Shotts v. GEICO
Citation943 F.3d 1304
Date Filed2019-12-02
Docket18-6206
Cited37 times
StatusPublished
Full Opinion (html_with_citations)
PUBLISH FILED
United States Court of Appeals
UNITED STATES COURT OF APPEALS Tenth Circuit
FOR THE TENTH CIRCUIT December 2, 2019
_________________________________
Elisabeth A. Shumaker
Clerk of Court
BRIAN SHOTTS,
Plaintiff - Appellant,
v. No. 18-6206
GEICO GENERAL INSURANCE
COMPANY, d/b/a GEICO among other
names,
Defendant - Appellee.
_________________________________
Appeal from the United States District Court
for the Western District of Oklahoma
(D.C. No. 5:16-CV-01266-SLP)
_________________________________
Clifton Naifeh of Naifeh & Associates, Norman, Oklahoma, for Plaintiff â Appellant.
Gerard F. Pignato (Justin R. Williams with him on the brief) of Roberson, Kolker,
Cooper, & Goeres, P.C., Oklahoma City, Oklahoma, for Defendant â Appellee.
_________________________________
Before MATHESON, PHILLIPS, and MORITZ, Circuit Judges.
_________________________________
MATHESON, Circuit Judge.
_________________________________
In 2014, Brian Shotts was injured in a car accident caused by Dana Pollard. Mr.
Shottsâs automobile insurance through GEICO General Insurance Company (âGEICOâ)
included underinsured motorist (âUMâ) coverage. 1 Ms. Pollard had automobile
insurance through Farmers Insurance (âFarmersâ).
Mr. Shotts filed a claim with Farmers, which offered Ms. Pollardâs policy limits as
settlement. Before accepting the offer, Mr. Shotts notified GEICO of the accident.
GEICO opened a claim, assigned an adjuster, and began an investigation. GEICO also
waived its subrogation rights, allowing Mr. Shotts to accept the offer from Farmers.
GEICOâs investigation determined that Mr. Shottsâs injuries exceeded Ms.
Pollardâs policy limits by $3,210.87. GEICO offered Mr. Shotts a settlement of that
amount, but Mr. Shotts declined the offer as âunreasonably low.â App., Vol. 5 at 144.
Mr. Shotts demanded GEICO promptly âpay the first dollar of his claim, up to the value
of [the] claim or the total available UM limitsâ of $25,000. Id. at 143. 2 He also asked
GEICO to reevaluate the offer. In response, GEICO requested additional information
1
As explained in greater detail below, UM coverage protects drivers from
accidents and injuries caused by individuals who have no insurance or who do not have
enough coverage to pay the full value of a claim. When an individual is involved in an
accident with an underinsured or uninsured motorist, the individualâs UM coverage pays
for the amount not covered by the at-fault underinsured motoristâs insurance.
The parties and Oklahoma case law use the abbreviations âUMâ and âUIMâ
interchangeably to refer to uninsured and underinsured motorist coverage. In this
opinion, we use âUM.â
2
As discussed in greater detail below, Oklahoma courts refer to this as the âfirst-
dollar paymentâ requirement. Under this requirement, if an insured individual is injured
by an underinsured motorist and his or her injuries exceed the underinsured driverâs
policy limits, the UM insurer must promptly pay the full value of the UM claim up to the
UM policy limits.
2
about Mr. Shottsâs injuries. It then proposed a peer review to determine whether his
injuries exceeded the $3,210.87 offer.
Mr. Shotts sued for bad faith breach of contract, alleging that GEICO acted in bad
faith by (1) conducting âa biased and unfair investigation and evaluation of [his] claimâ
and (2) failing to pay the full value of his claim. App., Vol. 1 at 30-31. He also
requested punitive damages. The district court granted summary judgment for GEICO on
both bad faith claims and denied punitive damages. Exercising jurisdiction under 28
U.S.C. § 1291, we affirm.
I. BACKGROUND
Before describing the factual and procedural background of this case, we provide a
brief overview of Oklahomaâs laws regarding UM insurance coverage and subrogation.
We then discuss the events leading to this appeal.
A. UM Coverage and Subrogation Overview
Uninsured Motorist Coverage
UM coverage pays for damage or injuries caused by uninsured or underinsured
drivers (the âunderinsured driverâ or âat-fault driverâ). 3 It âapplies in the situation where
the tortfeasor [i.e., the driver who causes an accident] is without insurance or where the
tortfeasor has insufficient insurance to satisfy the claim of the insured.â Buzzard v.
3
In this opinion, we use the term âUMâ coverage to refer to both underinsured
motorist coverage and uninsured motorist coverage. We use the term âunderinsured
motoristâ to describe both underinsured motorists and uninsured motorists.
3
Farmers Ins. Co., 824 P.2d 1105, 1110 (Okla. 1991). Put differently, if an individual is
in an accident caused by an underinsured at-fault driver, UM coverage will cover what
the underinsured driverâs insurance does not.
Under Oklahoma law, 4 every vehicle insurance policy must include UM coverage.
Okla. Stat. Ann. tit. 36, § 36365; Buzzard,824 P.2d at 1110
. Because of this, an
individual typically receives UM coverage through the same insurer that provides the
personâs automobile insurance (the âprimary insurer,â âUM insurer,â or âUM carrierâ).
Oklahoma considers UM coverage primary, or first-party, coverage. See Buzzard,
824 P.2d at 1110; see also Mustain v. U.S. Fid. & Guar. Co.,925 P.2d 533, 536
(Okla.
1996) (â[A]s between the insurer and its insured UM insurance is primary coverage.â).
Coverage is âprimaryâ when an individualâs âinsurer is liable without regard to any other
insurance coverage available.â Equity Mut. Ins. Co. v. Spring Valley Wholesale Nursery,
4
Because our jurisdiction is based on the partiesâ diversity of citizenship, 28
U.S.C. § 1332, we apply the substantive law of the forum stateâOklahoma. Klaxon Ins. Co. v. Stenor Elec. Mfg. Co.,313 U.S. 487, 496
(1941); Clark v. State Farm Mut. Auto. Ins. Co.,433 F.3d 703, 709
(10th Cir. 2005).
5
The statute states, in pertinent part,
No policy insuring against loss resulting from liability . . . for
bodily injury or death . . . arising out of the ownership,
maintenance or use of a motor vehicle shall be issued,
delivered, renewed, or extended in this state . . . unless the
policy includes . . . coverage . . . for the protection of persons
insured thereunder who are legally entitled to recover
damages from owners or operators of uninsured motor
vehicles . . . .
Okla. Stat. Ann. tit. 36, § 3636(A)-(B).
4
747 P.2d 947, 954(Okla. 1987). 6 In other words, an individual injured by an underinsured driver does not need to exhaust the at-fault driverâs policy limits before making a UM claim with his or her primary insurer. See Mustain,925 P.2d at 535
(â[T]he UM insurer may not withhold payment . . . on the sole basis that the liability insurance has not been exhausted.â); Buzzard,824 P.2d at 1112
(noting that âexhaustion
of limits is not required as a condition precedent to [UM] recoveryâ).
Subrogation
âSubrogation simply means substitution of one person for another; that is, one
person is allowed to stand in the shoes of another and assert that personâs rights against a
third party.â US Airways, Inc. v. McCutchen, 569 U.S. 88, 97 n.5 (2013) (quotations
omitted); see also 16 Couch on Ins. § 222:5 (ââSubrogationâ is the substitution of another
person in place of the creditor to whose rights [the substitute] succeeds in relation to the
debt[.] [Subrogation] gives to the substitute all the rights . . . of the [creditor].â). â[A]
subrogated insurer stands in [the] shoes of an insuredâ and âis subrogated in a
corresponding amount to the insuredâs right of action against any other person
responsible for the loss, such that the insurer is entitled to bring an action against this
third party . . . .â 16 Couch on Ins. § 222:5.
6
âSecondaryâ or âexcessâ coverage, by contrast, is available âonly after any
primary coverageâother insuranceâhas been exhausted.â Equity Mut. Ins. Co., 747
P.2d at 954.
5
In Oklahoma, UM insurers enjoy statutory subrogation rights. Okla. Stat. Ann.
tit. 36, § 3636(F). These rights allow UM insurers to pay an insuredâs claim and then seek reimbursement from the underinsured at-fault driverâs insurer. This process operates as follows. When insured individuals involved in an accident with an underinsured driver reach a tentative agreement to settle with that driverâs insurer, they must notify their UM insurer and submit documentation of any pecuniary losses.Id.
§ 3636(F)(1). The UM insurer then has 60 days to âsubstitute its payment to the
insured for the tentative settlement amountââthat is, to pay the injured individual the
amount owed by the underinsured driverâs insurer. Id. § 3636(F)(2). If the UM insurer
chooses to substitute payment, the injured individual receives payment for the entire
value of the claim directly from the UM insurer but loses the right to receive any payment
from the underinsured driverâs insurer. The UM insurer is then âentitled to the insuredâs
right of recovery,â id., and can exercise its subrogation rights to seek repayment from the
underinsured motoristâs insurer. 7
7
âIt is not unreasonable to ask, upon confronting the extensive and complicated
field of subrogation, why the law countenances a system under which [the] insurer first
settles with [the] insured, then . . . pursues [the] responsible party.â 16 Couch on Ins.
§ 222:4. As one scholar explains,
Several policy considerations underlie the doctrine of
subrogation. First, subrogation has its genesis in the principle
of indemnity. Although an insured is entitled to indemnity
from an insurer pursuant to coverage provided under a policy
of insurance, the insured is entitled only to be made whole,
not more than whole. Subrogation prevents an insured from
obtaining one recovery from the insurer under its contractual
obligations and a second recovery from the tortfeasor under
general tort principles. Additionally, subrogation rights
6
A UM insurer may waive its subrogation rights. See Buzzard, 824 P.2d at 1110. It may also forfeit the rights by failing to substitute payment within 60 days. SeeOkla. Stat. Ann. tit. 36, § 3636
(F)(2) (âIf the [UM] coverage insurer fails to pay the insured the
amount of the tentative tort settlement within sixty (60) days, the [UM] coverage insurer
has no right to the proceeds of any settlement or judgment . . . .â).
First-Dollar Payment Requirement
As just explained, Oklahoma law requires UM insurers to substitute payment
within 60 days of learning of an individualâs claim or waive their subrogation rights. See
id.Oklahoma courts have labeled this requirement as a âspeedy payment mechanism,â Phillips v. N.H. Ins. Co.,263 F.3d 1215, 1225
(2001), and have specified that it âentitle[s] [injured parties] to swift paymentâ of UM policy benefits, Mustain,925 P.2d at 535
. If an individual is damaged or injured by an underinsured driver, the UM insurer
enable the insurer to recover payments to the insured, who
theoretically should have been made whole through those
payments. Finally, subrogation advances an important policy
rationale underlying the tort system by forcing a wrongdoer
who has caused a loss to bear the burden of reimbursing the
insurer for indemnity payments made to its insured as a result
of the wrongdoerâs acts and omissions.
Elaine M. Rinaldi, Apportionment of Recovery Between Insured and Insurer in a
Subrogation Case, 29 Tort. & Ins. L.J. 803, 803 (1994).
Subrogation is not always beneficial to the insurer, however. Rather, â[i]nsurers
must . . . assess whether pursuing the third party [through subrogation] will be cost
effective or too time consuming.â 16 Couch on Ins. § 222:4. An insurer may decide to
waive its subrogation rights if âthe relative fault of the insured and third parties, the dollar
amount of the loss, . . . the estimated cost of legal prosecution of the claim,â or other
factors indicate that the action will not be âeconomically feasible.â Id.
7
âmay not delay the payment of benefits until exhaustion of [the other driverâs policy]
liability limits.â Buzzard, 824 P.2d at 1112. Instead, the UM insurer âmust take prompt action to determine what payment is due.âId.
If, âafter investigation, [it] determines that the likely worth of the claim exceeds the liability limits [of the underinsured at-fault driverâs policy], prompt payment must be offered.âId.
In Burch v. Allstate Insurance Company, 977 P.2d 1057(Okla. 1998), the Oklahoma Supreme Court held that â[a UM] carrier is liable for the entire amount of its insuredâs loss from the first dollar up to the UM policy limits without regard to the presence of any other insurance.âId. at 1058
(emphasis added). In other words, if an
individual is injured by an underinsured driver, and if the individualâs injuries exceed the
underinsured driverâs policy limits, the UM insurer must promptly pay the full value of
the UM claim, as capped by the UM policy limits. Following the parties, we refer to this
as the âfirst-dollar paymentâ or âdrop-down paymentâ requirement.
Once a UM insurer pays the full value of an injured partyâs claim, as capped by
the UM policy limits, the injured party can no longer seek recovery from the
underinsured driverâs insurance. Rather, the UM insurer âstands in [the] shoes of [the]
insured,â 16 Couch on Ins. § 222:5, and can exercise its statutory subrogation rights âto
proceed in its own right against the [at-fault underinsured driver],â Burch, 977 P.2d at
1065. The first-dollar payment requirement thus âdoes not make the UM carrier the final indemnitor for the injured partyâs loss.âId.
It also does not allow an injured party to
recover twiceâonce from the UM insurer and once from the underinsured driverâs
8
insurerâfor his or her injuries. Instead, the requirement âis only a temporary expedient
to facilitate prompt payment to the [injured party].â Id.
B. Factual Background
Pre-Accident Medical History
Beginning in 2001, Mr. Shotts visited multiple doctors with complaints of back
and neck pain. Between March 2007 and May 2011, he saw the same physician at least
33 times to receive treatment for his back. Between September 2011 and April 2013, he
received treatment from a chiropractor at least 15 times. He also had several x-rays and
MRIs, which revealed minor spinal abnormalities. His physicians prescribed medications
to treat his pain and encouraged him to take Ibuprofen and Tramadol daily.
Accident and Insurance Policy
On June 14, 2013, Mr. Shotts was involved in a car accident caused by Dana
Pollard. He received hospital treatment for injuries to his back, elbow, and neck.
Mr. Shotts had automobile insurance through GEICO. His policy included UM
coverage in the amount of $25,000 per person. It also contained a subrogation provision
that stated:
When payment is made under this policy, [GEICO] will be
subrogated to all the insuredâs rights of recovery against
others. The insured will help us to enforce these rights. The
insured will do nothing after loss to prejudice these rights.
This means [GEICO] will have the right to sue for or
otherwise recover the loss from anyone else who may be held
responsible.
App., Vol. 2 at 95.
9
Ms. Pollard had automobile coverage through Bristol West, a subsidiary of
Farmers. Her policy had a liability limit of $25,000.
Post-Accident Medical History
After the accident on June 14, 2013, Mr. Shotts was admitted to the emergency
department at the Comanche County Memorial Hospital. He reported âgeneralized
sorenessâ and rated his pain as â2/10 to 3/10.â Id. at 79. The treating physician recorded
Mr. Shottsâs condition as â[m]otor vehicle collision with musculoskeletal pain and
muscle spasm.â Id. at 80.
Over the next several years, various physicians concluded that âMr. Shottsâs
[preexisting back] condition ha[d] been exacerbated by [the] car accident.â App., Vol. 3
at 101; see also id. at 105; App., Vol. 2 at 189. Mr. Shotts continued taking daily
painkillers, and at a doctorâs visit in 2014, he reported â[t]aking Ibuprofen 800MG[,] 1
tablet [t]hree times a day.â App., Vol. 3 at 111.
In 2015, Mr. Shotts received treatment for digestive issues and ulcers. In June
2016, his physician sent a letter to his attorney, stating, âBrian Shotts is a patient under
my care for multiple diagnoses. [He] has a history of long term use of 800mg [of
nonsteroidal anti-inflammatory drugs] five to six times daily. Due to the length of use,
[he] developed peptic ulcer disease. The peptic ulcer disease then led to further
complications.â App., Vol. 2 at 227.
10
Workerâs Compensation and Farmers Claims
After the accident, Mr. Shotts filed a workerâs compensation claim and a claim
with Farmers, Ms. Pollardâs insurer. In January 2016, Farmers paid $10,154.51 for the
workerâs compensation claim. It offered the rest of Ms. Pollardâs policy limitsâ
$14,845.49âto resolve any remaining claims. 8
GEICO Claim
In March 2016, Mr. Shottsâs attorney, Clifton Naifeh, informed GEICO of the
accident. GEICO opened a claim and assigned the case to adjuster Larrisa Henley. Ms.
Henley requested a copy of Mr. Shottsâs policy declarations page and the police report.
She asked Mr. Shotts to sign and return authorizations allowing GEICO to access his
medical data. She also left a voice message with Farmers to request information about
the claim.
Mr. Shotts submitted the police report, his medical bills, and relevant medical
records to Ms. Henley. He also provided a recorded statement about the incident.
GEICOâs Waiver of Subrogation Rights
GEICO next received a letter from Mr. Naifeh. In the letter, Mr. Naifeh explained
that Farmers paid $10,154.51 for Mr. Shottsâs workerâs compensation claim and had
8
It appears from the record that Mr. Shotts never accepted this offer. In one of his
submissions to the district court, Mr. Shotts stated, â[GEICOâs] position that [Mr. Shotts]
may have prematurely or surreptitiously accepted Farmers [sic] partial policy limits, or
later the full policy limits, at any time is not shown in the record anywhere prior to
GEICOâs evaluation [that] the claim exceeds the tortfeasors [sic] limits.â App., Vol. 5 at
164.
11
offered the remaining policy limits as settlement. Mr. Naifeh stated this offer was
insufficient because âMr. Shotts suffered a significant injury well in excess of the adverse
carriers [sic] policy limits.â App., Vol. 5 at 128. He requested that GEICO âwaive its
subrogation interest, so that [Mr. Shotts] may accept the third-party tortfeasors [sic]
offerâ and âtimely pay in good faith all policy benefits to which [Mr. Shotts] is entitled.â
Id. at 129. He included a copy of the Farmers offer, a summation of the medical bills Mr.
Shotts attributed to the accident, and the medical records and bills supporting the
summation.
After reviewing the letter, Ms. Henley made a note in Mr. Shottsâs case file
attributing fault to Ms. Pollard. She then contacted Mr. Naifeh to request access to Mr.
Shottsâs medical records. She also informed Mr. Naifeh that GEICO âwaive[d] [its]
subrogation interest so that Mr. Shotts may accept the tort feasorâs [sic] offer.â App.,
Vol. 2 at 147.
GEICOâs Investigation and Initial Evaluation
Ms. Henley evaluated Mr. Shottsâs claim using the medical documents Mr. Naifeh
attached to his letter. She reviewed records from various medical facilities and providers,
including the Comanche County Memorial Hospital, the Southwest Medical Center, the
Oklahoma Spine Institute, and at least three physicians. She also reviewed Mr. Shottsâs
MRIs and other medical imaging. Based on her assessment, she concluded that Mr.
Shotts sustained âthoracic strain and back pain.â Id. at 191.
12
Ms. Henley then used Mr. Shottsâs medical bills to determine the value of his
claim. She excluded medical bills for visits to digestive health specialists because she
concluded they were not related to the accident. She determined Mr. Shottsâs claim had a
value between $19,822.91 and $24,822.91.
When Ms. Henley completed her evaluation, she wrote to Mr. Naifeh. She
explained, âWe have confirmed that Farmers has Bodily Injury limits of $25,000. Based
on the information you submitted in your demand, my evaluation . . . is within the
tortfeasors [sic] limits. Therefore, I will not be extending any offer.â App., Vol. 5 at
134. Mr. Naifeh responded with a letter stating that he did not agree with the evaluation
because it was too low. The letter also demanded a first-dollar payment under Burch. 9
GEICOâs Reevaluation and Additional Investigation
After receiving Mr. Naifehâs letter, Ms. Henley reevaluated Mr. Shottsâs claim.
She did not change her general damages evaluation or alter her assessment of Mr.
Shottsâs injuries, but she adjusted her calculation to reflect incurred, rather than paid,
medical expenses. Based on this reevaluation, Ms. Henley offered a settlement of
$3,210.87.
Mr. Naifeh declined âthe unreasonably low offer.â App., Vol. 2 at 206. He
requested that GEICO reevaluate the claim and, based on Burch, âpay the first dollar of
9
As explained above, Burch held âthat when the preconditions for the loss under
[UM] coverage exist, [a UM] coverage carrier is obligated to pay the entire loss of its
injured insured from the first dollar up to the policy limits.â 977 P.2d at 1064.
13
[Mr. Shottsâs] claim, up to the value of [the] claim or the total available UM limits.â Id.
at 205.
GEICO did not respond to Mr. Naifehâs requests. Shortly after, Mr. Naifeh
informed Ms. Henley that Farmers had offered $25,000 to settle the claim. He also
requested confirmation from GEICO that it had waived its subrogation rights. Ms.
Henley responded, confirming that GEICO would âwaive any subrogation rights to that
policy.â App., Vol. 5 at 148.
Over the next several weeks, Mr. Naifeh twice asked GEICO to reevaluate the
$3,210.87 settlement offer. In response, Ms. Henley requested further information
regarding Mr. Shottsâs injuries and inquired about the ulcers he claimed he developed
after the accident. Mr. Naifeh provided a doctorâs letter and medical authorization for
GEICO to obtain additional medical records. He stated the records he already produced
clearly âprovided that Mr. Shottsâs [sic] peptic ulcer did not develop until after the
subject collision,â App., Vol. 3 at 190, and asked GEICO to pay âwithin 30 daysâ
because â[i]t [was] well past time for GEICO to have paid,â id. at 191.
Ms. Henley used the medical authorizations to request additional records. She told
Mr. Naifeh that once she âreceived the requested documentation,â she would âreview to
determine if a peer review . . . [was] needed to complete [the] evaluation.â App., Vol. 2
at 248. She also wrote:
The medical records you have provided in the past indicate
that Mr. Shotts had prior chronic back pain issues and was
already taking the medication that you indicate caused his
Peptic Ulcer. In addition, the letter from [Mr. Shottsâs
14
doctor] indicates that multiple diagnoses caused his ulcer, but
it is unclear what diagnosis is or is not related to this loss.
The peer review . . . will assist in providing me the
information needed to determine if the ulcer was caused
directly as a result of the treatment from this loss.
Id.
C. Procedural Background
After learning that Ms. Henley intended to seek peer review of the claim, Mr.
Shotts sued GEICO in Oklahoma state court, asserting claims for breach of contract and
bad faith. Specifically, Mr. Shotts alleged that GEICO conducted âa biased and unfair
investigation and evaluation of [his] claim,â âunfairly failed and refused to pay any
amount which it owed . . . under the UM/UIM coverages,â and âbreached its contract and
its duties to [him].â App., Vol. 1 at 30-31.
Invoking diversity jurisdiction, GEICO timely removed to the United States
District Court for the Western District of Oklahoma. It then moved for summary
judgment. Mr. Shotts opposed the motion, arguing that GEICO acted in bad faith by (1)
conducting an inadequate investigation and evaluation of his claims, (2) failing to timely
pay the full policy limits as required under Burch, (3) requesting peer review, and
(4) mishandling his requests about policy stacking. 10 The court initially denied the
motion in part, but eventually granted summary judgment for GEICO on all claims.
10
Only the first and second bad faith claims are at issue on appeal.
15
In its initial ruling, the district court granted summary judgment on the inadequate
investigation, peer review, and stacking bad faith claims. It also granted summary
judgment for GEICO on the issue of punitive damages. But it concluded GEICO was
ânot entitled to summary judgment as to [Mr. Shottsâs] bad faith claim premised on a
violation of Burchâ because GEICO âdid not promptly tender âfirst dollarâ payment to
[Mr. Shotts] after [Ms.] Henley determined the value of [the] claim exceeded the
tortfeasorâs policy limits.â App., Vol. 5 at 104-05.
GEICO moved for reconsideration. The district court granted the motion and
entered summary judgment for GEICO on the Burch bad faith claim. In doing so, the
court noted that, although GEICO never paid the full value of Mr. Shottsâs claim, it had
waived its subrogation rights, which allowed Mr. Shotts to seek prompt payment from
Farmers. It concluded that âsummary judgment should be entered in GEICOâs favor as
to [Mr. Shottsâs] bad faith claim premised on Burch and alleging that GEICO failed to
make prompt payment of proceeds due under the policy.â Id. at 208.
Mr. Shotts timely appealed the district courtâs summary judgment rulings on his
unreasonable investigation bad faith claim, Burch bad faith claim, and punitive damages
request. We affirm on all three.
II. DISCUSSION
This appeal concerns whether the district court properly granted summary
judgment for GEICO on Mr. Shottsâs (1) unreasonable investigation bad faith claim,
(2) Burch bad faith claim, and (3) request for punitive damages.
16
On the unreasonable investigation claim, we affirm because Mr. Shotts has not
provided evidence to show that GEICOâs investigation demonstrated bad faith. On the
Burch claim, we affirm because GEICOâs waiver of subrogation rights extinguished its
duty to make a prompt first-dollar payment. The punitive damages issue is dependent on
and derivative of Mr. Shottsâs bad faith claims. Because those claims fail, we also affirm
the district courtâs summary judgment on punitive damages.
A. Background Law
Standard of Review
âWe review the grant of summary judgment by the district court de novo, applying
the same legal standard to the evidence in the record as did the district court.â Oulds v.
Principal Mut. Life Ins. Co., 6 F.3d 1431, 1436(10th Cir. 1993). In doing so, â[w]e view the evidence and draw reasonable inferences in the light most favorable to the nonmoving party.â Teets v. Great-W. Life & Annuity Ins. Co.,921 F.3d 1200, 1211
(10th Cir. 2019).
âThe court shall grant summary judgment if the movant shows that there is no genuine
dispute as to any material fact and the movant is entitled to judgment as a matter of law.â
Fed. R. Civ. P. 56(a).
Oklahoma Bad Faith Insurance Claims
Under Oklahoma law, â[a]n insurer has an âimplied-in-law duty to act in good
faith and deal fairly with the insured to ensure that the policy benefits are received.ââ
Badillo v. Mid Century Ins. Co., 121 P.3d 1080, 1093 (Okla. 2005) (quoting Christian v.
17
Am. Home Assurance Co., 577 P.2d 899, 901(Okla. 1977)). â[T]he violation of this duty gives rise to an action in tort . . . .â Christian,577 P.2d at 904
.
âThe core of a bad-faith claim âis the insurerâs unreasonable, bad-faith conduct,
including the unjustified withholding of payment due under a policy.ââ Flores v.
Monumental Life Ins. Co., 620 F.3d 1248, 1255(10th Cir. 2010) (quoting McCorkle v. Great Atl. Ins. Co.,637 P.2d 583, 587
(Okla. 1981)). To succeed on a bad faith claim, âthe insured must present evidence from which a reasonable jury could conclude that the insurer did not have a reasonable good faith belief for withholding payment of the insuredâs claim.â Oulds,6 F.3d at 1436
(citing McCoy v. Okla. Farm Bureau Mut. Ins. Co.,841 P.2d 568, 572
(Okla. 1992)); see also Garnett v. Govât Emps. Ins. Co.,186 P.3d 935, 944
(Okla. 2008) (âA party prosecuting a claim of bad faith carries the burden of proof . . . .â); Timberlake Constr. Co. v. U.S. Fid. & Guar. Co.,71 F.3d 335, 343
(10th
Cir. 1995) (â[T]he insured must present sufficient evidence reasonably tending to show
bad faith.â (quotations omitted)).
To determine whether a plaintiff has made this showing, courts assess âwhether
the insurer had a good faith belief in some justifiable reason for the actions . . . that are
claimed violative of the [insurerâs] duty of good faith and fair dealing.â Badillo, 121
P.3d at 1093-94. Courts make this determination âin light of all facts known or knowable concerning the claim at the time plaintiff requested the company to perform its contractual obligation.â Oulds,6 F.3d at 1439
(quotations omitted). â[U]ntil the
facts . . . have established what might reasonably be perceived as tortious conduct on the
18
part of the insurer, the legal gate to submission of the issue to the jury remains closed.â
Id. at 1437.
Courts generally conduct this analysis in two steps. First, the court considers
whether there is a legitimate dispute between the insurer and the insured regarding
coverage or the value of the claim. If there is no legitimate dispute between the parties,
the court may infer that the insurer denied payment in bad faith. See Barnes v. Okla.
Farm Bureau Mut. Ins. Co., 11 P.3d 162, 171, 175(Okla. 2000) (finding no legitimate dispute about the amount or extent of coverage and concluding that insurer denied payment in bad faith). But where there is a legitimate dispute between the parties, then âas a matter of law[,] . . . no reasonable inference of bad faith arises.â Timberlake,71 F.3d at 344
(quoting Oulds,6 F.3d at 1442
).
Because âthe denial of a claim based upon a legitimate dispute does not imply bad
faithâ as a matter of law, âjudgment as a matter of law is to be granted to the insurerâ
unless the insured âproduce[s] specific evidence of bad faith.â Oulds, 6 F.3d at 1442. Thus, if the court determines there is a legitimate dispute between the parties, it proceeds to the second step of its analysis and considers whether the plaintiff offered specific additional evidence to demonstrate bad faith. See Bannister v. State Farm Mut. Auto. Ins. Co.,692 F.3d 1117, 1128-32
(10th Cir. 2012) (identifying a legitimate dispute between
the parties and then considering whether plaintiff had identified additional evidence of
the insurerâs bad faith). If the court determines that the plaintiff has offered sufficient
19
evidence to show the insurer acted in bad faith, the court will send the case to a jury. Id.
at 1128; see also Oulds,6 F.3d at 1442
.
The additional evidence required for this showing may take several forms. For
example, a plaintiff may demonstrate bad faith by providing âevidence that the insurer
did not actually rely on th[e] legitimate [dispute]â to deny coverage, Bannister, 692 F.3d
at 1128, âdenied the claim for an illegitimate reason,âid.,
or otherwise âfailed to treat the insured fairly,â Thompson v. Shelter Mut. Ins.,875 F.2d 1460
, 1462 (10th Cir. 1989). A plaintiff may also show bad faith by providing evidence that the insurer performed an inadequate investigation of the claim. See, e.g., Oulds,6 F.3d at 1442
.
B. Mr. Shottsâs Bad Faith Claims
Mr. Shotts alleges that GEICO demonstrated bad faith by (1) conducting an
inadequate investigation, and (2) failing to pay the full, first-dollar value of his claim as
required under Burch. We provide additional legal background and analysis relating to
these claims.
Our analysis follows the two-step framework described above. We first consider
whether there was a legitimate dispute between the parties regarding the value of Mr.
Shottsâs claim and the extent of his injuries. We hold there was a legitimate dispute. We
therefore cannot conclude as a matter of law that GEICO breached the duty of good faith
by refusing to pay the full value of Mr. Shottsâs claim.
We thus proceed to consider whether Mr. Shotts has offered sufficient additional
evidence to support his unreasonable investigation and Burch bad faith claims. As to
20
both, we hold that Mr. Shotts has not presented evidence to show GEICO acted in bad
faith. We therefore affirm the district courtâs summary judgment for GEICO on both bad
faith claims.
Legitimate Dispute
a. Legal background
In Oklahoma, âa claim must be promptly paid unless the insurer has a reasonable
belief the claim is either legally or factually insufficient.â Barnes, 11 P.3d at 171. If there is no âlegitimate disputeâ between the parties regarding the amount or extent of coverage, then an insurerâs denial of payment gives rise to an inference of bad faith as a matter of law. See id.; see alsoid. at 175
. But where there is âa legitimate dispute,â then â[n]o reasonable inference of bad faith arises.â Oulds,6 F.3d 1440
. In such instances, courts will not conclude âas a matter of lawâ that the insurer âbreach[ed] the duty of good faith merely by refusing to pay [the] claim.â Timberlake,71 F.3d at 344
. Instead, courts will grant judgment for the insurer unless the insured can offer additional evidence of bad faith. See Oulds,6 F.3d at 1442
.
â[T]he fact that a reasonable jury could find in favor of the insurer based on all
facts known or that should have been known by the insurer when it denied a claim is
strong evidence that a dispute is âlegitimate.ââ Id.
b. Analysis
This case presents a legitimate dispute. Although GEICO and Mr. Shotts have
access to the same sets of medical records, the parties disagree about the nature and
21
extent of his injuries. Mr. Shotts claims he had a normal spine before the accident and
insists that his peptic ulcer developed only after the crash. GEICO, by contrast,
maintains that Mr. Shottsâs spinal problems predate the accident and that he âwas already
taking the medication that . . . caused his Peptic Ulcer.â App., Vol. 2 at 248.
The record contains evidence from which âa reasonable jury could find in favor of
the insurer.â Oulds, 6 F.3d at 1442. Specifically, a reasonable jury could conclude from Mr. Shottsâs medical records that his preexisting back injuries generated at least some of his post-accident medical expenses. The jury could also find that Mr. Shotts overestimates the value of his claim because some of his expenses were not necessitated by the accident. This is âstrong evidence that a dispute is âlegitimate.ââId.
Because the medical records in this case could support a finding that Mr. Shottsâs
back problems and peptic ulcer predated or are unrelated to the accident, there is a
legitimate dispute between the parties. Accordingly, we cannot conclude as a matter of
law that GEICO breached the duty of good faith by refusing to pay Mr. Shottsâs
requested claim. See Bannister, 692 F.3d at 1127-28.
Additional Evidence of Bad Faith
Because there is a legitimate dispute regarding the value of his claim, Mr. Shotts
must âproduce additional evidence of bad faith in order to send the issue to the jury.â
Timberlake, 71 F.3d at 344. Mr. Shotts attempts to make this showing by arguing that
GEICO (a) conducted an inadequate investigation, and (b) failed to make timely first-
dollar payment as required under Burch. We address these arguments in turn.
22
a. Inadequate investigation
i. Legal background
â[A] duty to timely and properly investigate an insurance claim is intrinsic to an
insurerâs contractual duty to timely pay a valid claim.â Brown v. Patel, 157 P.3d 117,
122(Okla. 2007); see also Buzzard,824 P.2d at 1109
(â[T]he insurer must conduct an investigation reasonably appropriate under the circumstances.â). Thus, even if there is a legitimate coverage dispute between the parties, an insurerâs failure to conduct a reasonable investigation may give rise to a bad faith claim. See Buzzard,824 P.2d at 1109
; see also Bannister,692 F.3d at 1128
(â[T]he jury may decide the issue . . . if there is evidence that the insurer failed to adequately investigate [the] claim.â (quotations omitted) (alterations in original)); Oulds,6 F.3d at 1442
(âThe investigation of a claim
may in some circumstances permit one to reasonably conclude that the insurer has acted
in bad faith.â).
âUnder Oklahoma law, . . . an insurerâs investigation need only be reasonable, not
perfect.â Roberts v. State Farm Mut. Auto. Ins. Co., 61 F. Appâx 587, 592(10th Cir. 2003) (unpublished) (citing Buzzard,824 P.2d at 1109
). 11 Accordingly, ââwhen a bad
faith claim is premised on inadequate investigation, the [claimant] must make a showing
that material facts were overlooked or that a more thorough investigation would have
11
Although not precedential, we find the reasoning in the unpublished opinions we
cite to be instructive. See 10th Cir. R. 32.1 (âUnpublished decisions are not precedential,
but may be cited for their persuasive value.â); see also Fed. R. App. P. 32.1.
23
produced relevant informationâ that would have delegitimized the insurerâs dispute of the
claim.â Bannister, 692 F.3d at 1128(quoting Timberlake,71 F.3d at 345
). â[E]vidence of inadequate investigation must âsuggest a sham defense or an intentional disregard of uncontrovertible factsâ in order to be put to a jury.â Id.; see also Oulds,6 F.3d at 1442
.
ii. Analysis
Summary judgment is inappropriate âif the evidence is such that a reasonable jury
could return a verdict for the nonmoving party.â Anderson v. Liberty Lobby, Inc., 477
U.S. 242, 248 (1986). To return a verdict in favor of Mr. Shotts, a jury would have to
determine that GEICOâs investigation was not reasonable. Mr. Shotts has not provided
evidence from which a reasonable jury could draw that conclusion.
The record shows that GEICO began its investigation immediately after it learned
about the accident. It took a recorded statement from Mr. Shotts. It also requested Mr.
Shottsâs medical records and reviewed all the documentsâincluding the MRIs and other
medical imagesâhe provided. GEICO continued this investigation after making its
initial settlement offer, and it conducted additional review at Mr. Shottsâs request. When
Mr. Shotts objected to the initial offer, for example, GEICO reevaluated the claim and
adjusted the offer to reflect incurred, rather than paid, medical expenses. And when he
insisted that his ulcer developed after the accident, GEICO requested additional medical
documentation and pursued peer review. Based on these facts, a reasonable jury could
not conclude that GEICOâs investigation was unreasonable.
24
Despite this, Mr. Shotts argued at summary judgment that âGEICO biasedly
refused to consider and evaluate all of [his] permanent lifetime injuriesâ; âintentionally
placed an unreasonably low dollar evaluationâ on the claim; and âunfairly looked for
ways to reduce, delay[,] or deny [his] claim.â App., Vol. 3 at 45. But he did not offer
specific evidence to support these bare allegations. For example, although Mr. Shotts
alleged that Ms. Henley used a biased computer tool to conduct her evaluation, he
provided no evidence to show the computer system was faulty or that the valuation was
arbitrary.
Mr. Shotts also stated that Ms. Henleyâs â[f]ailure to properly consider important
favorable information to the insured . . . is bad faith,â but he did not explain when or how
Ms. Henley overlooked information that might have been favorable to his claim. Id. at
47. He asserted that Ms. Henley ignored his workerâs compensation records, which
âwould [have] suggest[ed] an injury more significant than a strain,â id. at 40, but he did
not explain how those records would have contradicted the other medical records Ms.
Henley reviewed or âchanged the underlying facts already known to [her],â Timberlake,
71 F.3d at 345. Finally, he argued that Ms. Henley âshould have . . . investigated and
evaluatedâ facts âsuch as the difference between the before and after MRIâs [sic] and X-
rays, the permanence of the injuries, [and] the value of the lifelong additional pain,â but
he did not provide evidence to show that Ms. Henley did not do this during her
investigation. App., Vol. 3 at 48.
25
âUnder Oklahoma law, . . . an insurerâs investigation need only be reasonable, not
perfect.â Roberts, 61 F. Appâx at 592. The undisputed facts indicate that GEICO conducted a thorough, timely, and reasonable review of the claim. Mr. Shotts has not shown âthat material facts were overlooked or that a more thorough investigation would have produced relevant information that would have delegitimized the insurerâs dispute of the claim,â Bannister,692 F.3d at 1128
(quotations omitted), and he has not âproduce[d] additional evidence of bad faith,â Timberlake,71 F.3d at 344
. A reasonable
jury could not conclude that GEICOâs investigation was unreasonable. Summary
judgment was appropriate, and we affirm.
b. Burch first-dollar payment
i. Legal background
As explained above, Oklahoma UM insurers âmay not delay the payment of
benefits until exhaustion of [the other driverâs policy] liability limitsâ and must make
âprompt paymentâ on any claim that âexceeds the liability limits [of the underinsured
at-fault driver].â Buzzard, 824 P.2d at 1112. Burch clarified that this prompt-payment requirement applies to the âentire amount of [the claim] from the first dollar up to the UM policy limits.â977 P.2d at 1058
. Thus, if an individual is injured by an
underinsured motorist, and if the individualâs injuries exceed the underinsured motoristâs
policy limits, the UM insurer must promptly pay the full value of the UM claim.
Oklahoma case law recognizes a connection between the prompt-payment
requirement and a UM insurerâs subrogation rights. For example, Oklahoma courts have
26
specified the prompt-payment requirement does not apply if an insured party
intentionally interferes with or destroys a UM insurerâs subrogation rights. See Porter v.
MFA Mut. Ins. Co., 643 P.2d 302, 305(Okla. 1982); Torres v. Kan. City Fire & Marine Ins. Co.,849 P.2d 407, 413
(Okla. 1993). 12 And when the Oklahoma Supreme Court specified in Burch that the prompt-payment requirement applies âfrom the first dollar up to the policy limits,â977 P.2d at 1064
, it emphasized that, although the UM insurer was obligated to pay the full amount of the plaintiffâs claim, the insurer could still âproceed in its own right against the tortfeasor,âid. at 1065
. The Burch court also observed that it might be unfair to require the UM insurer to âduplicateâ coverage, but it concluded this would not happen when the UM insurer could obtain payment through subrogation.Id.
It emphasized that its holding â[did] not make the UM carrier the final indemnitorâ because â[t]he UM carrier is statutorily subrogated to the rights of its insured against the [underinsured at-fault driver].âId.
Put differently, Burch used the UM insurerâs ability
12
Oklahoma courts refer to this as the âPorter doctrineâ or âPorter defense.â It is
not absolute. An insured partyâs interference with a UM insurerâs subrogation rights does
not always extinguish the insurerâs duty to render prompt payment. Rather, âequitable
considerations come into play when a UM carrier seeks to avoid payment of a claim
based on allegations that the insured has prejudiced its subrogation rights.â Strong v.
Hanover Ins. Co., 106 P.3d 604, 610(Okla. Civ. App.); see, e.g., McFadden v. Arch Ins. Co.,2013 WL 105214
, at *3 (E.D. Okla. Jan. 8, 2013) (unpublished) (insuredâs release of claims against underinsured at-fault driver did not extinguish UM insurerâs prompt- payment duties because insured did not know he had UM coverage and âdid not voluntarily and knowingly interfere with [the UM insurerâs] right to subrogationâ (emphasis added)); Buzzard,824 P.2d at 1114
(insuredâs release of claims against at-fault
driver did not extinguish UM insurerâs prompt-payment duties because â[the UM
insurerâs] course of action forced [the insured] to negotiate with the [underinsured at-fault
driverâs] insurerâ).
27
to âseek recovery of paid indemnity through an exercise of its right to subrogationâ as
justification for the first-dollar payment requirement. Id.
ii. Analysis
Mr. Shotts has not demonstrated that GEICO acted in bad faith when it failed to
make a prompt first-dollar payment. Although âbeing legally able to exercise
subrogation rights is not the sine qua non of an obligation to pay a [UM] claim,â Phillips,
263 F.3d at 1222, the principles articulated in Oklahoma case law suggest that a UM insurerâs duty to render prompt payment is linked to its ability to exercise subrogation rights. 13 Burch, in particular, indicates that courts crafted the first-dollar payment requirement with an insurerâs subrogation rights in mind. Here, GEICO waived its subrogation rights. In doing so, it relinquished its ability âto proceed in its own right against the tortfeasor.â Burch,977 P.2d at 1065
. Under these circumstances, requiring
first-dollar payment would force GEICO to make a payment that it could not later recoup
13
In a few cases, Oklahoma courts have suggested that a â[UM] carrierâs legal
ability to exercise subrogation rights is not an indispensable condition of its obligation to
pay an otherwise valid [UM] claim.â Strong, 106 P.3d at 610; see also Torres,849 P.2d at 413
; Robertson v. U.S. Fid. & Guar. Co.,836 P.2d 1294, 1297
(Okla. 1992); Barfield v. Barfield,742 P.2d 1107, 1112
(Okla. 1987); Uptegraft, 662 P.2d at 686-87. In each of
these cases, the UM insurer attempted to avoid its payment obligations by arguing that
the insured had somehow interfered with its subrogation rights. And in each case, the
court held that the insurer could not assert a Porter defense because the insurer had itself
provoked or otherwise contributed to the insuredâs conduct. The cases thus stand for the
limited proposition that an insuredâs interference with a UM insurerâs subrogation rights
will not always extinguish the UM insurerâs prompt-payment duties. But they do not
suggest that subrogation rights are irrelevant to the prompt-payment requirement and do
not affect our analysis above.
28
from Farmers. This would, in essence, make GEICO âthe final indemnitor for the injured
partyâs lossââan outcome the Burch court sought to avoid. Id. We thus conclude that
GEICOâs waiver of subrogation rights extinguished its duty to render a prompt, first-
dollar payment.
Policy considerations support this conclusion. Requiring prompt first-dollar
payment when a UM insurer has waived its subrogation rights would enable injured
parties to obtain double recovery. Specifically, an injured party could (1) obtain a
settlement offer from the underinsured motoristâs insurer, (2) request that the UM insurer
waive its subrogation rights, (3) request and accept a first-dollar payment from the UM
insurer, and then (4) accept the underinsured driverâs settlement offer. This would allow
the injured party to recover from both the UM insurer and the underinsured driverâs
insurer. But because the UM insurer would have waived its subrogation rights, it would
not be able to recoup its payment from the underinsured driverâs insurer. The UM
insurerâs payment would thus âcreate a duplicate pool of insurance,â Burch, 977 P.2d at
1065, and would allow the injured party to receive payments from two insurers that could not later seek reimbursement from one another. The UM carrierâs payment also would not operate as âa temporary expedient to facilitate prompt payment to the insured,â Burch,977 P.2d at 1065
, but would instead be a final and unrecoverable payment to the
injured party.
Because GEICO waived its subrogation rights, requiring GEICO to render prompt,
first-dollar payment would allow Mr. Shotts to recover twice for his injuries: once from
29
GEICO, and once from Farmers. We decline to permit that outcome. Instead, we hold
that GEICOâs waiver extinguished its duty to promptly pay the full value of Mr. Shottsâs
claim. Mr. Shotts thus cannot show that GEICOâs failure to pay constituted bad faith.
Summary judgment on the Burch claim was appropriate, and we affirm.
C. Punitive Damages
As stated earlier, Mr. Shottsâs punitive damages claim is derivative of and
dependent on his bad faith claims. Because both of those claims fail, his request for
punitive damages must fail, too. We affirm the district courtâs summary judgment for
GEICO on Mr. Shottsâs request for punitive damages.
III. CONCLUSION
We affirm the district courtâs summary judgment for GEICO on Mr. Shottsâs bad
faith and punitive damages claims. 14
14
We grant Mr. Shottsâs February 22, 2019 motion to file the appendix to his
opening brief under seal. We deny his March 1, 2019 motion to unseal the same.
30