Tammy Lou Hope appealed against the decision of the Court of Justice to grant the defendant Integon National Insurance Company a summary judgment on her claims in Tammy Lou Hope v Integon National Insurance Company, No COA20-265, Court Av appeals in North Carolina (31 December 2020).
The plaintiff sued Integon, claiming that the plaintiff purchased a liability insurance for car liability and that her vehicle was damaged. She claims that her vehicle was hit by an unidentified vehicle in a hit-and-run accident. The plaintiff's vehicle has suffered a total loss. The plaintiff handed over the vehicle to the defendant and sought coverage. The defendant denied coverage and argued that the plaintiff was not entitled to compensation. since there was evidence that the defendant's investigators assumed that the damage was caused by the plaintiff encountering a stationary object.
She contended that the defendant did not pay the plaintiff's claim; and that the defendant "violated the [insurance] contract." The plaintiff also claimed an unreasonable professional claim and a claim for breach of the agreement's arbitration agreement, with a request for punitive damages.
The defendant specifically noted that in its investigation of the plaintiff's allegation, it determined that she “struck a fixed stationary object as she was moving forward and that none of her injuries matched that she was struck by another motor vehicle. “In its reply, the defendant pointed out that the plaintiff's claim was denied for fraud and misrepresentation.
Following a hearing in the case, the trial court concluded its decision on a summary judgment in favor of the defendant and against the plaintiff and taxed costs against the plaintiff.  ANALYSIS
Certain facts were undisputed: that the plaintiff had insurance with the defendant and that the plaintiff's vehicle was damaged beyond repair. It is common ground that the defendant denied the plaintiff's claims for insurance benefits under the insurance.
The Court of Appeal concluded that there was a substantive issue as to whether the plaintiff's coverage was annulled by her erroneous statement as to the cause of the damage. She claims it was caused by an unidentified driver. The defendant claims that it was caused by her own negligence when she hit a stationary object. Consequently, since the dispute is factual, the Court set aside a summary judgment on the requirement of coverage under the terms of the policy which must be resolved at a trial.
As regards the plaintiff's allegations of unfair and misleading commercial practices and for breach of the agreement of good faith and fair trade, the court upheld the trial court because the plaintiff offered no evidence to prove that the defendant did anything other than act honestly in the investigation of her claim.
The defendant's hard evidence shows that it carried out an investigation, that it found that the cause of the plaintiff's vehicle damage was different from her account and that it denied the claim due to fraud and misrepresentation. The defendant's register shows that it considered the plaintiff's version of the accident, but concluded after investigation that the accident probably did not occur as the plaintiff claims.
"Bad faith" does not mean based on honest disagreement or innocent mistake. That is, an honest disagreement between the parties does not constitute bad faith. With regard to the plaintiff's claims of unfair trading practices, the plaintiff failed in its burden of providing evidence showing that the defendant acted in any unfair or misleading manner. Consequently, the summary judgment of the defendant was upheld by the defendant on allegations of disloyalty and unfair trading practices, including the plaintiff's allegations of treble and punitive damages. The question of cause and deception was returned to the trial court to determine whether the plaintiff tried to deceive the insurer and the real cause of the destruction of the car.
When the investigation of an occupational injury or the investigator for the special investigation unit determines the evidence establishes that the vehicle was destroyed by the insured driving it in a stationary object and not by an unidentified hit and run vehicle, there is a real dispute between the insured and the insurer. At the trial, the insurer will present its expert opinion and either establish an insured against cause or that the claim was a fraud. Regardless, a decision on good faith, a disputed set of facts, is not sufficient to even consider a tort of unfair faith or unfair commercial practice and the court agreed.
© 2020 – Barry Zalma
Barry Zalma, Esq., CFE, now limits his practice to serving as an insurance consultant specializing in insurance coverage, insurance management, infidelity and insurance fraud almost equally for insurers and insurers. He also acts as an arbitrator or mediator for insurance-related disputes. He practiced law in California for more than 44 years as an insurance coverage and claims lawyer and more than 52 years in the insurance industry. He is available at http://www.zalma.com and firstname.lastname@example.org.
Mr. Zalma is the first recipient of the first annual Claims Magazine / ACE Legend Award.
For the past 53 years, Barry Zalma has devoted his life to insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to enable insurance companies and their claims staff to become insurance claims personnel.
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