Ballard v. Nationwide Ins. Co.
46 N.E.3d 170
Ohio Ct. App.2015Background
- Latia Ballard (passenger) and James Glenn (driver/insured) submitted medical-payments claims under a Nationwide auto policy after a 2001 accident; each claim was subject to a $5,000 medical-benefit provision.
- Nationwide initially issued payment to Glenn, but after Glenn’s counsel returned the check and asked it be reissued to the provider, Nationwide later denied both Glenn’s and Ballard’s claims.
- Appellants sued for breach of contract and bad faith; the trial court granted summary judgment to Nationwide on breach-of-contract (affirmed on appeal), leaving bad-faith claims pending.
- At summary judgment on bad faith, Nationwide relied on its investigation and a chiropractic peer review concluding the medical expenses were not related to the accident and argued the denials were “fairly debatable” and reasonably justified.
- The trial court granted Nationwide summary judgment on bad faith; the appellate majority reversed and remanded, finding genuine issues of material fact as to unreasonable delay and claim-handling for both Ballard and Glenn. Judge Robb dissented, arguing Nationwide’s investigative steps and the prior finding of a lawful basis to deny preclude bad-faith liability.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Nationwide unreasonably delayed processing/denying Ballard’s medical-payments claim | Ballard: insurer left claim pending ~10–11 months with minimal contact, creating a jury question on bad faith | Nationwide: investigation (including peer review) provided reasonable justification; delay was part of investigation | Reversed: genuine issue of material fact on unreasonable delay and claim handling — summary judgment inappropriate |
| Whether Nationwide acted in bad faith toward Glenn after initially issuing then later denying payment | Glenn: Nationwide issued a check then failed to reissue to provider or timely resolve, leaving claim unresolved ~10 months | Nationwide: subsequent investigation (similar treatment patterns, peer review) justified delay/denial; prior finding supported lawful basis to deny | Reversed: genuine issue of material fact exists given initial payment then ten-month handling — summary judgment inappropriate |
Key Cases Cited
- Tokles & Son, Inc. v. Midwestern Indemn. Co., 65 Ohio St.3d 621 (insurer owes duty of good faith in claim handling)
- Motorists Mut. Ins. Co. v. Said, 63 Ohio St.3d 690 (discusses bad-faith types and relation to intent; later modified by Zoppo)
- Zoppo v. Homestead Ins. Co., 71 Ohio St.3d 552 (actual intent not required; standard is reasonable justification)
- Cole v. Am. Industries & Resources Corp., 128 Ohio App.3d 546 (de novo standard for appellate review of summary judgment)