Wallace v. State Farm Fire & Casualty Co.
Wallace v. State Farm Fire & Casualty Co.
Opinion of the Court
After being seriously injured in an automobile accident, plaintiff-appellant Dennis J. Wallace brought suit against defendant-appellee State Farm Fire & Casualty Company for lost wages benefits under an automobile insurance policy issued him by the company. The policy’s lost wages coverage was limited to an amount not exceeding $15,000 for total disability,
It is undisputed in the record that defendant suspended payment of plaintiff’s lost wages benefits relying upon the opinion of a board-certified orthopedic surgeon. As a consequence, summary judgment on the question of plaintiff’s claim for bad faith damages under OCGA § 33-4-6 was proper. “As a matter of law, bad faith penalties and attorney’s fees under OCGA § 33-4-6 are not awardable if an insurer has a reasonable and probable cause for refusing to pay a claim.” (Citations and punctuation omitted.) Lancaster v. USAA Cas.
A defendant’s mere negligent performance of a contractual duty does not create a tort cause of action;7 rather, a defendant’s breach of a contract may give rise to a tort cause of action only if the defendant has also breached an independent duty created by statute or common law.
Traina Enterprises v. RaceTrac Petroleum, 241 Ga. App. 18, 19 (525 SE2d 712) (1999); Constr. Lender v. Sutter, 228 Ga. App. 405, 409 (2) (491 SE2d 853) (1997); Walton Elec. Membership Corp. v. Snyder, 226 Ga. App. 673, 678 (2) (487 SE2d 613) (1997). Even if there were a breach of a contractual duty in the instant circumstances (and we have found none), there is here no evidence of an insurance contract purporting to indemnify plaintiff for more than lost wages up to $15,000 in the event of plaintiff’s total disability. The plaintiff deposed that defendant made him no other promise. As a result, even an implied duty in the defendant to indemnify the plaintiff for damages attendant to the repossession of his privately owned vehicle and injury to his credit rating is here foreclosed. Absent a legal duty beyond the contract, no action in tort may lie upon an alleged breach of contractual duty. Traina Enterprises v. RaceTrac Petroleum, supra.
Judgment affirmed.
The policy defined “total disability” as the “insured, while living, is not able to do the usual work or any other work for which he or she is reasonably fitted by education, training or experience.”
Pertinently, the IME, a board-certified orthopedic surgeon, determined that the plaintiff could be returned to the work force if not required to do heavy lifting, squatting or climbing.
“OCGA § 33-4-6 is the exclusive remedy for bad faith denial of insurance benefits.” Collins v. Life Ins. Co., 228 Ga. App. 301, 304 (3) (491 SE2d 514) (1997).
“Under OCGA § 33-4-6, an insurer is subject to imposition of a penalty and attorney fees if it refuses in bad faith to pay a covered loss ‘within 60 days after a demand has been made by the holder of the policy.’ ” Jones v. State Farm &c. Ins. Co., 228 Ga. App. 347, 350 (3) (491 SE2d 830) (1997).
Though the “penalties provided by OCGA § 33-4-6 are exclusive, ... a tort action and an action for breach of contract may be asserted in the same complaint. [Cits.]” Gibbs v. Jefferson-Pilot Fire &c. Ins. Co., 178 Ga. App. 544, 545 (1) (343 SE2d 758) (1986).
The rule in Lancaster is not without limitation. If the recommendation of the IME is patently wrong and the facts are timely brought to the insurer’s attention, an IME would not provide a reasonable basis for the denial of the claim. See Haezebrouck v. State Farm &c. Ins. Co., 216 Ga. App. 809, 811 (2) (455 SE2d 842) (1995); Colonial Life &c. Ins. Co. v. Donaldson, 172 Ga. App. 211, 212-213 (1) (322 SE2d 510) (1984). Similarly, if an IME determination were in the nature of mere pretext for an insurer’s unwarranted prior decision to terminate benefits, such IME determination would not constitute reasonable and probable cause for the termination of benefits — this because it would not be a “reasonable defense which vindicates the good faith of the insurer.” (Citation and punctuation omitted.) Progressive Cas. Ins. Co. v. Avery, 165 Ga. App. 703, 707 (1) (302 SE2d 605) (1983).
“The four elements [of a] tort [cause of] action are a duty, a breach of that duty, causation and damages.” Traina Enterprises v. RaceTrac Petroleum, 241 Ga. App. 18 (525 SE2d 712) (1999); Nesmith v. Pierce, 226 Ga. App. 851, 852 (1) (487 SE2d 687) (1997).
Concurring Opinion
concurring specially.
Although I concur fully in the majority opinion under the evidence in this case, I write separately to point out that an insurance company’s mere assertion that the termination of benefits was based on an independent medical examination is not conclusive in the face of evidence that the independent medical examiner (IME) report was not the real reason the benefits were terminated.
An independent medical examination may provide a reasonable and probable cause to terminate benefits and thus be sufficient to preclude imposition of bad faith penalties (Lancaster v. USAA Cas. Ins. Co., 232 Ga. App. 805, 807 (3) (502 SE2d 752) (1998)), but that rule is not without limitation. If the recommendation of the IME is patently wrong and the facts are brought in a timely manner to the
Here, I concur with the majority even though Wallace’s affidavit alleged that State Farm told him before the independent medical examination was performed that his benefits would be terminated regardless of what the IME said. His affidavit was contradicted, without explanation, however, by his deposition testimony that no one at State Farm contacted him before his benefits were terminated and he did not contact State Farm until after his benefits were stopped.
Thus, applying the contradictory testimony rule, Wallace’s unexplained, self-conflicting testimony is of no assistance to him. Gentile v. Miller, Stevenson &c., Inc., 257 Ga. 583 (361 SE2d 383) (1987); Prophecy Corp. v. Charles Rossignol, Inc., 256 Ga. 27, 30 (343 SE2d 680) (1986). Once the self-contradictory favorable portions of Wallace’s affidavit are eliminated, the remaining evidence construed in Wallace’s favor is not sufficient to create an issue of fact on this issue because the record shows that the IME report is dated before his benefits were terminated.
Consequently, the issue of pretext is not properly raised in this case.
Reference
- Full Case Name
- Wallace v. State Farm Fire & Casualty Company
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- Published