Court: United States District Court for the Western District of Oklahoma
Case Name: Allianz Life Ins. Co. of N. Am. v. Muse
Citation: 2019 U.S. Dist. LEXIS 217447
In this life insurance dispute, the defendant retains an insurance expert witness to opine on his counterclaim of insurance bad faith. The plaintiff claims the expert’s testimony is not valuable beyond these bad faith claims and moves to exclude. The court, however, grants the plaintiff’s motion for summary judgment, agreeing that the defendant cannot prove he was eligible for insurance coverage. And without case standing, the expert admissibility challenge becomes moot and is dismissed altogether.
The plaintiff insurance company filed a lawsuit concerning a dispute in connection with a long-term-care insurance policy issued to the defendant. The policy included coverage for home care services. The policy also included coverage for personal continence, feeding, washing, grooming, transition, and toileting tasks. Per the policy, a health care professional must accredit a patient as “Chronically Ill” within the previous 12 months to be eligible for coverage.
After a period of service, the plaintiff denied policy coverage when its assessors could not certify the defendant as chronically ill. The defendant filed a counterclaim against the plaintiff claiming that the company had “breached the implied covenant of good faith and fair dealing.” The plaintiff requested summary judgment on this counterclaim on a variety of points. The defendant retained an insurance expert witness to support his counterclaim.
The Defendant’s Insurance Expert Witness
The defendant’s insurance expert witness was a cum laude graduate of Santa Clara University Law School. The expert was licensed to practice law in California. He also earned a Bachelor of Arts degree and a Master’s from San Jose State University. The insurance expert had previously served as General Counsel and as Senior Vice-President for Allied Management Services, Inc. At this company, he was responsible for overseeing the role of underwriters in the processing of insurance claims. The expert was also a member of the Faculty of Law and studied insurance law at Santa Clara University School of Law. As an expert witness, he had given hundreds of depositions in insurance cases and appeared nearly 80 times in both the state and federal courts.
The plaintiff sought to exclude the insurance expert’s report and testimony. The defendant submitted a complaint, to which the plaintiff responded. The defendants described their expert as an authority on insurance claims procedures and requirements. They explained he could also offer analysis and evaluation on long-term care cases. The defendant relied on the expert’s opinion as evidence for his bad-faith counterclaim. However, there was no suggestion from either counsel that the expert’s testimony was relevant to any other claim or counterclaim in the case.
The court noted that to establish a cause of action against an insurance company for bad faith under Oklahoma law, the claimant must show:
- Insurance coverage under the insurance policy and that the insurer was obliged to take reasonable action;
- The insurer’s actions were unreasonable;
- The insurer did not act in good faith and did not deal fairly in handling the insured’s claim; and
- Breach of the covenant of good faith and fair dealing directly caused the damages sustained by the insured.
The court noted that the defendant was unable to create a legitimate argument as to whether he was eligible for benefits under the policy. Therefore, he could not assert that he was eligible as required to prove his bad faith argument against the plaintiff. Thus, the court granted the plaintiff’s request for summary judgment. However, since the court granted summary judgment for reasons that did not apply to the expert’s expertise or report, the plaintiff’s motion to exclude was dismissed as moot.
The plaintiff’s motion to exclude the defendant’s insurance expert witness was dismissed as moot.
Key Takeaways for Experts
This case demonstrates an instance of an expert challenge dismissed altogether. Further, the expert’s dismissal was by no fault of his own. Rather, this was due to the defendant’s own lack of standing.