Negligence & Intentional Tort
The court held that the plaintiff-insurer was liable to pay penalty interest to defendants because it failed to pay PPI benefits within 30 days of being provided reasonable proof of the fact and the amount of the loss. The court also upheld the trial court's award of attorney fees to defendants based on the trial court's determination that plaintiff failed to rebut the presumption under Ivezaj that its delay in payment was unreasonable. The court rejected plaintiff's argument that it did not have reasonable proof of the fact and amount of the loss because the available evidence reflected that the insured (R) may have intended to harm herself when she intentionally exited her boyfriend's moving vehicle. The court noted that the record established that by 12/12/08, plaintiff knew that R was injured in an incident involving a motor vehicle, that it was the responsible insurer, and that defendants-Spectrum were providing medical care to R. The court further noted that the record revealed that by 12/12/08, plaintiff had received Spectrum's treatment records and its first billing invoices. "Despite any initial question as to whether coverage might be excluded, plaintiff ultimately determined that it was liable for the payment of the claim." Thus, the court concluded, "because any good faith by plaintiff in withholding payment is wholly irrelevant to the award of penalty interest, the trial court did not clearly err by determining that benefits were overdue as of" 1/12/09, and awarding Spectrum penalty interest accordingly. The court also rejected plaintiff's argument that the amount of penalty interest should be reduced, concluding that the trial court correctly calculated the amount due under the statute. Further, the court rejected plaintiff's argument that defendants were not entitled to attorney fees, noting that the trial court was unable to find evidence that plaintiff possessed relative to an intentional injury. Rather, all the trial court and the court were able to ascertain was that plaintiff's refusal to pay was based on the fact that R "jumped from a moving vehicle and generally, people do not leave moving vehicles unless they intend to injure themselves . . . ." In finding that the trial court's ultimate legal conclusions did not constitute clear error, the court noted that the trial court took into consideration all evidence available to plaintiff regarding R's mental state and corresponding testimony from those who were with her on the date of the incident, and made extensive use of the record evidence provided by the only eyewitness to the incident. Further, the trial court also found that "when queried, representatives of plaintiff could not proffer what evidence plaintiff needed as proof that the injury was accidental." Finally, the court observed that the trial court found that much of the delay in payment was due to plaintiff's decision to delay deposing witnesses. Affirmed.