Lead Opinion
¶1 In 2007, the legislature passed, and the voters of this state ratified, the Insurance Fair Conduct Act (IFCA), RCW 48.30.015. IFCA gives insureds a new cause of action against insurers who unreasonably deny coverage or benefits. RCW 48.30.015(1). IFCA also directs courts to grant attorney fees and authorizes courts to award triple damages if the insurer either acts unreasonably or violates certain insurance regulations. RCW 48.30.015(2)-(3), (5). These regulations broadly address unfair practices in insurance, not just unreasonable denials of coverage or benefits. RCW 48.30.015(5). We are asked to decide whether IFCA also created a new and independent private cause of action for violation of these regulations in the аbsence of any unreasonable denial of coverage or benefits.
Facts
¶2 In November 2010, Isidoro Perez-Crisantos was waiting to turn left off snowy Wellesley Avenue in Spokane when his car was struck from behind by Martin Reyes. Clerk’s Papers (CP) at 5, 391. Perez-Crisantos
¶3 Perez-Crisantos sued on a variety of grounds. Among other things, he alleged that State Farm had violated IFCA, several of IFCA’s implementing regulations, and the Consumer Protection Act (CPA), chapter 19.86 RCW. He also brought bad faith and negligence claims. Most of the claims were stayed while the UIM claim was sent to arbitration. The arbiter largely found for Perez-Crisantos. Based on the damages awarded, it appears the arbiter concluded the shoulder injury was related to the accident, disallowed some of the chiropractic physical therapy treatments as excessive, and awarded Perez-Crisantos a gross amount of about $51,000. After adjusting for Reyes’s settlement, PIP benefits, and attorney fees, Perez-Crisantos received about $24,000 from the UIM arbitration. The court lifted the stay, and Perez-Crisantos amended his complaint to make clear he was alleging an IFCA claim based on the violation of IFCA regulations relating to unfair settlement practices. Specifically, he alleged that State Farm forced him to litigate in order to get payments that were due to him.
¶4 Meanwhile, Perez-Crisantos sought discovery about State Farm’s incentive programs and the personnel files of State Farm employees involved in processing his claim, apparently seeking evidence that State Farm’s incentive program was improperly encouraging its employees tо deny claims or settle them for unreasonably low amounts. While it is not in the record, it appears State Farm provided discovery on the incentive programs but resisted release of the personnel files. The trial court allowed some discovery about the employee compensation and reviewed some materials under seal. The judge declined to order State Farm to release the personnel files themselves, finding Perez-Crisantos had not made a sufficient showing.
¶5 State Farm moved for summary judgment dismissal, largely on the merits. It argued that there was no genuine dispute that it had acted reasonably and in good faith throughout the claims process, that Perez-Crisantos had not alleged a cognizable claim, and that the parties merely had a reasonable disagreement about the value of the claim. Unfortunately, the record does not reveal State Farm’s valuation of the UIM claim. Relying largely on unreported cases out of federal court, State Farm argued that a delay in payment of UIM benefits until after arbitration is not a denial of payment under IFCA. CP at 56-57 (citing Beasley v. State Farm Mut. Auto. Ins. Co., No. C13-1106RSL,
Analysis
¶7 This case is before us on appeal from summary judgment and asks us to interpret a statute. Our review of both is de novo. Auto. United Trades Org. v. State,
1. IFCA Cause of Action
¶8 For many years, insureds have been able to sue their insurers for violations of certain insurance regulations in a CPA or bad faith action. See Truck Ins. Exch. v. VanPort Homes, Inc.,
¶9 RCW 48.30.015 says in most relevant part:
(1) Any first party claimant to a policy of insurance who is unreasonably denied a claim for coverage or payment of benefits by an insurer may bring an action in the superior court of this state to recover the actual damages sustained, together with the costs of the action, including reasonable attorneys’ fees and litigation costs, as set forth in subsection (3) of this section.
(2) The superior court may, after finding that an insurer has acted unreasonably in denying a claim for coverage or payment of benefits or has violated a rule in subsection (5) of this section, increase the total award of damages to an amount not to exceed three times the actual damages.
(3) The superior court shall, after a finding of unreasonable denial of a claim for coverage or payment of benefits, or after a finding of a violation of a rule in subsection (5) of this section, award reasonable attorneys’ fees and actual and statutory litigation costs, including expert witness fees, to the first party claimant of an insurance contract who is the prevailing party in such an action.
(5) A violation ofany of the following is a violation for the purposes of subsections (2) and (3) of this section:
(a) WAC 284-30-330, captioned “specific unfair claims settlement practices defined.”
¶10 The relationship between subsections (2), (3), and (5) is, as Judge Peterson put it, “vexing.” Workland & Witherspoon, PLLC v. Evanston Ins. Co.,
¶11 The regulations in question are long standing and have long been enforceable by the insurance commissioner and, in some cases, by first party insureds in bad faith or CPA actions. Laws of 1947, ch. 79, § 30.01 (partially codified at RCW 48.30.010); Wash. St. Reg. 78-08-082 (Aug. 16, 1978); Truck Ins. Exch.,
¶12 Perez-Crisantos argues that State Farm compelled him to litigate his UIM claim through “a pre-suit offer of $0,” CP at 104, which, he contends, violated insurance regulations that deem it unfair or deceptive to “[c]ompel[ ] a first party claimant to initiate or submit to litigation, arbitration, or appraisal to recover amounts due under an insurance policy by offering substantially less than the amounts ultimately recovered in such actions or proceedings.” WAC 284-30-330(7). He contends that this regulatory violation is independently actionable under IFCA. State Farm contends that the statute clearly sets forth thе basis for private causes of action and those causes of action do not include regulatory violations.
¶13 Local federal courts have split on this question.
¶14 Perez-Crisantos urges us to follow the Langley decision.
¶15 We respectfully disagree with the Langley opinion that legislative intent supports creating an implicit IFCA cause of action. IFCA explicitly creates a cause of action for first party insureds who were “unreasonably denied a claim for coverage or payment of benefits.” RCW 48.30.015(1). IFCA dоes not state it creates a cause of action for first party insureds who were unreasonably denied a claim for coverage or payment of benefits or “whose claims were processed in violation of the insurance regulations listed in (5),” which strongly suggests that IFCA was not meant to create a cause of action for regulatory violations. “ ‘[W]here a statute specifically designates the things upon which it operates, there is an inference that the Legislature intended all omissions.’ ” State v. LG Elecs., Inc.,
¶16 We recognize that IFCA is ambiguous, and as it is ambiguous, courts have appropriately turned to extrinsic evidence of legislative intent. See Campbell & Gwinn,
“ESSB 5726 would authorize any first party claimant to bring a lawsuit in superior court against an insurer for unreasonably denying a claim for coverage or payment of benefits, or violation of specified insurance commissioner unfair claims handling practices regulations, to recover damages and reasonable attorney fees, and litigation costs.”
Langley,
¶17 However, as amicus curiae the American Insurance Association notes, the ballot title that would have been in front of voters as they voted on IFCA did not suggest IFCA creates a privatе cause of action for regulatory violations. The official ballot title said:
The legislature passed Engrossed Substitute Senate Bill 5726 (ESSB 5726) concerning insurance fair conduct related to claims for coverage or benefits and voters have filed a sufficient referendum petition on this bill.
This bill would make it unlawful for insurers to unreasonably deny certain coverageclaims, and permit treble damages plus attorney fees for that and other violations. Some health insurance carriers would be exempt.
State of Washington Voters Pamphlet, General Election 13 (Nov. 6, 2007). This language does not suggest an intent to create a private cause of action for regulatory violations. Quite the opposite: it suggests that IFCA creatеs a cause of action for unreasonable denials of coverage and also permits treble damages in some circumstances. On balance, we conclude that the legislative history suggests that IFCA does not create a cause of action for regulatory violations.
¶18 We recognize that the pattern jury committee recently came to the opposite conclusion. The pattern jury instruction for an IFCA claim provides:
(Name of plaintiff) claims that (name of insurer) has violated the Washington Insurance Fair Conduct Act. To prove this claim, (name of plaintiff) has the burden of proving each of the following propositions:
(1) That (name of insurer) [unreasonably dеnied a claim for coverage] [unreasonably denied payment of benefits] [or] [violated a statute or regulation governing the business of insurance claims handling];
(2) That (name of plaintiff) was [injured] [damaged]; and
(3) That (name of insurer’s) act or practice was a proximate cause of (name of plaintiff’s) [injury] [damage].
If you find from your consideration of all of the evidence that each of these propositions has been proved, your verdict [on this claim] should be for (name of plaintiff). On the other hand, if any of these propositions has not been proved, your verdict [on this claim] should be for (name of insurer).
6A Washington Practice: Washington Pattern Jury Instructions: Civil 320.06.01 (6th ed. 2013 Supp.) (alterations in original). Put another way, the pattern jury committee concluded that IFCA created a cause of action if an insurer “unreasonably denied a claim for coverage,” or “unreasonably denied payment of benefits,” or “violated a statute or regulation governing the business of insurance claims handling.” Id. (emphasis added). That last alternative contemplates, at least, violations of the regulations listed in RCW 48.30.015(5).
¶19 But jury instructions are not the law. State v. Brush,
¶20 Finally, we note that it is unlikely the legislature would have intended to create a private cause of action for violation of only some of the specific regulations listed in RCW 48.30.015(5). For example, if we found that violation of regulations listed in IFCA was independently actionable, then “[m]aking a claim payment to a first party claimant or beneficiary not accompanied by a statement setting forth the coverage under which the payment is made,” not responding until the 11th working day to “pertinent communications from a claimant reasonably suggesting that a response is expected,” and notifying a claimant on the 16th day that a claim had been accepted would all be actionable even if the insured was never unreasonably denied coverage or the payment of benefits. WAC 284-30-330(9), -360(3), -380(1).
¶21 We conclude that IFCA does not create an independent cause of action for regulatory violations.
2. Summary Judgment
¶22 Perez-Crisantos argues that summary judgment dismissal of his claims was inappropriate because there were material facts in dispute. He also contends that his partial summary judgment motion should have been granted and that more discovery into State Farm’s incentive programs was required. The trial judge dismissed the case on the merits because she concluded that State Farm had acted reasonably and that State Farm had not “ ‘lowball [ed]’ their insured such that their insured was required to litigate.” VRP at 24.
¶23 Disparity between an offer and an arbitration award alone does not establish a violation of WAC 284-30-330(7). Am. Mfrs. Mut. Ins. Co. v. Osborn,
¶24 As to the CPA claim, in order to prevail “a plaintiff must establish five distinct elements: (1) unfair or deceptive act or practice; (2) occurring in trade оr commerce; (3) public interest impact; (4) injury to plaintiff in his or her business or property; (5) causation.” Hangman Ridge Training Stables, Inc. v. Safeco Title Ins. Co.,
¶25 Perez-Crisantos also argues that summary judgment was premature because more discovery into State Farm’s incentive
Conclusion
¶26 We hold that an IFCA claim cannot be predicated on a regulatory violation alone. We find that summary judgment was appropriately granted and affirm.
Notes
The concurrence objects to the way we have framed the issue, suggesting that this caused us to stray from the language and intent of IFCA. But it is the concurrence that strays from RCW 48.30.015. Rather than insert language into the statute that the legislature purposefully omitted, our decision comports with the actual language of RCW 48.30.015 and is framed сonsistently with the way the parties have framed the issue.
A learned practitioner has observed that IFCA cases tend to be heard in federal court sitting in diversity jurisdiction. Shannon M. Kilpatrick, Sounding the Alarm: Is Diversity Jurisdiction Interfering with Washington State’s Development of Its Own Body of Law Related to the Insurance Fair Conduct Act?, 49 Gonz. L. Rev. 553, 554 (2013/14). Many of the cases are unreported.
Perez-Crisantos also cites three cases for the proposition that recent federal cases allow IFCA claims based on regulatory violations. Appellant’s Br. at 22 (citing Meirill v. Crown Life Ins. Co.,
The concurrence, purporting to avoid confusion surrounding IPCA’s purpose and scope, instead would perpetuate the confusion that already exists. Compare Langley, 89 R Supp. 3d 1083 (implied cause of action), with Workland, 141 R Supp. 3d 1148 (no implied cause of action). It simply prefers the current confusion to a clear holding that subsections (2), (3), and (5) of IFCA do not create an independent implied cause of action in addition to that expressly created in subsection (1).
Perez-Crisantos’s motion for attorney fees under RCW 48.30.015(3) and RCW 19.86.090 is denied.
Concurrence Opinion
(concurring in result only)
¶27 In 2007, the legislature enacted and the people ratified the Insurance Fair Conduct Act (IFCA), RCW 48.30.015, to strengthen the remedies and penalties available for the unfair handling of first-party insurаnce claims. To date, litigation under IFCA has proceeded mainly in federal court, with this case marking the first time this court has been asked to entertain arguments as to the statute’s meaning. Encouraged by amici, the majority embraces this opportunity to offer an interpretation, even though interpreting IFCA is unnecessary and irrelevant to the resolution of this case.
¶28 We should await an appropriate case before taking such a significant step, and instead resolve this appeal on the grounds reached below. The superior court dismissed this case on summary judgment because the plaintiff could not establish a violation of Washington Administrative Code (WAC) 284-30-330(7). The majority affirms this holding. It is therefore entirely unnecessary to decide whether a WAC violation gives rise to an implied cause of action under IFCA. I fear that the majority’s gratuitous “holding” on IFCA will lead to confusion and will frustrate the intent of this remedial statute. I respectfully dissent from that holding, though I concur in the decision to affirm the superior court’s order on summary judgment.
I. This Appeal Does Not Require the Court To Decide Whether a WAC Violation Supports Remedies and Penalties under IFCA
¶29 The majority frames the issue in this case as whether a violation of WAC 284-30-330(7) supports an implied cause of action under IFCA. Majority at 672, 676. Nonetheless, it ultimately agrees with the superior
¶30 In granting summary judgment of dismissal, the superior court drew no distinction between the plaintiff’s allegations based on the WAC provision and his overarching allegation that State Farm Fire and Casualty Company acted unreasonably. The court noted, “We do not have a lot of law on IFCA. We have quite a bit of law on some of these WACs. The point is that the issue for the court is to determine if the insurance company is acting reasonably or unreasonably.” Verbatim Report of Proceedings (Aug. 21, 2015) (VRP) at 23. The court continued, “The issue before the court is whether or not State Farm reasonably handled this claim, and that their position was a reasonable position. And that they did not ‘lowball’ their insured such that their insured was required to litigate. That is what this claim is about.” Id. at 24. Here, the superior court was plainly describing a claim under WAC 284-30-330(7), which addresses unfair settlement conduct that forces an insured to arbitrate or litigate. That provision states:
The following [practices] are hereby defined as unfair methods of competition and unfair or deceptive acts or practices of the insurer in the business of insurance, specifically аpplicable to the settlement of claims:
(7) Compelling a first party claimant to initiate or submit to litigation, arbitration, or appraisal to recover amounts due under an insurance policy by offering substantially less than the amounts ultimately recovered in such actions or proceedings.
WAC 284-30-330(7). The superior court explained:
The gravamen of the WAC is that the plaintiff is being forced to [arbitrate or litigate] because of the intransigence and unreasonableness of the first party insurance company. My view is that is not what . . . went on in this case. There was a reasonable dispute between the two parties that ultimately had to be resolved through an arbitration proceeding, and it was.
VRP at 26-27. Having cоncluded that State Farm did not violate WAC 284-30-330(7)—or more generally act unreasonably—the superior court determined that further proceedings (including additional discovery) were unnecessary. Id. at 29 (“Really, the discussion ends at that point.”).
¶31 Understanding the basis for the superior court’s summary judgment ruling, which the majority affirms, this case is not an appropriate vehicle for deciding whether a WAC violation (if proved) could support liability under IFCA. While the briefing before this court invites consideration of that broader issue, we should resist. I would await better briefing and a full opportunity to consider the impact of an IFCA holding in a case where it matters.
II. The Majority’s Putative “Holding” Adds to the Confusion Surrounding IFCA’s Purpose and Scope
¶32 The majority conсludes that “an IFCA claim cannot be predicated on a regulatory violation alone.” Majority at 686. To reach this conclusion, it frames the issue in terms of whether the cause of action created in IFCA’s subsection (1) is exclusive, or whether instead “IFCA also created a new and independent private cause of action for violation of these regulations in the absence of any unreasonable denial of coverage or benefits.” Id. at 672 (emphasis added). This framing of the issue is somewhat confusing and leaves many questions unanswered.
¶33 As the majority notes, federal district courts in Washington have considered whether there is an implied cause of action under IFCA prеmised on violations of certain WAC provisions. See Langley v. GEICO Gen. Ins. Co.,
¶34 Chapter 48.30 RCW addresses unfair practices and fraud in the business of insurance. RCW 48.30.010 generally outlines available “remedies and penalties” against insurers who engage in unfair or decеptive acts or practices. Amended alongside the enactment of RCW 48.30.015, RCW 48.30.010(7) references IFCA’s language prohibiting insurers from “unreasonably denying] a claim for coverage or payment of benefits to any first party claimant.” Importantly, chapter 48.30 RCW does not purport to enumerate all available causes of action; instead, it contemplates a range of possible private actions, in addition to enforcement actions by the insurance commissioner. Private actions may include claims sounding in bad faith, negligence, or breach of contract, as well as statutory claims.
¶35 IFCA, as part of chapter 48.30 RCW, must be understood in this context. While RCW 48.30.015(1) crеates a new cause of action based on unreasonable denials of claims for coverage or benefits, subsections (2) and (3) speak to new remedies and penalties superior courts are authorized or required to impose when certain findings are made. Subsections (2) and (3) refer to remedies and penalties based upon a finding “that an insurer has acted unreasonably in denying a claim for coverage or payment of benefits or has violated a rule in subsection (5) of this section.” RCW 48.30.015(2), (3) (emphasis added). The majority’s interpretation renders the second half of this sentence inoperative, requiring the superior court to find a violation of subsection (1) as a precondition to affоrding IFCA remedies and penalties—despite the obvious disjunctive phrasing.
¶36 I believe a problem with the majority’s analysis is that it asks the wrong question, i.e., whether subsections (2), (3), and (5) of IFCA create an implied cause of action in addition to that expressly created in subsection (l).
¶37 After the dust settles on this case, questions will remain as to what remedies and penalties IFCA authorizes, even if we accept as a holding the majority’s unnecessary conclusion that subsections (2), (3), and (5) do not create an implied cause of action. I believe today’s opinion will engender only further debate and not the definitive interpretation the majority is apparently reaching for. I would resolve this case on the grounds reached by the court below without addressing the question of whether a WAC violation alone can support a claim under IFCA. Accordingly, I dissent from the majority’s analysis of IFCA but concur in its decision to affirm the summary judgment order of dismissal.
In fairness to the majority, the parties and amici sometimes frame the question this way, following the analysis of the federal district court in Langley. See Langley, 89 E Supp. 3d at 1084-85; Appellant’s Br. at 22-27; Br. of Resp’t State Farm at 16-20; Br. of Amicus Curiae Am. Ins. Assn at 7-11; Br. of Amicus Curiae Wash. State Assn for Justice Found, at 14.
