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The Law of Insurance Company Claim Misconduct in West Virginia

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The Law of Insurance Company Claim Misconduct in West Virginia Volume 101 Issue 1 Article 4 September 1998 The Law of Insurance Company Claim Misconduct in West Virginia Thomas C. Cady West Virginia University College of Law Amy Andrews West Virginia University College of Law Daniel Cuppett West Virginia University College of Law Mark Glover West Virginia University College of Law Mary Loss West Virginia University College of Law Follow this and additional works at: https://researchrepository.wvu.edu/wvlr Part of the Insurance Law Commons Recommended Citation Thomas C. Cady, Amy Andrews, Daniel Cuppett, Mark Glover & Mary Loss, The Law of Insurance Company Claim Misconduct in West Virginia, 101 W. Va. L. Rev. (1998). Available at: https://researchrepository.wvu.edu/wvlr/vol101/iss1/4 This Article is brought to you for free and open access by the WVU College of Law at The Research Repository @ WVU. It has been accepted for inclusion in West Virginia Law Review by an authorized editor of The Research Repository @ WVU. For more information, please contact [email protected]. Cady et al.: The Law of Insurance Company Claim Misconduct in West Virginia THE LAW OF INSURANCE COMPANY CLAIM MISCONDUCT IN WEST VIRGINIA Thomas C. Cady* Amy Andrews** Daniel Cuppett*** Mark Glover**** Mary Loss***** PART I: FIRST PARTY COMMON LAW BAD FAITH I. INTRODUCTION ........................................................................... 4 II. HISTORY .................................................................................... 4 A . National .............................................................................. 4 B. West VirginiaHistory ........................................................ 6 1. Contract....................................................................... 6 2. Extra-ContractualLiability ........................................ 7 III. NATIONAL LAWNORMS ............................................................ 8 IV. WEST VIRGINIA OVERVIEW .......................................................... 11 V. WEST VIRGINIA CAUSE OF ACTION ......................................... 18 A. The UnderlyingClaim Must Have Been Ultimately Resolved ............................................................................ 18 B. The InsuredMust Have SubstantiallyPrevailed ............. 18 1. How does a court determine whether an insured substantiallyprevailed? ............................................. 19 2. When does substantiallyprevail apply? ..................... 21 3. What types of damages are recoverable?................... 22 C. The InsurerMust Have Acted In Bad Faith..................... 25 D. The InsurerMust Have Acted With Actual Malice .......... 27 VI. QUESTIONS AND ANSWERS / THE FUTURE .............................. 28 A. Bright Line Testsfor Substantially Prevailed................... 28 B. To What Kinds of Insurance Will Hayseeds Attach? ..... 29 C. Defenses ............................................................................ 29 D. Preemptionby ERISA ..................................................... 31 Professor of Law, West Virginia University College of Law. B.A., Rice University; LL.B., University of Texas; LL.M., Georgetown University. B.S., West Virginia Wesleyan College. J.D., West Virginia University College of Law. B.A., West Virginia University. J.D., West Virginia University College of Law. B.A., West Virginia University. J.D., West Virginia University College of Law. B.A., Monmouth University. J.D., West Virginia University College of Law. Disseminated by The Research Repository @ WVU, 1998 1 West Virginia Law Review, Vol. 101, Iss. 1 [1998], Art. 4 2 WEST VIRGINIA LA WRE VIEW [Vol. 101:1 PART II: FIRST PARTY STATUTORY INSURANCE MISCONDUCT I. INTRODUCTION ......................................................................... 32 II. H ISTORY ..................................................................................32 A . N ational........................................................................... 32 B. West Virginia .................................................................... 33 III. NATIONALNORM ..................................................................... 34 IV. WEST VIRGINIA LAW- OVERVIEW ........................................... 34 A . Statutes.............................................................................. 35 B. R egulations ....................................................................... 41 V. WEST VIRGINIA CAUSE OF ACTION FOR VIOLATION OF UNFAIR CLAIMS SETTLEMENT PRACTICES ........................................... 42 A. Sequential Step One: Underlying Claim Is Ultimately R esolved ............................................................................ 43 B. Sequential Step Two: Violation of the Statute ................... 43 C. Sequential Step Three: Frequency as to Indicate a General Business Practice............................................... 45 D. Sequential Step Four: Actual Malice ................................ 46 VI. OTHER ISSUES RELATED TO RECOVERY .................................. 46 A. Bifurcation and The Big TrialMess .................................. 46 B. Attorney's Fees and Costs- Not for the Jury.................... 47 C. Common Law and Statutory Theories Asserted Together ........................................................................... 48 D. ERISA Preemption............................................................ 49 E. Statute of Limitations ........................................................ 50 VII. QUESTIONS AND ANSWERS AND THE FUTURE .......................... 50 A. Definitions......................................................................... 50 B. The Future of The Act ...................................................... 52 PART III: THIRD PARTY COMMON LAW BAD FAITH I. INTRODUCTION ......................................................................... 53 II. H ISTORY ....................................................................................... 53 A . N ational........................................................................... 53 B. W est Virginia..................................................................... 56 III. NATIONAL LAW NORMS ............................................................ 61 A . Factors Test ..................................................................... 61 B. Equality of Interests Test ................................................. 61 C. Disregardthe Limits Rule ................................................. 62 D. Probable Outcomes Test ................................................. 63 IV. WEST VIRGINIA LAW OVERVIEW ............................................ 63 V. WEST VIRGINIA CAUSE OF ACTION .......................................... 70 A. Underlying Claim Is Ultimately Resolved ....................... 70 B . Bad F aith ......................................................................... 71 C. Willful, Malicious, and Intentional.................................. 73 https://researchrepository.wvu.edu/wvlr/vol101/iss1/4 2 Cady et al.: The Law of Insurance Company Claim Misconduct in West Virginia 1998] INSURANCE COMPANY CLAIM ISCOND UCT 3 VI. QUESTIONS, ANSWERS, AND THE FUTURE ................................ 73 A. May Third Party ClaimantsBring DirectActions for Bad FaithAgainst an Insurer?........................................ 73 B. What is the Appropriate Statute ofLimitations?.............. 75 C. Defenses Available to the Defendant/Insurer................... 75 1. Comparative Bad Faith............................................ 75 2. Reverse Bad Faith...................................................... 76 D. Other PrimaFacie Cases of Bad Faith............................ 77 PART IV: THIRD PARTY STATUTORY INSURANCE MISCONDUCT I. INTRODUCTION ......................................................................... 78 II. HISTORY ................................................................................. 79 A. National ........................................................................... 79 B. West Virginia .................................................................. 79 III. NATIONAL LAWNORM ............................................................ 81 IV. WEST VIRGINIA LAW-OVERVIEW ......................................... 82 A. Statutes that Apply to Third Party Claimants .................. 83 1. W. Va. Code Section 17D-4-12((3) ......................... 83 2. W. Va. Code Section 33-11-4(1)-(1) ........................ 83 a. General ............................................................... 83 b. Sub-paragraphsapplicable to thirdparty claims .................................................................. 83 B. Regulations ...................................................................... 84 V. WEST VIRGINIA CAUSE OF ACTION ........................................ 85 A. Introduction..................................................................... 85 B. Sequential Steps in a Third Party Cause ofAction .......... 85 1. SequentialStep One: Ultimate Resolution of the Underlying Claim ...................................................... 85 2. Sequential Step Two: Violation of the Statute ............ 89 3. Sequential Step Three: Committed With Such Frequency as to Indicate a GeneralBusiness Practice .................................................................... 90 4. Sequential Step Four: Actual Malice.......................... 91 VI. OTHER ISSUES RELATED TO RECOVERY .................................. 92 A. Bifurcation..................................... .................................92 B.
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