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The Collaborative Clearinghouse for Lawsuits and Other Claims Against ACE Group Insurance Companies

SANBORN et al v. CENTURY INDEMNITY COMPANY

ATTENTION: It is possible that this information may no longer be current and therefore may be inaccurate. The index contains both open and closed cases and is not a complete list of cases in which an ACE Insurance Group company is involved. This information is provided to give interested persons an idea of the issues disputed in the indexed cases. For a full understanding of a case, one should read the rest of the court file, including the response. For the most up-to-date and complete information on a case, visit www.pacer.gov or contact the clerk of the relevant court.

Case Number: 
3:15-cv-05952 Search Pacer
ACE Group party(s): 
Opposing Party: 
Kathryn M. Sanborn
Court Type: 
Federal
US District Court: 
Western District of Washington
Date Filed: 
Dec 30 2015
  1. BACKGROUND FACTS
  1. The Plaintiff KATHRYN M. SANBORN was involved in an automobile-trolley
    car accident and was critically injured on December 12, 1980.
  1. The accident left Mrs. Sanborn with debilitating injuries to her head and spine,
    which do not improve over time, but require treatment to prevent deterioration of her condition
    and to reduce chronic pain.
  2. At the time of the accident, Mrs. Sanborn was covered under a lifetime medical
    policy through IN A Insurance Company.
  3. Later her policy was transferred to CIGNA Insurance, then to Defendant
    CENTURY IMDEMNITY COMPANY through its subsidiary ACE INSURANCE COMPANY
    because of corporate purchases and transfers occurring over the last thirty-five years.
  4. In June 2013, Mrs. Sanborn rejected an offer from Trina Faison-Washington of
    ESIS Claims INC, the claims representative for ACE INSURANCE COMPANY (ACE), to
    discuss the purchase of her insurance policy.
  5. Immediately after Mrs. Sanborn’s rejection of the offer, the defendant/s) failed to
    approve and pay any of Mrs. Sanborn’s current or later claims.
  6. After requiring the plaintiff to repeat the submission of the same claim forms
    numerous times, defendant through ESIS, INC. (ESIS) finally disclosed through its claims
    representative Ms. Faison-Washington that Mrs. Sanborn did indeed have lifetime coverage
    under her policy, yet because of Mrs. Sanborn’s own description of her spinal condition as
    scoliosis, the claimed treatments were not covered, because “scoliosis is a natural condition, not
    based upon injury.”
  7. Mrs. Sanborn’s claims included the same type of medical treatments which had
    been covered by the defendant(s) prior to this time and had been covered by all former
    insurance providers.
  1. After months had lapsed, defendant(s) through ESIS required an independent
    medical exam which was performed on August 19, 2014.
  2. The independent medical exam was performed by Drs. Jeremey P. Walton, D.C.
    and Neal Shonnard, M.D. of MES Solutions. The report defined different types of scoliosis and
    the physicians identified Mrs. Sanborn’s scoliosis as the type that was caused by her injuries
    from the accident in 1980.
  3. The defendant(s) had a duty to pay all claims before the independent medical
    exam and after it was completed.
  4. The refusal to pay the claims, and failure to put the reasons for denial in writing,
    constitute bad faith under Washington State law.
  5. Additionally, the defendant’s(s’) repeated requests to Mrs. Sanborn and her
    medical providers to send duplicate forms and claims, and defendant’s(s’) failure to respond to
    repeated requests for payment within thirty days, constitute bad faith in Washington.
  6. defendant’s(s’) failure to act after Mrs. Sanborn refused the offer to buy her out
    of her policy was particularly egregious and caused financial damage and pain and suffering for
    her and Mr. Sanborn.
  1. CLAIMS AND CAUSES OF ACTION
  1. The Plaintiffs allege the following claims and causes of action against
    the defendants:

A. CONSUMER PROTECTION VIOLATION

  1. Under RCW § 19.86.020 Unfair competition, practices, declared
    unlawful, “[u]nfair methods of competition and unfair or deceptive acts or practices in
    the conduct of any trade or commerce are hereby declared unlawful.” Further, under
    RCW § 19.86.093 Civil action — Unfair or deceptive act or practice — Claim
    elements:

In a private action in which an unfair or deceptive act or practice is alleged
under RCW § 19.86.020, a claimant may establish that the act or practice
is injurious to the public interest because it:

  1. Violates a statute that incorporates this chapter;
  2. Violates a statute that contains a specific legislative declaration of
    public interest impact; or (3)(a) Injured other persons; (b) had the capacity
    to injure other persons; or (c) has the capacity to injure other persons.

RCW §19.86.020

  1. Under RCW § 19.86.090 Civil action for damages — Treble damages
    authorized— Action by governmental entity:

Any person who is injured in his or her business or property by a violation of
RCW 19.86.020, 19.86.030, 19.86.040, 19.86.050, or 19.86.060, or any person
so injured because he or she refuses to accede to a proposal for an arrangement
which, if consummated, would be in violation of RCW 19.86.030, 19.86.040,

19.86.050, or 19.86.060, may bring a civil action in superior court to enjoin
further violations, to recover the actual damages sustained by him or her, or
both, together with the costs of the suit, including a reasonable attorney's fee. In
addition, the court may, in its discretion, increase the award of damages up to an
amount not to exceed three times the actual damages sustained.

The defendant’s(s’) actions or failure to act violated RCW § 19.86 et seq. There was
never a concern for my clients’ physical or emotional pain and suffering during the continual
violation of Washington law. This is true even though the defendant(s) was cognizant that Mrs.
Sanborn has and continues to suffer from permanent injuries and she was and is entitled to
lifetime medical coverage under her policy.

The defendant(s) has injured and continue to injure the plaintiffs under Washington State
Consumer Protection statutes.

B. INSURANCE BAD FAITH

  1. Under RCW § 48.30.015, a first party claimant to an insurance policy
    who is unreasonably denied a claim for coverage or payment of benefits, may bring an
    action in superior court to recover actual damages sustained, costs, reasonable
    attorney’s fees, and litigation costs. Additionally, the court may decide in its discretion
    to increase the total award of damages to an amount not to exceed three times the actual
    damages.
  2. Under the Washington Administrative Code 284-30-330 Specific Unfair Claims
    Settlement Practices Defined the following is identified as an unfair method of competition and
    an unfair or deceptive act or practice of the insurer: Misrepresenting pertinent facts or insurance
    policy provisions.
  3. Under the Washington Administrative Code 284-30-350 the following is
    identified as an unfair method of competition and an unfair or deceptive act or practice
    of the insurer: Misrepresentation of Policy Provisions.
  4. Under the Washington Administrative Code 284-30-360 the following is
    identified as an unfair method of competition and an unfair or deceptive act or practice
    of the insurer: Failure to Acknowledge Pertinent Communications.
  5. Under the Washington Administrative Code 284-30-370 the following is
    identified as an unfair method of competition and an unfair or deceptive act or practice
    of the insurer: Failure to Follow Standards for Prompt Investigation of Claims.
  6. Under the Washington Administrative Code 284-30-380 the following is

identified as an unfair method of competition and an unfair or deceptive act or practice of the
AMENDED COMPLAINT - 6                  t.f.annf. m. lucas

insurer: Failure to Follow Settlement Standards for Prompt, Fair and Equitable Settlements
Applicable to All Insurers.

The defendant(s) has injured and continue to injure the plaintiffs under
Washington State Insurance Bad Faith Statutes and Washington Administrative Code
violations.

C PRE AND POST JUDGMENT INTEREST

  1. The interest rate for tort judgments is prescribed by RCW § 4.56.110(3),
    which provides:

Interest on judgments shall accrue as follows:

  1. Judgments founded on the tortious conduct of individuals or other entities,
    whether acting in their personal or representative capacities, shall bear interest
    from the date of entry at two percentage points above the equivalent coupon
    issue yield, as published by the board of governors of the federal reserve
    system, of the average bill rate for twenty-six week treasury bills as determined
    at the first bill market auction conducted during the calendar month immediately
    preceding the date of entry. In any case where a court is directed on review to
    enter judgment on a verdict or in any case where a judgment entered on a
    verdict is wholly or partly affirmed on review, interest on the judgment or on
    that portion of the judgment affirmed shall date back to and shall accrue from
    the date the verdict was rendered.

The plaintiffs request the Court to order pre and post judgment interest as is statutorily
proper and within the discretion of the Court.

  1. DAMAGES
  1. The plaintiffs have sustained the following damages due to the
    defendant’s (s’) bad faith:
  1. pain and suffering

 

  1. medical costs
  2. interest and late fees
  3. attorney’s fees
  4. punitive damages if statutorily permitted
  1. REQUEST FOR RELIEF

PLAINTIFFS KATHRYN M. SANBORN and KEVIN M. SANBORN beg the
court to enter judgment against the defendant(s):

  1. Awarding plaintiffs all claimed damages in an amount to be established

at trial.

  1. Awarding plaintiffs all statutory costs and fees, if any, including treble
    damages under RCW 48.30.015.
  2. Awarding plaintiffs all litigation expenses and attorney’s fees as
    provided by statute.
  3. Awarding plaintiffs pre and post-judgment interest on the damages

award.

  1. Awarding plaintiffs any further or additional relief which the court finds
    equitable, appropriate, or just.

The provided text is an excerpt from a document filed in this case. For a full understanding of the case, one should read the complete court file, including the response.

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