Oklahoma Insurance Law : Oklahoma Insurance Lawyer & Attorney : Buckman & Roach Law Firm : Tulsa Bad Faith Insurance & Declaratory Judgment Commentary

A homeowner searching for a low-cost insurance policy for his home purchased an insurance policy for his residence. The property coverage policy differed from a traditional homeowner’s insurance policy in that the property coverage provided reduced coverage for certain types of losses and didn’t cost as much as homeowners coverage would have. The contract provided coverage to the structure as a result of a burglary, however "theft" of personal contents was specifically an excluded loss.

After the policy was issued, the homeowner was burglarized and filed a claim with his insurance company for the loss of personal property associated with the theft. Since the insurance policy did not provide coverage for theft loss of personal contents, the insurer denied the claim.  The homeowner filed a lawsuit alleging there was an improper denial of the claim payment. The homeowner prevailed in the trial court and the insurer appealed.

The Oklahoma Court of Civil Appeals found in favor of the insurance company holding that theft loss was specifically excluded from coverage and that the policy was limited strictly to actual damage to the structure and reversed the trial court decision.  The Oklahoma Court of Civil Appeals stated:  "Loss of personal property arising out of burglary of insured's home fell outside scope of covered peril for burglary damage to actual premises." Jones v. Union Mutual Insurance Company, 295 P.3d 612, 2013 OK CIV APP 12.

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An Oklahoma insurance company's reliance upon a legal opinion that there was no payment due under the policy did not prevent a judgment for bad faith and punitive damages.  In Barnes v. Oklahoma Farm Bureau Mutual Ins. Co., 2000 OK 55, 11 P.3d 162, the insurer purportedly obtained a legal opinion from an Oklahoma lawyer before refusing to pay UIM coverage.  The case was submitted to the jury on the issue of bad faith as well as punitive damages and an award entered in favor of the plaintiffs.

Oklahoma Farm Bureau Mutual Insurance Company was sued by its insured, Julie Barnes, for underinsured motorist (UIM) benefits and for breach of the implied duty of good faith and fair dealing in failing to pay her claim.  The trial judge granted partial summary judgment to Barnes for the $15,000.00 of UIM policy limits and submitted the remainder of the damages to a jury.  The jury awarded an additional $10,000.00 in actual damages and $1.5 Million in punitive damages.  Additionally, the trial court granted her $300,000.00 in attorney fees.

Barnes had been injured in a head on collision with another vehicle and her injuries were extensive.  The other driver had liability coverage of $10,000.00 per person and Barnes had uninsured motorist/underinsured motorist coverage with Oklahoma Farm Bureau and another $25,000.00 with State Farm Mutual Automobile Insurance Company. 

Barnes incurred $15,000.00 in medical bills and lost over $10,000.00 in wages.  She submitted a claim for UIM benefits to both of her insurers.  The claims not being timely paid, Barnes filed suit.

Eventually, the tortfeasor tendered its $10,000.00 of liability limits, but Oklahoma Farm Bureau refused to waive subrogation and further refused a proper substitution under 36 O.S. § 3636(E).  Likewise, the insurer refused to pay the $15,000.00 in UIM benefits claiming it was entitled to the liability coverage from the tortfeasor.

State Farm, unlike the other insurer, evaluated Barnes' claim to be at least $50,000.00 and paid its full UIM limits of $25,000.00 without claiming entitlement to a portion of the liability policy.  State Farm elected not to substitute its own $10,000.00 payment for the tentative settlement from the tortfeasor and instead waived any right at subrogation.

The main defense to the bad faith claim was that Oklahoma Farm Bureau reasonably relied upon the advice of its legal counsel concerning the proper interpretation of 36 O.S. § 3636(E) and, therefore, its behavior in litigating the issue was a legitimate dispute.

The Oklahoma Supreme Court stated:

In a tort case against an insurer for breach of the implied duty of good faith and fair dealing (i.e. for bad faith) it is the unreasonableness of the insurer's actions that is the essence of the tort. Conti v. Republic Underwriters Ins. Co., 1989 OK 128, 782 P.2d 1357, 1360; Alsobrook v. National Travelers Life Ins. Co., 1992 OK CIV APP 168, 852 P.2d 768, 770. Although reliance on the advice of counsel can be a defense to a bad faith suit, the reliance on counsel's advice must be reasonable. Durbin and Loy, Current Status of Good Faith Law in Oklahoma, supra, 24 Okla. City U.L.Rev. at 169-170. Particularly applicable here is the following statement made by the United States Court of Appeals for the Fifth Circuit concerning the advice of counsel defense in bad faith insurance claim litigation:

[I]t is simply not enough for the carrier to say it relied on advice of counsel, however unfounded, and then expect that valid claims for coverage can be denied with impunity pursuant to such advice. The advice of counsel is but one factor to be considered in deciding whether the carrier's reason for denying a claim was arguably reasonable. We believe that where, through verbal sleight of hand, the advising attorney concocts an imagined loophole in a policy whose plain language extends coverage, such advice is heeded at the carrier's risk.

Szumigala v. Nationwide Mutual Ins. Co., 853 F.2d 274, 282 (5th Cir.1988). Further, even where there has been no judicial interpretation of a relevant statutory provision, the reasonableness of reliance on advice of counsel will normally be a fact question where counsel misreads the plain language of a statute. Murphree v. Federal Ins. Co., 707 So.2d 523, 532-535 (Miss.1997).

In short, the Oklahoma Supreme Court held the opinion of the attorney was not reasonable and the insurer should not have relied upon advice that it knew or should have known from its own judgment was patently wrong.

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Bad faith can result in Oklahoma from failing to obtain a legal opinion before denying coverage.  In Harrell v. Old American Ins. Co., 1991 OK CIV APP 91, 829 P.2d 75, a claims examiner failed to seek legal advice regarding a coverage question before denying payment.  The Oklahoma Court of Appeals said it was reasonable to infer the lack of a legal opinion was either because the examiner knew there was coverage or she did not want confirmation the claim was not properly excluded under the terms and conditions of the policy.  The Court determined the trial court was justified in submitting the issue of punitive damages to the jury. 

Some advantages to obtaining a legal opinion as to whether coverage exists before issuing a denial are:

• demonstrates good faith on the part of the insurer
• having an objective, third person gives a different perspective
• qualified, competent Oklahoma attorneys give insight into the law
• the cost for a legal opinion is substantially less than a bad faith award 

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Coverage decisions tend to be expensive one way or the other.  If an insurance company determines coverage exists, then it has to pay for the underlying claim.  If the claim was not really covered by the terms of the insurance policy, then the company has incurred an expense that was unnecessary and which adversely impacts the year end financial picture.  Decisions to deny coverage, when in fact it exists, is even more expensive.  There is the litigation expense plus the potential bad faith claim. 

Christopher J. Boggs wrote a commentary about what his 19 years of experience in the insurance industry had taught which he was kind enough to share. 

• Only good lawyers realize they don't know everything about the law
• Someone who truly understands insurance can explain its concepts in simple language.  The person with no idea how it works masks his ignorance with $10.00 words and legalese
• There is ALWAYS more than one possible answer to a coverage question.  One is just more correct than the others based upon the particular situation
• Only "newbies" know everything about insurance
• Regardless of how much I know (or think I know) about insurance, there is always MUCH more to learn.  It is NEVER okay to guess at the answer to a coverage question
• It's perfectly acceptable to say, "I don't know", as long as you follow it up with "but I'll find out and get right back to you."

The only other thing I have to add from my 25 years of coverage analysis is the answer is always simple - just ask either side!  They always know the answer!

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The Oklahoma legislature in 36 O.S. § 4803 has adopted a statutory version of a fire policy sometimes referred to as the "New York Standard Fire Policy". The statute requires all insurance companies issuing homeowners' policies in Oklahoma to have the minimum coverage required by the statute unless special approval has been received from the insurance commissioner allowing them to sell something less than the minimum requirement. Typically, obtaining the commissioner's approval for a nonstandard policy form is difficult unless the insurer is enlarging or expanding the available coverage.

Section 4803 provides for many of the defenses that are normally used by insurers in denying claims.  Fraud by insureds upon Oklahoma insurance companies is a valid concern.  There is provision for denial for fraud or concealment on the part of the insured. The statute also provides that bills, currency, deeds, evidences of debt, money, or securities are not covered by the insurance policy unless specifically provided by the insurance contract.

The statutory insurance policy provides there is no coverage for certain types of perils such as military invasions, rebellions, insurrections, civil war, neglect on the part of the insured to use all reasonable means to save and preserve property, and further that the insurer is not responsible for theft losses.

The statute sets minimum time periods in which the policy can be cancelled and the type of notice that must be given to an insured as well as a mortgage company before coverage is actually cancelled. In the event of a claim, it requires the insureds to tender a proof of loss within 60 days of the event and allows the mortgage company to submit the proof of loss if the policy holder does not take timely action.

The statute also makes provisions Oklahoma insurance attorneys use in taking examinations under oath, inspection of damaged property, and require preparation of a complete inventory detailing the quantities, cost, and actual cash value of the items claimed.  

Most homeowners' policies provide more coverage than the statutory minimum. For instance, the typical homeowners' policy will have coverage for theft, wind storm, liability coverage, and contain other clauses that give greater protection to a homeowner than the statutory framework enacted many years ago.  Questions about the minimum required coverages under a homeowners' policy should be reviewed by a competent attorney knowledgeable about Oklahoma insurance laws.

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