Wednesday, July 08, 2009, 6:29 AM

Court of Appeals Spells Out Claims Settlement Rules for Insurers and Unfair Trade Practices

In Martini v. Companion Property & Casualty Insurance Co., decided yesterday, the court of appeals considered the issue of when an insurer engages in unfair trade practices in connection with claims settlement.

Section 58-63-10 of the General Statutes defines unfair practices by insurance companies but doesn’t, in itself, create a private right of action. The courts have ruled, however, that violations of the insurance statute also violate N.C.G.S. § 75-1.1 which does provide for a private right of action.

In Martini, the plaintiff alleged that the auto insurer engaged in unfair claims settlement practices by refusing to pay a claim without conducting a reasonable investigation in violation of N.C.G.S. § 58-63-15(11)(d).

The court of appeals reversed summary judgment in favor of the insurer based on plaintiff’s contention that the insurance company’s failure to speak directly with the plaintiff before denying the claim constituted an incomplete investigation and that the company's continued denial – after receiving plaintiff’s explanation on a critical issue – and failure to follow its own claims handling guidelines also was an unfair trade practice.

Judge Steelman dissented on the grounds that the reversal was based solely on allegations in plaintiff’s unverified complaint as opposed to record evidence.

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