Case details

Insurer wrongfully denied fire damage claim, plaintiff alleged

SUMMARY

$8463833

Amount

Verdict-Plaintiff

Result type

Not present

Ruling
KEYWORDS
emotional distress, mental, psychological
FACTS
On Dec. 22, 2017, plaintiff Octavio Lopez was on his way to work when he learned that his 2013 Thor Motor Coach recreational vehicle was on fire. By the time he returned home, the Riverside Fire Department had extinguished the fire, but the RV was destroyed. Lopez reported the fire to his insurer, National General Assurance Co., that same day, and National General sent an investigator to examine the RV on Dec. 26, 2017. National General then sent out a second investigator to examine the RV four days later, on Dec. 30, 2017. That investigator conducted a thorough inspection and took more than 260 photographs of the RV. A third investigation was also performed. On Feb. 5, 2018, while the investigation was still ongoing, National General received the final origin and cause report, which indicated that the fire was incendiary in nature, as there were two, noncommunicating areas of origin. As a result, even though Lopez provided all relevant documents when requested, appeared for an examination under oath, and fully cooperated with the investigation, his claim was denied. Lopez sued National General Assurance, alleging that the insurer’s denial of the claim constituted a breach of contract, and a breach of the implied covenant of good faith and fair dealing. Plaintiff’s counsel contended that the examination on Dec. 26, 2017, revealed that the cause of the fire was electrical in nature and that there was no sign of an intentional fire. However, counsel asserted that after National General’s claims adjuster discovered that Lopez had an endorsement on the policy that could cover the RV up to its original purchase price, National General sought to conduct additional inspections of the RV. Counsel contended that, as a result, the claims adjuster immediately found the incident suspicious without any evidence and took notes stating the RV was “set” on fire, rather than had “caught” fire. Plaintiff’s counsel contended that, on Jan. 2, 2018, the second investigator reported that there were “no signs of arson and [that it was] a clear electrical fire” and reported that there were “no signs of intentional fire or arson.” However, counsel contended that despite the investigator’s findings following a thorough inspection on Dec. 30, 2017, and taking more than 260 photographs of the RV, as well as there being several witnesses who corroborated the investigator’s findings, National General continued the investigation. Plaintiff’s counsel argued that even thorough the investigation on Dec. 26, 2017, showed that the fire was an electrical fire and that no “accelerants” were found inside the RV, National General continued the investigation once it realized that Lopez’s policy was a replacement policy under a “guaranteed purchase price” endorsement. Counsel also argued that even though the second, more thorough, investigation also found no sign of arson and determined that it was an electrical fire, the insurer still contended that the fire had been intentionally set and even suggested that Lopez had something to do with it. Plaintiff’s counsel contended that National General then conducted an examination of Lopez under oath, during which Lopez was questioned by two of National General’s investigators, with the sole purpose of setting Lopez up to deny his claim. Counsel argued that prior to Lopez’s examination under oath, National General believed that Lopez had set the RV on fire, based on the final fire investigator’s report, and used that examination under oath as a setup to fabricate and manufacture material misrepresentations to be able to deny Lopez’s claim, which it did only two days later. Defense counsel argued that after the completion of the claim investigation, National General found at least four areas of material misrepresentations and that, based upon those findings of material misrepresentations, the claim was denied, as Lopez had breached his policy provision by engaging in material misrepresentations in the presentation of the claim. Counsel contended that National General conducted a reasonable investigation, retained an origin and cause investigator, and reasonably relied upon the origin and cause final report, which found the fire to be incendiary. Defense counsel argued that, based upon the information available at the time of the investigation, National General reasonably relied upon a qualified origin and cause investigator, and statements provided by multiple witnesses. Counsel also argued that National General’s investigation found that Lopez had made multiple, material misrepresentations about the cause of the fire, the timing of the incident and the content of his text messages, as well as the delinquency of loan payments, the condition of the RV and the timing of his departure from the fire scene. Counsel further argued that, based upon expert opinion and unbiased witnesses, National General appropriately found Lopez’s statements to be inconsistent and to have misrepresented those areas of concern. Defense counsel argued that National General acted reasonably and within the standard of care, when it issued its denial and stated that the reasons for the denial was on grounds that Lopez misrepresented the incident and filed a fraudulent claim. The defense’s claims-handling expert opined that National General conducted its claim investigation in accordance with the California Fair Claims Act and that the claims handling was reasonable and within the standard of care. The expert also opined that National General reasonably relied upon the finds of the origin and cause expert, who formed a basis for the finding that Lopez had allegedly made statements that were material misrepresentations. The claims-handling expert further opined that National General did not violate any of the regulations of the California Fair Claims Act and/or the Special Investigations Regulations for California and that National General made reasonable decisions, and operated with the standard of care and in good faith., Lopez claimed that he suffered emotional distress as a result of the investigations, questioning under oath and denial of his claim. As a result, he sought recovery of damages for his emotional pain and suffering. Plaintiff’s counsel contended that National General failed to consider Lopez’s interest, failed to diligently search for and consider evidence that would support coverage, and acted with malice, oppression or fraud during the investigation and ultimate denial. As a result, Lopez sought recovery of punitive damages.
COURT
Superior Court of Riverside County, Riverside, CA

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