PER CURIAM.
We have for consideration Burger v. Time Insurance Co., 115 F.3d 880 (11th Cir. 1997), in which the United States Court of Appeals for the Eleventh Circuit certified a question to this Court. We have jurisdiction under article V, section 3(b)(6) of the Florida Constitution.
In its opinion, the Court of Appeals set forth the following predicate
for the question:
Sometime in 1991, Harvey Burger submitted for reimbursement a $500
medical bill for an endoscopy to his medical insurance carrier, Time Insurance,
Inc. According to Burger, the bill he received from the doctor's office
contained a "stray" mark, leading him to believe that he owed $1,500 for
the endoscopy. Burger further contends that, once informed by the doctor
of the correct amount owed on the bill, he immediately relayed the information
to Time Insurance and resubmitted a corrected bill for reimbursement. Sometime
later, Burger submitted the bill a third time, marking it "Paid $500."
Two weeks later, in August of 1991, Burger was informed that Time's Special
Investigations Unit (SIU) was investigating the possibility that he had
attempted to defraud the company. Between August, 1991 and November, 1992,
Time did not pay any of Burger's outstanding health care claims. (Burger
did not submit any new claims during this period.)
In February, 1992, consistent with Florida law (Fla. Stat. § 624.155(2)(a)),
Burger's counsel submitted notice of a civil remedy claim to Time, requesting
its payment of the non-suspect claims. Time failed to respond to the notice
within the 60-day period allowed by law. Time did not satisfy its payment
obligations with respect to Burger's claims until November, 1992.
At trial, Burger alleged that, because of Time's failure to pay his
medical bills between August, 1991 and November, 1992, and his lack of
financial resources to pay for medical services, he felt he could not go
to the doctor or otherwise obtain medical services. Thus, he claimed that
as a direct result of Time's failure to pay his claims in a timely fashion,
he could not obtain needed medical treatment. He also complained of depression
and an inability to communicate with his family as a result of his dealings
with Time. For its part, Time attempted to discredit Burger's claims that
he could not obtain health care during the relevant period by insisting
that Burger never submitted new claims for reimbursement; Time's failure
to pay related only to claims that Burger submitted prior to August, 1991.1
A jury found that Time Insurance violated Florida Statute § 624.155
by not attempting in good faith to settle Burger's claims, awarding him
$50,000 in compensatory damages and $1 in punitive damages.2
On appeal, Time argues that Burger presented only evidence of emotional
distress, and no evidence of economic harm, to support his claim for damages.
According to Time, Fla. Stat. § 624.155 only created a cause of action
for first-party claims of bad faith failure to pay; it did not alter case
law which recognized mental anguish damages only in cases of intentional
infliction of emotional distress. The jury award of $50,000 to Burger was
therefore improper. Burger insists that: (1) Florida law does not preclude
an award of damages for emotional distress in this type of action; and
(2) the damages he alleged qualify as non-emotional injury sufficient to
support the award.
1 This argument does not join Burger's claim that he simply
did without the medical care he needed.
2 The jury also awarded Burger
$500 for unfair claim settlement practices by Time Insurance, pursuant
to Florida Statute § 626.9541.
The question reads as follows:
In order to address this question properly, it is necessary to review the evolution of the applicable Florida law. Historically, Florida has long permitted so-called third-party bad faith claims in which an insured sues his liability insurance company for bad faith in failing to settle a claim which ultimately results in a third-party judgment against him in excess of the policy limits. Auto Mut. Indem. Co. v. Shaw, 134 Fla. 815, 184 So. 852 (1938); American Fire & Cas. Co. v. Davis, 146 So. 2d 615 (Fla. 1st DCA 1962).
In Butchikas v. Travelers Indemnity Co., 343 So. 2d 816 (Fla. 1976), this Court considered the propriety of a jury award for punitive damages and mental anguish in a third-party bad faith claim. Butchikas, the insured, had been involved in an accident with Mr. and Mrs. Tompkins. Butchikas' liability insurer, Travelers Indemnity Company, declined to settle the Tompkins' claim against Butchikas. The Tompkins ultimately obtained a judgment in excess of the limits of the Travelers policy. Butchikas then sued Travelers and obtained a verdict awarding him damages for (1) the liability to the Tompkins in excess of the policy limits, (2) mental anguish as a result of problems caused by Travelers, and (3) punitive damages. This Court upheld the award of damages for the excess liability. However, we reasoned that Travelers' conduct was not so egregious as to support a claim for punitive damages. We also rejected the claim for mental anguish, pointing out that the rule in Florida was that absent a physical injury, a plaintiff can recover damages for mental anguish only where it is shown that the defendant acted with such malice that punitive damages would be justified.
In contrast to third-party bad faith claims, Florida common law did not permit first-party claims in which an insured contends that his insurance company is acting in bad faith for refusing to pay for benefits under the policy. Baxter v. Royal Indem. Co., 285 So. 2d 652 (Fla. 1st DCA 1973). As Judge Wigginton explained, unlike the fiduciary relationship existent in a third-party claim, the relationship between the parties in a dispute over the insurance contract is that of debtor and creditor. Id.
The prohibition against first-party bad faith claims was lifted in 1982
by the enactment of section 624.155, which reads in pertinent part:
. . . .
(b) By the commission of any of the following acts by the insurer:
1. Not attempting in good faith to settle claims when, under all the
circumstances, it could and should have done so, had it acted fairly and
honestly toward its insured and with due regard for her or his interests[.]
This Court addressed the damages recoverable in first-party claims under
section 624.155 in McLeod v. Continental Insurance Co., 591 So.
2d 621 (Fla. 1992). Relying upon section 624.155(1)(b)1, McLeod sued his
uninsured motorist carrier for failing to settle within the limits of his
policy. He sought to recover the excess of the verdict he obtained against
the uninsured motorist over the payments received from the tort-feasor's
insurance carrier and another uninsured motorist carrier. At the outset,
we acknowledged that the statute now authorized first-party bad faith claims
against insurance companies. However, we rejected McLeod's claim for recovery
of the "excess judgment" because even though the amount of that judgment
represented damages sustained by him, it was the tort-feasor rather than
the insurance company that caused those damages. We held that the damages
recoverable in a first-party bad faith action under the statute "may include,
but are not limited to, interest, court costs, and reasonable attorney's
fees incurred by the plaintiffs." Id. at 626. Of significance to
the instant case, we went on to state in footnote 10:
Time Insurance relies upon footnote 10 of McLeod for the proposition that we have already answered the certified question adversely to Burger's position. In response, Burger contends that McLeod is no longer controlling authority because its holding was overturned by the legislature through the enactment of section 627.727(10), Florida Statutes (1997). Burger also points out that section 624.155(7), which provides that the damages recoverable for violation of the statute "shall include those damages which are a reasonably foreseeable result of a specified violation of this section," places no limitation on the recovery of damages for emotional distress.
We do not agree that the enactment of section 627.727(10) diminished the effect of footnote 10 of the McLeod opinion. That legislation merely overturned the holding of McLeod by authorizing the recovery of the "excess judgment" in first-party bad faith actions against uninsured motorist insurance carriers. On the other hand, we must acknowledge that footnote 10 was clearly obiter dictum. The specific issue of whether damages for emotional distress can be recovered in first-party actions against health insurers under section 624.155(1)(b)(1) is now before us.
Prior to the enactment of section 624.155, the damages recoverable by a health insurance policyholder against an insurance carrier were limited to breach of contract damages and attorney's fees. Industrial Fire & Cas. Ins. Co. v. Romer, 432 So. 2d 66 (Fla. 4th DCA 1983); Shupak v. Allstate Insurance Co., 367 So. 2d 1103 (Fla. 3d DCA 1979). The fact that the legislature has specifically authorized first parties to recover damages in bad faith actions suggests that it may have contemplated more than the recovery of the same damages already available in a breach of contract action. In view of the possibility that an unjustified refusal to pay an insured's medical or hospital bills could result in the inability to obtain health care, we hold that section 624.155(1)(b)(1) authorizes the recovery of damages for emotional distress in a first-party bad faith claim against a health insurance company.
We now turn to the specific question posed by the Eleventh Circuit Court
of Appeals, and rephrase it as follows:
In another context, our fear of speculative claims also caused us to
adopt the more likely than not standard of causation in negligence actions
described by Dean Prosser:
In Brown v. Cadillac Motor Car Division, 468 So. 2d 903 (Fla. 1985), this Court established the impact rule, which holds that in the absence of a discernible physical injury a person cannot recover compensatory damages for mental distress or psychiatric injury. While we have concluded that section 624.155 creates a statutory exception to this rule, at least in health insurance cases, we note that the statute does not specify the standard of recovery for damages for emotional distress. Thus, we believe that we must narrowly construe the scope of recovery for such damages. Southern Attractions, Inc. v. Grau, 93 So. 2d 120 (Fla. 1956)(statute in derogation of the common law must be strictly construed). A court will presume that such a statute was not intended to alter the common law other than as clearly and plainly specified in the statute. Ady v. American Honda Finance Corp., 675 So. 2d 577 (Fla. 1996); Law Offices of Harold Silver, P.A. v. Farmers Bank & Trust Co., 498 So. 2d 984 (Fla. 1st DCA 1986) (statute designed to alter the common law must speak in unequivocal terms).
To allow recovery of compensatory damages for mental anguish on the basis of lay testimony would subject health insurers to such claims every time such an insurer contested a claim. Insurers would be pressured into paying claims that the insurer legitimately should dispute because, if a jury disagreed with the decision not to pay, the insurer would have the additional exposure of a claim for mental distress. Insurers have a right and a duty to other policyholders to contest illegitimate claims. This statute should not be given a construction which destroys that right or frustrates that duty. Payment of illegitimate claims raises the cost of insurance for all policyholders.
On the other hand, if there is proof of bad-faith conduct in denying or untimely paying a claim and that conduct results in an insured not receiving either necessary or timely health care, we believe that the insured ought to have an opportunity to claim damages for emotional distress. The standard for recovery shall require proof: (1) that the bad-faith conduct resulted in the insured's failure to receive necessary or timely health care; (2) that, based upon a reasonable medical probability, this failure caused or aggravated the insured's medical or psychiatric condition; and (3) that the insured suffered mental distress related to the condition or the aggravation of the condition. In order for the insured to recover, these allegations will have to be substantiated by testimony of a qualified health care provider.
Having addressed the issue framed by the Eleventh Circuit Court of Appeals, we return the record to that court[1].
It is so ordered.
OVERTON, HARDING and WELLS, JJ., and GRIMES, Senior Justice, concur.
ANSTEAD, J., concurs in part and dissents in part with an opinion, in which KOGAN, C.J., and SHAW, J., concur.
NOT FINAL UNTIL TIME EXPIRES TO FILE REHEARING MOTION AND, IF FILED,
DETERMINED.
ANSTEAD, J., concurring in part and dissenting in part.
I concur in the majority's holding that the legislature intended that health care insurance consumers have a remedy, beyond mere breach of contract damages, when health care insurers act in bad faith in dealing with their insureds. I do not agree, however, with the rigid evidentiary restrictions judicially engrafted upon this consumer protection legislation by the majority opinion. It appears that the majority has given the health insurance consumer a favorable interpretation of the first party bad faith statute with one hand, but has rendered that interpretation substantially meaningless with the other.
The rationale offered by the majority for this judicial amendment of the statute is that "[i]nsurers have a right and a duty to other policyholders to contest illegitimate claims." Majority op. at 5-6. One obvious flaw in this reasoning is that an insurer would not be acting in bad faith by contesting illegitimate claims. It is apparent that the actual basis for the majority's action is a distrust of the jury system, a system that serves as the foundation of both our civil and criminal justice systems. I would also note that the imposition of such a specific and restrictive standard upon the insured in this case would be patently unfair, since the standard is being announced for the first time today[2].
KOGAN, C.J., and SHAW, J., concur.
Certified Question of Law from the United States Court of Appeals for
the Eleventh Circuit - Case No. 95-4521
Kevin P. O’Connor of O’Connor & Meyers, P.A., Coral Gables, Florida,
and R. Fred Lewis of Kuvin, Lewis, Restani & Stettin, P.A., Miami,
Florida,
for Appellant
Scott E. Perwin of Kenny, Nachwalter, Seymour, Arnold, Critchlow &
Spector, P.A., Miami, Florida, and Brian S. Keif, Key Biscayne, Florida,
for Appellee
William F. Merlin, Jr., Tampa, Florida,
for The Merlin Law Group, Amicus Curiae
FOOTNOTES:
1.Burger's claim that the judgment in his favor should be affirmed because punitive damages were awarded is beyond the scope of the certified question.
2.Prior to this opinion, this Court has never required expert testimony of mental pain and suffering. To the contrary, this Court in Angrand v. Key, 657 So. 2d 1146 (Fla. 1995), specifically limited the use of expert testimony in establishing damages for mental anguish. While Angrand involved the issue of whether an expert may testify as to the existence of "grief" in a wrongful death context, we held that qualified experts who treated a person for mental anguish may provide testimony of such matters so long as the testimony is necessary to assist the jury in understanding matters not within their common knowledge or everyday life experiences. With regard to mental pain and suffering, we noted that:
Therefore, in addition to retroactively imposing a set of standards on an insured in first party claims against an insurer, the majority now apparently requires expert testimony on the issue of mental pain and suffering, a requirement that did not exist at the time the insured filed suit in this case. In answering certified questions from the federal courts, we should settle uncertain issues of law and limit any new rules or requirements to future litigants.
FLORIDA SUPREME COURT
NOTICE OF CORRECTION
DATE: June 18, 1998
CASE OF: TIME INSURANCE COMPANY v. HARVEY BURGER
DOCKET NO. 90,869 OPINION FILED: June 12, 1998
ATTENTION: ALL PUBLISHERS
THE FOLLOWING CORRECTION HAS BEEN MADE IN THE ABOVE OPINION:
On page 6, right-hand column, in the separate opinion of ANSTEAD, J., concurring in part and dissenting in part, in footnote 2, the first two sentences of footnote 2 have been deleted.
SIGNED: JANIE L. BENTLEY, OPINION CLERK
The corrected hard copy will follow by mail.