United American Ins. Co. v. Brumley

542 So. 2d 1231, 1989 WL 35162
CourtSupreme Court of Alabama
DecidedMarch 10, 1989
Docket85-1227
StatusPublished
Cited by32 cases

This text of 542 So. 2d 1231 (United American Ins. Co. v. Brumley) is published on Counsel Stack Legal Research, covering Supreme Court of Alabama primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
United American Ins. Co. v. Brumley, 542 So. 2d 1231, 1989 WL 35162 (Ala. 1989).

Opinion

United American Insurance Company ("United American") appeals from a judgment on a bad faith action filed by Chester Brumley1 against United American and other defendants. The jury awarded Mr. Brumley $1,005,000, and the trial court entered judgment on the verdict; the trial *Page 1233 court denied United American's motion for judgment notwithstanding the verdict or, in the alternative, a new trial. United American argues that the trial court should have directed a verdict in its favor on Mr. Brumley's bad faith claim, or, failing to grant the directed verdict, should have granted United American a judgment notwithstanding the verdict, a new trial, or a remittitur.

Throughout its entire brief, United American protests the findings of fact made by the jury. As the Court stated inHill Air of Gadsden, Inc. v. Marshall, 526 So.2d 15 (Ala. 1988):

"Factual disputes are to be resolved by the trier of fact. . . . A jury's verdict is presumed correct and will not be disturbed unless plainly erroneous or manifestly unjust. This presumption of correctness is further strengthened when a motion for new trial is denied by the judge. Pate v. Sunset Funeral Home, 465 So.2d 347 (Ala. 1984)."

526 So.2d at 17. Accordingly, we present those facts which the jury could have found that support Mr. Brumley's claim, though we will also note that version of the facts that United American contends the jury should have found.

John Dollar and Karen Hill, United American agents, sold Chester Brumley a United American "Medicare supplement" policy2 that Dollar said would "pay one hundred percent of what your other insurance won't pay." When Mr. Brumley applied for the policy in August 1983, he was 64 years old and was not covered by Medicare, and Mr. Brumley's application for United American's insurance stated both of these facts. United American agreed to sell Mr. Brumley the insurance, and he paid the insurance premium. Mr. Brumley's insurance policy stated at paragraph 6:

"[I]f you have not established entitlement to hospital and/or medical insurance benefits under Medicare, we will pay the benefits provided under this policy as though you had established entitlement."

In December 1983, Mr. Brumley was hospitalized for about a week for heart problems and dizzy spells. He was released from the hospital but returned once for an EEG test. Mr. Brumley received a bill from the hospital, a doctor's bill, and a bill for the EEG test.

Sometime between February and May 1984, Mr. Brumley's wife, Ethel, mailed the three bills to United American at the address indicated on United American envelopes. United American did not respond in any way. About August 1984, Mr. Brumley told United American agent Karen Hill that United American had not responded in any way to the claim he had filed. Hill took copies of the bills and gave the copies to Denver Green, United American's manager for eight counties in northwest Alabama; Green's duties included assisting policyholders in filing claims. Green mailed copies of the bills to United American, and Mr. Brumley received a letter from Hill dated September 25, 1984, that stated that Mr. Brumley's claim had been filed. United American sent Mr. Brumley a slip that stated:

"Your policy is a Medicare supplement contract. In order to pay benefits, we need the EXPLANATION OF MEDICARE BENEFITS or YOUR RECORD OF PART B MEDICARE BENEFITS USED forms sent you by Medicare.

"If you have recently sent these forms, disregard this notice. If you are not eligible to receive Medicare Part B, please return the enclosed bills with a note to that effect.

"Policy Benefits Department"

Shortly after receiving this slip, Mrs. Brumley wrote a letter to United American explaining that Mr. Brumley did not have Medicare because he was 64 years old. United American did not respond.

Mrs. Brumley telephoned Hill, and Hill telephoned United American's home office. Hill spoke to Janet Babb, a United American supervisor. Hill testified to the following conversation with Babb: *Page 1234

"Q. What did you tell Mrs. Babb or she tell you?

"A. She told me the reason they refused to pay was because Mr. Brumley did not have Medicare at that time.

"Q. What did you say to that?

"A. I just told her that they were supposed to pay as though he had Medicare.

"Q. What did she say to that?

"A. They still refused to pay because he didn't have Medicare."

Hill further testified on cross-examination:

"Q. When you were talking to Mrs. Babb, did she say anything to you about the need of this 'Explanation of Medicare Benefit' form that is referred to here in this note?

"A. No, sir. She just explained to me that the reason they were not paying is because he did not have Medicare."

Hill contacted Green and told him about her conversation with Babb. Green telephoned United American and was transferred to a claims representative named Betty, the person to whom Babb had previously spoken about Mr. Brumley's claim. Betty admitted to Green that she had told Babb that Mr. Brumley's claim was not payable because Mr. Brumley did not have Medicare; however, Betty now told Green this was a mistake, and to resubmit the claim with a letter to her attention. That same day, Green mailed the bills back to United American and to Betty's attention.

United American responded by sending another "Medicare Explanation of Benefits" form to the Brumleys. The Brumleys contacted Green. Even before Green had contacted Babb and Betty, Green had submitted the bills with a cover letter stating both that Mr. Brumley did not have Medicare and that he should be paid under paragraph 6 of his policy. When Green learned of the latest slip sent to Mr. Brumley, he called United American a second time. He talked to a claims supervisor. Following the directions of the claims supervisor, Green submitted the claim with another cover letter to the attention of the claims supervisor and wrote "resubmitted November 15, 1984" on the bills. United American sent the Brumleys a slip identical to the other slips United American had already sent. After this response from United American, Green gave up, saying he had done everything he knew to do to get the claim paid.

In November or December 1984, Mrs. Brumley wrote a letter sending one of the "slips" back to United American, informing the insurance company that she was cancelling the policy because United American would not pay Mr. Brumley's claim, and requesting that United American return that portion of the premiums applicable to the remainder of the term. On January 3, 1985, United American wrote Mr. Brumley and refused to refund any of Mr. Brumley's premium; the letter did not mention Mr. Brumley's claim, which Mrs. Brumley had specifically referred to in her letter.

Two months later, in March 1985, Mrs. Brumley wrote to United American, again complaining of United American's "unfair treatment" of Mr. Brumley. United American did not respond. On June 7, 1985, Mrs. Brumley wrote another letter to United American requesting payment for Mr. Brumley's claim.

United American counters Mr. Brumley's evidence with testimony from its employees that United American simply did not receive most of the telephone calls, claims, and other correspondence that Mr. Brumley's evidence indicated occurred.

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Bluebook (online)
542 So. 2d 1231, 1989 WL 35162, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-american-ins-co-v-brumley-ala-1989.