Zappile v. AMEX Assurance Co.

928 A.2d 251, 2007 Pa. Super. 171, 2007 Pa. Super. LEXIS 1580
CourtSuperior Court of Pennsylvania
DecidedJune 8, 2007
StatusPublished
Cited by24 cases

This text of 928 A.2d 251 (Zappile v. AMEX Assurance Co.) is published on Counsel Stack Legal Research, covering Superior Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Zappile v. AMEX Assurance Co., 928 A.2d 251, 2007 Pa. Super. 171, 2007 Pa. Super. LEXIS 1580 (Pa. Ct. App. 2007).

Opinions

OPINION BY

KLEIN, J.:

¶ 1 AMEX Assurance Company (AMEX) appeals from the judgment entered against it following a non-jury trial on a bad faith claim made by plaintiffs, Richard and Stephanie Zappile. The trial court awarded $75,000 to the Zappiles. After a thorough review of the official record, the submissions by the parties and relevant law, we reverse.

¶ 2 The bad faith claim arises from the “dance” plaintiffs and defendants go through in attempting to settle a dispute. Here, Richard Zappile, ex-Deputy Police Commissioner for the Philadelphia Police Department, ex-Deputy Mayor under now Governor Rendell and current Chief of Police for the Philadelphia Housing Authority, was struck by an automobile while walking his dog. Zappile suffered left knee and shoulder injuries as well as other assorted bumps and bruises. Ultimately, he was diagnosed with a torn rotator cuff and underwent arthroscopic surgery, which was successful. Zappile settled his claim against the tortfeasor for the limits of her $15,000 automobile insurance policy. Zappile made a claim against his own automobile insurance policy, issued by defendant, AMEX, for first party benefits, which were paid to the limits of coverage, including $1,000 for lost wages. After the third party claim settled, Zappile made a [254]*254claim for underinsured motorist (UIM) benefits from AMEX. Zappile had a total stacked coverage of $150,000, for three insured vehicles each with $50,000 in UIM coverage.

¶3 Zappile, through his attorney, demanded the policy limits. AMEX believed the value of the damages was far less and offered slightly more than $32,000. The negotiation process, such as it was, was not successful and the case went to arbitration in September, 2004, slightly less than three years after the accident and slightly more than two years after the third party claim settled and the UIM claim was first made. AMEX never officially offered more than the original $32,000 and Zappile never officially requested less than the policy limits. Ultimately, the arbitrators awarded Richard Zappile $95,000 and his wife Stephanie an additional $10,000 for loss of .consortium. This money was paid and Zappile filed this bad faith action against AMEX.

¶ 4 The trial court found by clear and convincing evidence that AMEX had acted in bad faith in handling the Zappile claim and awarded $75,000. The trial court determined that AMEX showed bad faith in failing to make a partial payment representing an excess wage loss claim of approximately $4,000; undervalued the claim, thereby forcing the claim into arbitration; never raising the offer; and telling trial counsel that the plaintiffs would not accept anything less than $150,000 to settle.

¶ 5 On appeal, AMEX raises five issues: 1) insufficient evidence; 2) error in determining that defending the claim/taking adversarial position equated to bad faith; 3) error in ignoring AMEX’s reasonable reb-anee on advice of counsel; 4) error in determining AMEX owed a duty to make partial payments; and 5) allowing expert testimony.

¶ 6 In reviewing a non-jury verdict, we are mindful that we must determine whether the findings of the trial court are supported by competent evidence and whether the trial court erred in the application of the law. Bergman v. United Servs. Auto Ass’n., 742 A.2d 1101 (Pa.Super.1999). We may interfere with the trial court’s conclusions only if they are unreasonable in light of the trial court’s findings. Temple Univ. Hosp. v. Healthcare Mgmt. Alternatives findings, 764 A.2d 587 (Pa.Super.2000). Additionally, bad faith may be found where there is clear and convincing proof that the insurer’s actions lacked any reasonable basis and that the insurer recklessly disregarded its lack of reasonable basis in denying the claim. Williams v. Nationwide Mutual Ins. Co., 750 A.2d 881 (Pa.Super.2000). Further, mere negligence or bad judgment is not bad faith; bad faith imports a dishonest purpose and means a breach of a known duty (i.e. good faith and fair dealing), through some motive of self-interest or ill will. Id.

¶ 7 With those standards in mind, we now turn to the official record and the evidence presented. Because much of the evidence and the conclusions drawn therefrom are interrelated, we will address this as a whole, rather than piecemeal.

Discussion

¶ 8 We first note that the plaintiffs’ expert testimony on bad faith and insurance practices, upon which the trial court relied, contains several factual and legal errors. First, the expert testified that, “It’s up to the court and juries to decide whether that conduct is sufficiently wrongful to impose a variety of statutory damages set forth in 8371 (the bad faith statute).” N.T. Trial, 1/23/06 at 18. Our Supreme Court has ruled that neither the Pennsylvania Constitution nor the bad faith statute allows for a jury trial in a bad faith action. See [255]*255Mishoe v. Erie Ins. Co., 573 Pa. 267, 824 A.2d 1153 (2003).

¶ 9 The expert also repeatedly testified that a UIM claim is a first party claim and that it is not an adversarial situation.

Here it’s not an adversarial claim. This, again, is not the bad guy suing their insured, trying to take money out of their insured’s pockets, here the only people they have to protect is AMEX’s own pocket. This is a first party claim.

N.T. Trial, 11/23/06, p. 102.

¶ 10 First, technically, under both the MVFRL (Motor Vehicle Financial Responsibility Law, 75 Pa.C.S. §§ 1701 et seq.) and virtually every insurance policy, a first party claim refers to claims for medical payments. There are specific rules regarding the resolution of disputes over these medical payments that do not apply to other forms of coverage. The arbitration clauses typically found in insurance policies do not apply to these first party claims. See 75 Pa.C.S. §§ 1711-25. Uninsured (UM) and underinsured coverage is a separate entity with separate rules and statutory requirements. See 75 Pa.C.S. §§ 1731-38. Underinsured coverage is referred to colloquially as a first party claim in that it is typically the insured who is making the claim against his or her own policy.

¶ 11 Then, until recently, every motor vehicle insurance policy was required by the Insurance Commissioner to contain an arbitration clause. This alone indicates that UIM coverage is seen to be adversarial in nature. Arbitration necessarily means that two parties have differing views of the nature and value of the claim or a dispute as to whether the claimant is even entitled to the coverage at all. These are adversarial positions that require an independent adjudication. Although our courts have recently ruled that the arbitration clause cannot be a required component of an insurance policy, this only means that any disputes of UIM coverage can now be heard by a trial court. Once again, this indicates the adversarial nature of the claim.

¶ 12 Our Court recently commented on this very issue in Condio v. Erie Ins. Exch., 899 A.2d 1136

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Cite This Page — Counsel Stack

Bluebook (online)
928 A.2d 251, 2007 Pa. Super. 171, 2007 Pa. Super. LEXIS 1580, Counsel Stack Legal Research, https://law.counselstack.com/opinion/zappile-v-amex-assurance-co-pasuperct-2007.