should have known, Plaintiff was entitled to”; and defendant failed to adequately investigate plaintiff’s injuries and damages. On November 18, defendant filed a motion to compel arbitration. It was accompanied by a memorandum of points and authorities and the declaration of defense counsel. The declaration in turn attached a copy of plaintiff’s policy; defense counsel’s letter to plaintiff’s counsel demanding the parties arbitrate their dispute over the UIM claim pursuant to the arbitration provision in the policy; and plaintiff’s counsel’s subsequent email again pressing for tender of policy limits of $275,000, but otherwise not responding to the arbitration demand. In its motion, defendant asserted that it “has disputed the amount that Plaintiff claimed under the policy and

3 therefore the dispute falls squarely within the arbitration provision of [t]he Auto Policy.” Plaintiff filed her opposition, which was accompanied by her counsel’s declaration. The declaration attached plaintiff’s written demands to defendant for tender of the available policy limits in the amount of $275,000. It also attached copies of medical bills and expenses purportedly totaling $30,451.98 as of August 2022, which plaintiff had incurred as a result of the accident and she had produced in response to defendant’s discovery requests. In her opposition, plaintiff argued that “[t]his case falls outside the narrow scope of . . . section 11580.2 and, simply, does not present an arbitrable UM dispute.” She maintained that “arbitration cannot be compelled as to funds that are undisputedly owed.” (Capitalization omitted.) According to plaintiff, defendant “cannot dispute that [she] is entitled to at least $30,451.98 for medical expenses on her UM claim.” She further asserted defendant “engaged in delay tactics to avoid payment.” Defendant’s failure to pay her $30,451.98, plaintiff argued, “is a violation of [defendant’s] duty to Plaintiff” and “is unacceptable and should not be condoned by allowing [defendant] to hide behind arbitration.” Next, relying mainly on Hightower v. Farmers Insurance Exchange (1995) 38 Cal.App.4th 853 (Hightower), plaintiff argued she “should not be required to complete arbitration proceedings prior to filing [her lawsuit].” She claimed that “[i]f an insurer breaches the insurance contract and/or engages in tortious conduct, as [defendant] has done here by delaying payment of undisputed funds, it should not be allowed a safe-harbor while the arbitration is being conducted.” Finally, plaintiff raised a waiver defense. She argued that the trial court “can, and should, hold that [defendant’s] bad faith in refusing to pay its

4 insured $30,451.98 undisputedly owed . . . has resulted in the waiver of [defendant’s] right to compel arbitration of Plaintiff’s claim for payment of the $244,548.02 remaining in dispute under the $300,000.00 UM policy.” (Italics omitted.) Defendant filed a reply, asserting that plaintiff’s opposition made “two key factual misstatements.” First, defendant argued that contrary to plaintiff’s assertion, it had in fact offered to pay plaintiff $2,920 for medical expenses. Second, defendant refuted plaintiff’s claim that $30,451.98 is “ ‘undisputedly owed’ ” to her. Defendant explained: “This case presents the complication of there being Medi-Cal insurance payments made for medical services related to the claim. Defendant has asked Plaintiff to provide the Medi-Cal documentation, as Defendant acknowledges that the reduced amount of Medi-Cal’s actual payments is legally owed.

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Tornai v. CSAA Insurance Exchange CA1/2, Counsel Stack Legal Research, https://law.counselstack.com/opinion/tornai-v-csaa-insurance-exchange-ca12-calctapp-2023.