**Author's Note: If you have reached this blog through a list that carries advertising, your computer may or may not be put at risk either through the list or through the advertising. I do not accept or authorize any commercial advertising of any kind on any list or post. Placing commercial advertisements with or near any of my web log posts is prohibited. Further, I do not recommend any products or services advertised with or near any of my posts or any list of my posts.**
In Download Hogan v. Provident Life and Accident Insurance Co. (M.D. Fla. Case No. 6.08cv1897, Opinion Filed October 15, 2009), Hogan v. Provident Life & Accident Insurance Co., 665 F. Supp. 2d 1273 (M.D. Fla. 2009) (subscription required), a Federal Court was confronted with several allegations of Unfair Claims Practices under Florida Statutes. Right or wrong on the merits, this decision provides guidance as to what this Federal Court deemed adequately alleged, and what not, among these alleged Claims of Statutory Unfair Claims Practices.
The Plaintiff, Ronnie Hogan, was an Insured under a Long Term Disability Insurance Policy issued by Provident. The Federal Court disposed of four (4) Statutory Unfair Claims Practices in Mr. Hogan's Amended Complaint, which will be addressed here. First, Mr. Hogan alleged that Provident failed to adopt and implement standards for the proper investigation of claims. This Claim was adequately alleged in the eyes of the Federal Court, i.e., the alleged Claim was sufficient to withstand a Motion to Dismiss under Federal Procedure:
However, Provident's alleged failure to adopt and implement standards for the proper investigation of claims is plausibly established by allegations that it failed to evaluate the totality of Hogan's medical condition, set goals for claims termination to obtain financial gain without respect to the merit of Hogan's claim, and terminated Hogan's benefits solely for financial reasons.
Download Hogan v. Provident Life and Accident Insurance Co. (M.D. Fla. Case No. 6.08cv1897, Opinion Filed October 15, 2009), attached Official Slipsheet Opinion at 9-10; Hogan v. Provident Life & Accident Insurance Co., 665 F. Supp. 2d 1273, 1283 (M.D. Fla. 2009).
Second, he alleged that Provident "misrepresented" certain pertinent facts or insurance policy provisions relating to Coverages at issue in the case, an alleged Statutory Unfair Claim Settlement Practice. The Federal Court granted Provident's Motion to Dismiss because the allegations were legally insufficient to support a Claim pled with particularlity as required of any Claim, in the eyes of the Court, which involved alleged Fraud. Fraud is required to be alleged with particularity under Fed. R. Civ. P. 9(b). Download Hogan v. Provident Life and Accident Insurance Co. (M.D. Fla. Case No. 6.08cv1897, Opinion Filed October 15, 2009), at 10; Hogan v. Provident Life & Accident Insurance Co., 665 F. Supp. 2d 1273, 1283 (M.D. Fla. 2009).
Third, Mr. Hogan alleged that Provident denied claims without conducting reasonable investigations, which is also an alleged Statutory Unfair Claim Settlement Practice. The Federal Court denied Provident's Motion to Dismiss this alleged Claim. The Court held that this Claim "is plausibly established by allegations that Provident set targets and goals for claims termination without regard to the merits of Hogan's claim and terminated Hogan's benefits solely for financial reasons." Download Hogan v. Provident Life and Accident Insurance Co. (M.D. Fla. Case No. 6.08cv1897, Opinion Filed October 15, 2009), at 10; Hogan v. Provident Life & Accident Insurance Co., 665 F. Supp. 2d 1273, 1283 (M.D. Fla. 2009).
Fourth and finally, Mr. Hogan alleged another Statutory Unfair Claim Settlement Practice against Provident, alleging that Provident failed to promptly provide a reasonable explanation in writing to him of the basis in his Long Term Disability Insurance Policy, in relation to the facts or applicable law, for denial of his Disability Claim. This Claim, too, withstood a Motion to Dismiss in this case under the Federal Rules of Civil Procedure: "Provident's failure to provide Hogan a reasonable explanation for the denial of benefits is plausibly established by the assertion that Provident told Hogan he was not entitled to further benefits under his policy because he was no longer disabled, during which time Provident was allegedly engaging n a scheme to deny claims without respect to the merit of such claims solely for financial gain." Download Hogan v. Provident Life and Accident Insurance Co. (M.D. Fla. Case No. 6.08cv1897, Opinion Filed October 15, 2009), at 10; Hogan v. Provident Life & Accident Insurance Co., 665 F. Supp. 2d 1273, 1283-84 (M.D. Fla. 2009).
The Online Docket of this Case reflects that the Mediator filed a Report on January 5, 2010 that the Case was completely settled. The Online Docket further reflects that an Order of Dismissal With Prejudice was entered upon the parties' Stipulation, on February 4, 2010.
Statutory Claims in Third-Party Bad Faith Cases are discussed in Dennis J. Wall, "Litigation and Prevention of Insurer Bad Faith" § 3:25 (Second Edition Shepard's/McGraw-Hill; 2009 Supplement West Publishing Company), and Statutory Claims in First-Party Bad Faith Cases like the Hogan Case, are discussed in id. § 9:8.
Please Read The Disclaimer.
Comments