1. Unfair Trade Practices--insurance advertising--settlement of fraudulent claims
The trial court did not err by granting defendant State Farm a 12(b)(6) dismissal on a
claim for unfair and deceptive practices arising from State Farm's settlement of a claim which
plaintiff insured contended was fraudulent and following advertising in which State Farm claimed
it did not want to pay for fraudulent losses. The alleged statement does not indicate that State
Farm will not pay fraudulent claims, only that it does not wish to do so.
2. Insurance--settlement practices--fraudulent claim
The trial court did not err by granting a 12(b)(6) dismissal for defendant State Farm on a
claim under N.C.G.S. § 58-63-15(11)(a) or (b) arising from settlement of an allegedly fraudulent
claim where plaintiff insured made no allegation that State Farm engages in the general business
practice of misrepresenting pertinent facts or insurance policy provisions, that State Farm failed to
acknowledge and act reasonably promptly upon communications with respect to claims arising
under plaintiff's policy, or that State Farm failed to adopt and implement reasonable standards for
the prompt investigation of claims arising under plaintiff's policy.
3. Civil Procedure--prior Rule 41 dismissal--claim not brought in prior action--statute
of limitations--not raised in current action
The issue of the statute of limitations was beyond the purview of an appeal from a Rule
12(b)(6) dismissal where a claim for tortious breach of contract had not been brought in a prior
action dismissed pursuant to Rule 41(c) but the current complaint nowhere indicated that the
tortious breach of contract action was not brought in the prior action and the order appealed from
did not indicate that the motion was converted into a Rule 56 motion.
4. Insurance--settlement of alleged fraudulent claim--tortious breach of contract action
by policyholder
The trial court did not err by granting a 12(b)(6) dismissal on a tortious breach of contract
claim in an action arising from the settlement of personal injury insurance claims which plaintiff-
policyholder alleged were fraudulent. Plaintiff failed to allege facts indicating a sufficient level of
aggravation or an intentional wrong by defendant. An insurance company acts in its own interest
when settling claims with third party outsiders.
5. Civil Procedure--12(c) dismissal--12(b)(6) dismissal--different standards
The trial court did not err by dismissing claims for breach for contract and constructive
fraud under N.C.G.S. § 1A-1, Rule 12(c) following the denial of defendant's motions for
dismissal under Rule 12(b)(6). Neither Rule employs the same standard.
6. Insurance--settlement of alleged fraudulent claim--breach of contract--12(c)
dismissal
The trial court did not err by dismissing plaintiff's claim for breach of contract under
N.C.G.S. § 1A-1, Rule 12(c) where plaintiff had alleged that defendant-insurer settled fraudulent
claims against plaintiff arising from an automobile accident. An affidavit which was part of thepleadings presented evidence that defendan
t investigated the accident and acted in the interest of
plaintiff in settling the claims, as they were settled for less than demanded and within policy limits,
and plaintiff was released from further liability. The settlement by defendant insurer has not
affected plaintiff's rights or precluded him from seeking redress against claimants for alleged
fraudulent activity.
7. Fraud--constructive--settlement of insurance claim--fiduciary duty of insurer
The trial court did not err by dismissing under N.C.G.S. § 1A-1, Rule 12(c) a claim for
constructive fraud against an insurer arising from the settlement of personal injury claims against
plaintiff by third parties. Plaintiff failed to present evidence of a fiduciary relationship between
defendant insurer and plaintiff.
Corry, Cerwin & Luptak, by Todd R. Cerwin, for plaintiff-
appellant.
Stott, Hollowell, Palmer & Windham, L.L.P., by Martha Raymond
Thompson, for defendant-appellee.
HUNTER, Judge.
Ted F. Cash (plaintiff) appeals the granting by the trial
court of motions by State Farm Mutual Automobile Insurance Company
(State Farm) to dismiss for failure to state a claim for which
relief may be granted and for judgment on the pleadings, pursuant
to Rule 12(b)(6) and Rule 12(c), respectively, of the North
Carolina Rules of Civil Procedure. We affirm.
Plaintiff's pleadings indicate that he was driving his 1969
GMC truck on 26 December 1993 when he backed into a 1978 Chevrolet
Camaro (Camaro). Plaintiff alleges that he was traveling at
approximately one mile per hour and the Camaro was occupied by the
driver Dameion Poston, and two other occupants, Darrell Jackson and
Deron Thompson. Plaintiff, who is a medical doctor, determinedthat no one involved suffered any apparent injury at the time of
the accident. Additionally, all occupants of the Camaro declined
medical assistance at the scene.
Following the accident, claims were made for personal injuries
by Poston, Jackson and Thompson, and in addition, a claim for
personal injuries and property damage was made by a fourth
individual, Arthur Poston, Jr., the owner of the Camaro. Plaintiff
informed his car insurance carrier, State Farm, that there were
more claims for personal injuries than there were occupants of the
vehicles and that it appeared that these were fraudulent claims
which should be denied. Despite plaintiff's contentions, State
Farm paid the claims within the confines of the limits of the
policy issued to plaintiff. Dameion Poston, Darrell Jackson and
Deron Thompson were paid the sum of $250.00 for their personal
injuries and Arthur Poston, Jr., was paid the sum of $350.00 for
his personal injuries. Plaintiff alleges claimants were also paid
certain medical and other expenses despite his objection, and that
as a result of settlement of these fraudulent claims, plaintiff's
insurance premiums with State Farm increased by fifty-three percent
(53%).
The record reveals that plaintiff filed suit against State
Farm in 1996, but it was dismissed pursuant to Notice of VoluntaryDismissal without prejudice pursuant to Rule 41(c) of the North
Carolina Rules of Civil Procedure. He brought the present actionagainst State Farm in August 1998 with claims for (1) breach of
contract of insurance, (2) constructive fraud in the form of a
breach of fiduciary duty, (3) unfair methods of competition or
unfair and deceptive acts or practices, and (4) tortious breach of
the insurance contract, specifically the implied duties of good
faith and fair dealing. Plaintiff asked for relief in the form of
compensatory and punitive damages. State Farm made a motion to
dismiss and the trial court granted it under North Carolina Rule of
Civil Procedure 12(b)(6) as to plaintiff's claims for unfair
methods of competition or unfair and deceptive acts or practices,
and tortious breach of the insurance contract. After filing its
answer, State Farm made a motion for judgment on the pleadings.
The trial court allowed State Farm's motion based on Rule 12(c) of
the North Carolina Rules of Civil Procedure, dismissing all other
claims of plaintiff with prejudice.
[1]Plaintiff first contends that the trial court erred in
granting State Farm's Rule 12(b)(6) motion on its claims for unfair
and deceptive acts or practices and tortious breach of the
insurance contract. In the determination whether a complaint is
sufficient to survive a motion to dismiss under N.C. Gen. Stat. §
1A-1, Rule 12(b)(6), the question presented is whether the
allegations of the complaint, treated as true, are sufficient to
state a claim upon which relief may be granted under some legal
theory . . . . Harris v. NCNB, 85 N.C. App. 669, 670, 355 S.E.2d
838, 840 (1987). A complaint may be dismissed pursuant to Rule
12(b)(6) if no law exists to support the claim made, if sufficientfacts to make out a good claim are absent, or if facts are
disclosed which will necessarily defeat the claim. Burgess v.
Your House of Raleigh, 326 N.C. 205, 209, 388 S.E.2d 134, 136
(1990). In ruling upon a Rule 12(b)(6) motion, the trial judge
must treat the allegations of the complaint as admitted. Id.
In plaintiff's claim for unfair and deceptive practices and
acts, he asserts that State Farm violated N.C. Gen. Stat. § 58-63-
15 by settling fraudulent claims after advertising
at State Farm, we pay what we owe to settle a
claim, but we don't want to pay for fraudulent
losses. If we all do our part to help fight
insurance fraud, the result will be more
reasonable premiums for everyone.
N.C. Gen. Stat. § 58-63-15 provides that unfair methods of
competition and unfair and deceptive acts or practices in the
business of insurance include:
(1) Misrepresentations and False Advertising
of Policy Contracts. -- Making, issuing,
circulating, or causing to be made,
issued or circulated, any estimate,
illustration, circular or statement
misrepresenting the terms of any policy
issued or to be issued or the benefits or
advantages promised thereby . . . .
(2) False Information and Advertising
Generally. -- Making, publishing,
disseminating, circulating, or placing
before the public, or causing, directly
or indirectly, to be made, published,
disseminated, circulated, or placed
before the public, in a newspaper,
magazine or other publication, or in the
form of a notice, circular, pamphlet,
letter or poster, or over any radio
station, or in any other way, an
advertisement, announcement or statement
containing any assertion, representation
or statement with respect to the business
of insurance or with respect to anyperson in the conduct of his insurance
business, which is untrue, deceptive or
misleading.
N.C. Gen. Stat. § 58-63-15(1), (2) (1999). In the present case,
State Farm's alleged statement does not indicate that it will not
pay fraudulent claims, only that it wishes not to do so. Plaintiff
does not allege in his pleadings that State Farm does, in fact,
wish to pay fraudulent claims. Therefore, the complaint does not
state facts sufficient to give rise to a cause of action under this
section.
[2]Plaintiff also argues that State Farm also breached N.C.
Gen. Stat. § 58-63-15(11)(a), (b), and (c), which provide that
[u]nfair [c]laim [s]ettlement [p]ractices occur when, as a
general business practice, an insurer:
a. Misrepresent[s] pertinent facts or
insurance policy provisions relating to
coverages at issue;
b. Fail[s] to acknowledge and act reasonably
promptly upon communications with respect
to claims arising under insurance
policies;
c. Fail[s] to adopt and implement reasonable
standards for the prompt investigation of
claims arising under insurance
policies[.]
N.C. Gen. Stat. § 58-63-15(11)(a)-(c) (1999). N.C. Gen. Stat. §
58-63-15 specifically states that it does not of itself create any
cause of action in favor of any person other than the [Insurance]
Commissioner. N.C. Gen. Stat. § 58-63-15(11). However, a remedy
'in the nature of a private action' for the conduct described by
and in [N.C. Gen. Stat.] § 58-63-15(11) is created by N.C. Gen.Stat. § 75-1.1. Murray v. Nationwide Mutual Ins. Co.
, 123 N.C.
App. 1, 10, 472 S.E.2d 358, 363 (1996), disc. review denied, 345
N.C. 344, 483 S.E.2d 172, disc. review denied, 345 N.C. 344, 483
S.E.2d 173 (1997) (quoting Miller v. Nationwide Mutual Ins. Co.,
112 N.C. App. 295, 302, 435 S.E.2d 537, 542 (1993)). Violation of
any form of conduct listed in § 58-63-15(11) operates as a per se
instance of unfair and deceptive trade practice under N.C. Gen.
Stat. § 75-1.1. Id. In order for plaintiff to prevail on a claim
for unfair or deceptive trade practices, plaintiff must demonstrate
the existence of three factors: '(1) an unfair or deceptive act
or practice, or unfair method of competition, (2) in or affecting
commerce, and (3) which proximately caused actual injury to the
plaintiff or his business.' Murray, 123 N.C. App. at 9, 472
S.E.2d at 362 (quoting Miller v. Nationwide Mutual Ins. Co., 112
N.C. App. 295, 301, 435 S.E.2d 537, 542). The plaintiff must also
allege that State Farm engaged in the prohibited practices with
such frequency as to indicate that the acts are its general
practice. Von Hagel v. Blue Cross and Blue Shield, 91 N.C. App.
58, 60, 370 S.E.2d 695, 698 (1988).
In the present case, plaintiff has made no allegation that
State Farm engages in the general business practice of
[m]isrepresenting pertinent facts or insurance policy provisions
relating to coverages at issue. N.C. Gen. Stat. § 58-63-
15(11)(a). Thus, he fails to state facts sufficient to make a
claim based on conduct in violation of N.C. Gen. Stat. § 58-63-
15(11)(a). Therefore, our review is limited to whether plaintiffhas alleged a cause of action based on conduct in violation of N.C.
Gen. Stat. § 58-63-15(11)(b), [f]ailing to acknowledge and act
reasonably promptly upon communications with respect to claims
arising under insurance policies, and (c), [f]ailing to adopt and
implement reasonable standards for the prompt investigation of
claims arising under insurance policies. N.C. Gen. Stat. § 58-63-
15(11)(b), (c).
The pleading in the present case alleges in pertinent part, on
the issues of State Farm's promptness in acting on plaintiff's
communication and promptness in investigation:
24. That, upon information and belief,
after Plaintiff's automobile accident or
collision on December 26, 1993, claims for
personal injury were submitted to Defendant
for alleged personal injuries sustained in the
collision on December 26, 1993, hereinbefore
described, by not only the driver of the
described Camaro, Dameion Poston, and the
other two occupants, Darrell Jackson and Deron
Thompson, all three of whom were occupants of
said Camaro at the time of the collision, but
also a claim for personal injury from Arthur
Poston, Jr., who was the owner of said Camaro
but was not an occupant of said Camaro at the
time of the collision alleged herein.
25. That Plaintiff demanded of Defendant
that it deny and defend against said claims
and Plaintiff insured [sic] that Defendant had
full knowledge of Plaintiff's observations and
opinions as well as those of the investigating
officer.
26. That Defendant owed Plaintiff a
contractual, a fiduciary and a statutory duty
to act in good faith in it's [sic]
investigation, evaluation and determination as
to whether to settle or defend against the
above-referenced claims for personal injury
against Plaintiff, Defendant's insured.
27. That in the exercise of a good faith
effort to fulfill the aforesaid duties owed to
the Plaintiff, Defendant knew or should have
known that aforesaid claims for personal
injury were false and fraudulent and that
settlement or payment of said claims was
contrary to the public policy of the State of
North Carolina in that such settlement or
payment of false and fraudulent claims
promoted, encouraged or acquiesced in criminal
conduct on the part of the claimants; further
said settlement or payment of the false and
fraudulent claims was contrary to Defendant's
own advertising campaign and contrary to it's
[sic] contractual and fiduciary and statutory
duties owed Plaintiff.
28. That, upon information and belief,
Defendant, nevertheless, thereafter settled
with and paid claimants Dameion Poston,
Darrell Jackson, and Deron Thompson . . .
[and] Arthur Poston, Jr. . . . .
29. That not only did Defendant fail to
act in good faith but in fact acted in bad
faith by its failure to make adequate
investigation and evaluation of the false and
fraudulent claims and by its failure to honor
its duty to defend against the false and
fraudulent claims in that Defendant was
motivated by considerations of its own
pecuniary gain . . . .
While plaintiff alleges that State Farm's investigation was not
adequate in that it should have revealed that the claims in
question were false and fraudulent, nowhere does plaintiff allege
that State Farm failed to acknowledge and act reasonably promptly
upon communications with respect to claims arising under
plaintiff's policy, or failed to adopt and implement reasonable
standards for the prompt investigation of claims arising under
plaintiff's policy. N.C. Gen. Stat. § 58-63-15(11)(b), (c)
(emphasis added). Again, plaintiff has failed to state facts
sufficient to make claims under N.C. Gen. Stat. § 58-63-15(11)(b)and (c). Accordingly, plaintiff's first assignment of error is
overruled.
[3]Next, plaintiff asserts that it was error to dismiss his
claims for tortious breach of the insurance contract and punitive
damages for failure to state a claim for which relief may be
granted. State Farm argues that plaintiff brought a prior suit
similar to the one at bar, which was dismissed pursuant to Rule
41(c) of the North Carolina Rules of Civil Procedure, except that
the tortious breach of contract claim was not included in the
former suit; therefore, Rule 41(c) did not preserve this claim and
because it was brought beyond the statute of limitations period,
the trial court correctly dismissed it.
Our review of the amended record reveals that the prior suit
did not contain a tortious breach of contract claim. However, the
trial court stated that this issue was ruled on only after
reviewing the complaint, its amendment, and applicable law.
Plaintiff's complaint nowhere indicates that the tortious breach of
contract action was not brought in the prior action. Matters
outside the complaint are only considered in a 12(b)(6) motion if
the motion has been converted into a motion for summary judgment:
If, on a [12(b)(6)] motion . . . to dismiss
for failure of the pleading to state a claim
upon which relief can be granted, matters
outside the pleading are presented to and not
excluded by the court, the motion shall be
treated as one for summary judgment and
disposed of as provided in Rule 56, and all
parties shall be given reasonable opportunity
to present all material made pertinent to such
a motion by Rule 56.
N.C. Gen. Stat. § 1A-1, Rule 12(b) (1990). The order appealed from
does not indicate that this motion was converted into a Rule 56
motion, therefore our review is limited to the same standard as the
trial court. Because the statute of limitations defense is outside
our purview, we shall determine if plaintiff has stated a claim for
which relief may be granted under Rule 12(b)(6).
[4]Tortious breach of contract has been recognized as a cause
of action in North Carolina. Olive v. Great American Ins. Co., 76
N.C. App. 180, 333 S.E.2d 41, disc. review denied, 314 N.C. 668,
336 S.E.2d 400 (1985).
It is well-settled that punitive damages
are generally not allowed for a breach of
contract with the exception of breach of
contract to marry. Punitive damages are not
allowed even when the breach is wilful,
malicious or oppressive. However, when the
breach of contract also constitutes or is
accompanied by an identifiable tortious act,
the tort committed may be grounds for recovery
of punitive damages. Mere allegations of an
identifiable tort are insufficient alone to
support a claim for punitive damages.
Furthermore, in order to sustain a claim for
punitive damages, there must be an
identifiable tort which is accompanied by or
partakes of some element of aggravation.
Shore v. Farmer, 133 N.C. App. 350, 361, 515 S.E.2d 495, 501-02
(1999) (Walker, J., concurring in part and dissenting in part)
(citations omitted) (quoting Taha v. Thompson, 120 N.C. App. 697,
704-05, 463 S.E.2d 553, 558 (1995), disc. review denied, 344 N.C.
443, 476 S.E.2d 130, disc. review denied, 344 N.C. 443, 476 S.E.2d
131 (1996)). Therefore, assuming plaintiff has sufficiently pled
a breach of contract action, he must also allege a tort whichpartakes some element of aggravation, along with the breach, in
order to withstand State Farm's 12(b)(6) motion.
Aggravation includes 'fraud, malice, such a degree of
negligence as indicates a reckless indifference to consequences,
oppression, insult, rudeness, caprice, [and] willfulness.' Taha
v. Thompson, 120 N.C. App. 697, 705, 463 S.E.2d 553, 558 (quoting
Newton v. Insurance Co., 291 N.C. 105, 112, 229 S.E.2d 297, 301
(1976)). While plaintiff alleges claimants have committed fraud,
he nowhere alleges that State Farm has, in fact, committed fraud.
Plaintiff does allege that State Farm's action promoted,
encouraged or acquiesced in criminal conduct on the part of the
claimants and was made in total and reckless disregard of
[plaintiff's] . . . protestations. However, State Farm had the
right to settle the subject claims without the approval of
plaintiff. N.C. Gen. Stat. § 20-279.21(f)(3). Our Supreme Court
has recognized that an insurance company, when settling claims with
third party outsiders, is acting in its own interest. Lampley v.
Bell, 250 N.C. 713, 110 S.E.2d 316 (1959). It is a matter of
common knowledge that fair and reasonable settlements can generally
be made at much less than the financial burden imposed in
litigating claims. Alford v. Insurance Co., 248 N.C. 224, 229,
103 S.E.2d 8, 12 (1958). Therefore, we can deduce that settling a
potentially fraudulent claim may cost an insurance company less
than actually litigating it, and thus is in the insurer's best
interest. Plaintiff has not indicated that State Farm acted
illegally, as it was not under any obligation to gain his consentbefore settling the claims in question. Plaintiff has also failed
to state facts indicating State Farm was in collusion with
claimants.
Based on the foregoing, we hold that plaintiff has failed to
state facts indicating that State Farm's settlement with claimants
rose to the level of aggravation defined in Taha v. Thompson.
Plaintiff has also failed to allege facts indicating an intentional
wrong by State Farm. Punitive damages are only awarded as
punishment for intentional wrongful conduct. Transportation Co. v.
Brotherhood, 257 N.C. 18, 30, 125 S.E.2d 277, 286, cert. denied,
371 U.S. 862, 9 L. Ed. 2d 100, reh'g denied, 371 U.S. 899, 9 L. Ed.
2d 131 (1962). Accordingly, we hold that plaintiff has failed to
state a claim for which relief may be granted and this assignment
of error is overruled.
[5]Plaintiff next assigns error to the dismissal of his
breach of contract and constructive fraud claims. Plaintiff argues
that because the trial court considered these claims in State
Farm's 12(b)(6) motion and did not thereupon dismiss them, they
should have survived State Farm's 12(c) motion. As we have
recognized, a complaint is subject to dismissal under Rule 12(b)(6)
if no law exists to support the claim made, if sufficient facts to
make out a good claim are absent, or if facts are disclosed which
will necessarily defeat the claim. Burgess v. Your House of
Raleigh, 326 N.C. 205, 209, 388 S.E.2d 134, 136. On the other
hand, a motion for judgment on the pleadings pursuant to Rule 12(c)
should only be granted when the movant clearly establishes that nomaterial issue of fact remains to be resolved and that the movant
is entitled to judgment as a matter of law. Minor v. Minor, 70
N.C. App. 76, 78, 318 S.E.2d 865, 867, disc. review denied, 312
N.C. 495, 322 S.E.2d 558 (1984). Neither rule employs the same
standard. It is plainly evident under our Rules of Civil Procedure
that because a plaintiff has survived a 12(b)(6) motion, and thus
has alleged a claim for which relief may be granted, his survival
in the action is not the equivalent of the court determining that
conflicting issues of fact exist and no party is entitled to
judgment as a matter of law under Rule 12(c). Accordingly, this
assignment of error is overruled.
[6]Next, plaintiff contends the trial court incorrectly
dismissed his claim for breach of contract under Rule 12(c) of the
North Carolina Rules of Civil Procedure.
Judgment on the pleadings, pursuant to Rule
12(c), is appropriate 'when all the material
allegations of fact are admitted in the
pleadings and only questions of law remain.'
[Town of Bladenboro v. McKeithan, 44 N.C. App.
459, 460, 261 S.E.2d 260, 261] (quoting
Ragsdale [v. Kennedy], 286 N.C. [130,] 136-37,
209 S.E.2d [494,] 499 [(1974)).] The trial
court must 'view the facts and permissible
inferences in the light most favorable to the
non-moving party[],' taking all well-pleaded
factual allegations in the non-moving party's
pleadings as true. Id. at 461, 261 S.E.2d at
262 (quoting Ragsdale, 286 N.C. at 136-37, 209
S.E.2d at 499.
When ruling on a motion for judgment on
the pleadings, the trial court is to consider
only the pleadings and any attached exhibits,
which become part of the pleadings. Minor v.
Minor, 70 N.C. App. 76, 78, 318 S.E.2d 865,
867, disc. review denied, 312 N.C. 495, 322
S.E.2d 558 (1984).
Terrell v. Lawyers Mut. Liab. Ins. Co., 131 N.C. App. 655, 659-660,
507 S.E.2d 923, 926 (1998). In a Rule 12(c) motion, [n]o evidence
is to be heard, and the trial judge is not to consider statements
of fact in the [appellate] briefs of the parties or the testimony
of allegations by the parties in different proceedings. Minor v.
Minor, 70 N.C. App. at 78, 318 S.E.2d at 867. Therefore, matters
outside of the pleadings and their attached exhibits were not
considered by the trial court and are not subject to our
examination in a determination of the issue at hand.
Plaintiff alleges that the breach of contract occurred when
the settlement of claims was made by State Farm absent good faith.
State Farm argues that settlement of the claims, if the claims were
fraudulent, may have been a bad judgment, but such conduct did not
rise to the level of bad faith.
The insurance policy in the present case provides that State
Farm may settle or defend any claim or suit as it considers
appropriate. This provision is supported by our statutory code,
which provides that an auto insurer, has the right to settle
without an insured's consent under N.C. Gen. Stat. § 20-
279.2(f)(3). N.C. Gen. Stat. § 20-279.21 provides, in pertinent
part: The insurance carrier shall have the right to settle any
claim covered by the policy, and if such settlement is made in good
faith, the amount thereof shall be deductible from the limits of
liability . . . . N.C. Gen. Stat. § 20-279.21(f)(3). In North
Carolina, [r]egardless of any contractual provision reserving to
the insurer the exclusive right to settle a claim as it sees fit,any settlement must be made in good faith. Nationwide Mutual Ins.
Co. v. Public Service Co. of N.C., 112 N.C. App. 345, 350, 435
S.E.2d 561, 564 (1993); see N.C. Gen. Stat. § 20-279.21. Good
faith is defined as absence of malice . . . . Honesty of
intention, and freedom from knowledge of circumstances which ought
to put [one] upon inquiry. Black's Law Dictionary 693 (6th ed.
1990).
We have found no case in this state which considers the issue
of whether an insurance company can be held liable for settling a
claim where the insured notified his insurer that the claim was
fraudulent. In a similar case from Ohio, Marginian v. Allstate
Insurance Co., 18 Ohio St. 3d 345, 481 N.E.2d 600 (1985), an
insured had instructed his insurer not to pay two claims asserted
against his policy due to an automobile accident because the
insured was not at fault, and payment of the claims would be
fictitious and fraudulent. The Ohio Supreme Court held that where
a contract of insurance provides that the insurer may, as it deems
appropriate, settle any claim or action brought against its
insured, a cause of action alleging a breach of the insurer's duty
of good faith will not lie where the insurer has settled such claim
within the monetary limits of the insured's policy. Id. at 348,
481 N.E.2d at 603. It is undisputed that State Farm settled within
the monetary limits of plaintiff's policy in the present case.
Many jurisdictions mandate that a liability insurer must
consider the insured's interests in accepting or rejecting acompromise offer, 7A Am. Jur. 2d Automobile Insurance § 374 (1990).
Similarly, our Supreme Court has stated:
The law imposes on the insurer the duty
of carrying out in good faith its contract of
insurance. The policy provision giving the
insurer the right to effectuate settlement was
put in for the protection of the insured as
well as the insurer. It is a matter of common
knowledge that fair and reasonable settlements
can generally be made at much less than the
financial burden imposed in litigating claims.
It is for this reason that courts have
consistently held that an insurer owes a duty
to its insured to act diligently and in good
faith in effecting settlements within policy
limits, and if necessary to accomplish that
purpose, to pay the full amount of the policy.
Liability has been repeatedly imposed upon
insurance companies because of their failure
to act diligently and in good faith in
effectuating settlements with claimants.
Alford, 248 N.C. at 229, 103 S.E.2d at 12 (emphasis added). An
insurance company is expected to deal fairly and in good faith with
its policyholders. Robinson v. N.C. Farm Bureau Ins. Co., 86 N.C.
App. 44, 50, 356 S.E.2d 392, 395 (1987), disc. review improv.
allowed, 321 N.C. 592, 364 S.E.2d 140 (1988). However, as we have
previously noted, [i]nsurance companies and their agents . . . do
not act as agents for the insured when settling claims. An
insurance company, if it admits that its insured is liable, without
its insured's knowledge or consent, is acting in its own interest,
and not as the agent of the insured. Anderson v. Gooding, 43 N.C.
App. 611, 614, 259 S.E.2d 398, 400, appeal dismissed, 299 N.C. 119,
261 S.E.2d 921 (1979), rev'd on other grounds, 300 N.C. 170, 265
S.E.2d 201 (1980). Based on the foregoing, it is evident that State Farm owed the
duty of good faith in carrying out its contract of insurance. The
affidavit with attached exhibits of State Farm's claims
superintendent were part of State Farm's pleadings and indicate in
pertinent part that: (1) an investigation was conducted by State
Farm, and revealed that the investigating officer did not remember
how many occupants were in the Camaro and this was not indicated on
the accident report; (2) plaintiff was most likely responsible for
the accident, as plaintiff admitted driving in reverse down a city
street after dark when he failed to see claimants' vehicle and
collided with it; (3) it is not uncommon for medical treatment to
be rendered following an accident, although there is no report of
injury at the scene; (4) all claims were settled for substantially
less than claimant's medical expenses; (5) as a result of
settlement, plaintiff was released from any further liability; and
(6) plaintiff's premiums were increased pursuant to the North
Carolina Rate Bureau requirements, and plaintiff's points
assessment would be the same whether or not the personal injury
claim of Arthur Poston, Jr., the individual plaintiff alleged was
not in the Camaro at the time of the accident, was settled. The
affidavit presents evidence that State Farm investigated the
accident and acted in the interest of plaintiff in settling the
claims, as they were settled for less than demanded and plaintiff
was released from any further liability. As previously noted, the
claims were settled within policy limits. Plaintiff has not
contested any of these facts. Similar to the Marginian court, wehold that a cause of action alleging breach of good faith will not
lie when the insurer settles a claim within the monetary limits of
the insured's policy; however, in doing so, we believe the insurer
has the duty to consider the insured's interest. See Alford, 248
N.C. 224, 103 S.E.2d 8. In so holding, we recognize that an
insurer may act in its own interest in settlement of the claim, see
Anderson, 43 N.C. App. 611, 259 S.E.2d 398, and has statutory
authority to settle claims without the consent of the insured.
N.C. Gen. Stat. § 20-279.21(f)(3). Our review indicates that no
issues of material fact remain, and based on our holding, State
Farm was entitled to judgment as a matter of law under Rule
12(b)(c) on plaintiff's breach of contract claim. We note that the
settlement of any fraudulent claim by State Farm with claimants
appears not to have affected plaintiff's rights or precluded him
from seeking redress against claimants for alleged fraudulent
activity:
The standard automobile liability insurance
policy provides that the insurer may, in its
discretion, settle any claim against the
insured for which it would be liable under the
terms of the policy. When exercised in good
faith these provisions are valid and binding
on the insured. However, it is now settled
law in this State that the exercise of this
privilege by the insurer will not bar the
right of the insured, or anyone covered by his
policy, to sue the releasor for his damages
where he has neither ratified nor consented to
such settlement.
Bradford v. Kelly, 260 N.C. 382, 383-84, 132 S.E.2d 886, 887-88
(1963) (citations omitted). [A] liability carrier cannot impair
the rights of the insured by settling his claim without hisauthority. Phillips v. Alston, 257 N.C. 255, 259, 125 S.E.2d 580,
583 (1962). Accordingly, this assignment of error is overruled.
[7]Lastly, plaintiff assigns error to the trial court's
dismissal of its claim for constructive fraud pursuant to Rule
12(c) of the North Carolina Rules of Civil Procedure. The North
Carolina Supreme Court has summarized the law pertaining to
constructive fraud as follows:
Constructive fraud arises where a
confidential or fiduciary relationship exists,
and its proof is less exacting than that
required for actual fraud. Terry v. Terry,
302 N.C. 77, 83, 273 S.E.2d 674, 677 (1981).
When a fiduciary relationship exists between
parties to a transaction, equity raises a
presumption of fraud when the superior party
obtains a possible benefit. This presumption
arises not so much because [the fiduciary] has
committed a fraud, but [because] he may have
done so. Atkins v. Withers, 94 N.C. 581, 590
(1886). The superior party may rebut the
presumption by showing, for example, that the
confidence reposed in him was not abused, but
that the other party acted on independent
advice. 37 Am. Jur. 2d Fraud and Deceit §
442, at 603. Once rebutted, the presumption
evaporates, and the accusing party must
shoulder the burden of producing actual
evidence of fraud.
In stating a cause of action for
constructive fraud, the plaintiff must allege
facts and circumstances (1) which created the
relation of trust and confidence, and (2) led
up to and surrounded the consummation of the
transaction in which defendant is alleged to
have taken advantage of his position of trust
to the hurt of plaintiff. Rhodes v. Jones,
232 N.C. 547, 549, 61 S.E.2d 725, 726 (1950).
Watts v. Cumberland County Hosp. System, 317 N.C. 110, 115-16, 343
S.E.2d 879, 884 (1986) (citations omitted). Plaintiff in the
present case has failed to present evidence of a fiduciaryrelationship between State Farm and plaintiff. While we have
recognized that an insurance agent has a fiduciary duty to keep the
insured correctly informed as to his insurance coverage, R-Anell
Homes, Inc. v. Alexander & Alexander, Inc., 62 N.C. App. 653, 303
S.E.2d 573 (1983), we have not held that an insurance company or an
adjuster has a fiduciary duty to an insured with respect to
settlement of claims. Accordingly, this assignment of error is
overruled, and the order of the trial court is affirmed.
Affirmed.
Judges JOHN and McGEE concur.
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