FRED W. CAMPBELL, APPELLANT/CROSS-APPELLEE,
v.
THE PRUDENTIAL INSURANCE COMPANY, APPELLEE/CROSS-APPELLANT

Fla. 5th DCA | 1985-11-29
No. 84-1824
UPCHURCH and SHARP, JJ., concur.
480 So. 2d 666 Florida District Court of Appeal, Fifth District (1985) Positive Treatment
Cited by 10 cases

AI-generated. These summaries, headnotes, and key points are machine-generated and may contain errors or omissions. Always verify against the full opinion text below. Not legal advice.

Synopsis

Campbell sought damages from Prudential Insurance for disability benefits disputes and emotional distress. The appellate court affirmed summary judgment against Campbell's emotional distress claim, reversed the denial of attorney's fees on a valid underpayment claim, and reversed judgment in Campbell's favor on Prudential's counterclaim for overpaid benefits.


Holding

The court held that: (1) negligent failure to pay benefits does not constitute the affirmative, outrageous conduct required for intentional infliction of emotional distress, so summary judgment for Prudential was proper; (2) Campbell is entitled to reasonable attorney's fees under section 627.428(1) for the valid underpayment claim on count one; and (3) waiver and estoppel doctrines cannot extend insurance coverage or overcome policy limitations, so Prudential can recover the overpaid benefits.


Headnotes

[1] An insurer's negligent failure to pay benefits does not constitute the affirmative, outrageous conduct required for intentional infliction of emotional distress.

[2] An insured is entitled to reasonable attorney's fees when summary judgment is entered in their favor against an insurer on a claim for underpayment of benefits.

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Key Quotes

“the insurer's negligent failure to pay employee benefits between May, 1978, and August, 1978, did not constitute the affirmative, outrageous conduct required by Metropolitan Life Ins. Co. v. McCarson”

Establishes that negligence alone cannot support intentional infliction of emotional distress claim against an insurer

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Facts & Procedural History

Campbell, an insured employee, had a group disability insurance policy with Prudential. The insurer negligently failed to pay employee benefits betwee…

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Opinion of the Court
COWART, Judge.

COWART, Judge.

This case involves disputes between an insured employee and his employer’s group disability insurer. The trial court correctly entered summary judgment in favor of the insurer as to punitive and compensatory damages for intentional infliction of emotional distress because here the insurer’s negligent failure to pay employee benefits between May, 1978, and August, 1978, did not constitute the affirmative, outrageous conduct required by Metropolitan Life Ins. Co. v. McCarson, 467 So. 2d 277 (Fla.1985), and Crawford and Company v. Dominguez, 467 So. 2d 281 (Fla.1985). See also Arab Termite and Pest Control v. Jenkins, 409 So. 2d 1039 (Fla.1982); Campbell v. Government Employees Ins. Co., 306 So. 2d 525 (Fla.1974); Food Fair, Inc. v. Anderson, 382 So. 2d 150 (Fla. 5th DCA 1980); Stetz v. American Casualty Company of Reading, Pennsylvania, 368 So. 2d 912 (Fla. 3d DCA 1979), cert, denied, 378 So. 2d 349 (Fla.1979); MacDonald v. Penn Mutual Life Ins. Co., 276 So. 2d 232 (Fla. 2d DCA 1973).

The trial court erred in denying the insured an award of reasonable attorney’s fees under section 627.428(1), Florida Statutes, in view of the summary adjudication against the insurer and in favor of the insured on count one of the amended complaint as to the underpayment of the $1,102.04 in long term disability benefits relating to certain employee “fringe benefits.” See Florida Rock and Tank Lines, Inc. v. Continental Insurance Company, 399 So. 2d 122 (Fla'. 1st DCA 1981).

The trial court also erred in granting the insured a summary judgment on the insurer’s counterclaim to recover $3,407.73 overpaid disability benefits based on the insured’s argument that the insurer had waived the set off provisions of the policy by making those overpayments and was, therefore, estopped to recover them. Insurance coverage cannot be extended by applying doctrines of waiver and estoppel to restrictions and limitations on coverage. See Starlite Services, Inc. v. Prudential Ins. Company of America, 418 So. 2d 305 (Fla. 5th DCA 1982), pet. for rev. dismissed, 421 So. 2d 518 (Fla.1982). The judgment in favor of the insurer on the insured’s claim for punitive damages and intentional infliction of emotional distress is affirmed, as is the order denying the insured attorney’s fees relating to those claims.

The judgment denying the insured’s claim for attorney’s fees on count one of the amended complaint is reversed as is the judgment for the insured on the insurer’s counterclaim for overpayments.

AFFIRMED in part; REVERSED in part; and REMANDED.

UPCHURCH and SHARP, JJ., concur.


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Citator

Cited By

  • Williams v. City OF Minneola, 575 So. 2d 683 (Fla. 5th DCA 1991)
    …87): (a) deliberate or reckless infliction of mental suffering; (b) outrageous conduct; (c) the conduct must have caused the emotional distress; and (d) the distress must be severe. 510 So. 2d at 986. See also Campbell v. Prudential Insurance Co., 480 So. 2d 666 (Fla. 5th DCA 1985) and Food Fair, Inc. v. Anderson, 382 So. 2d 150 (Fla. 5th DCA 1980). In our recent opinion in Lashley v. Bowman, 561 So. 2d 406 (Fla. 5th DCA 1990), we discussed the nature and elements of the tort, quoting comment d to section 4…
  • Dependable Life Ins. Co. v. Harris, 510 So. 2d 985 (Fla. 5th DCA 1987)
    …tly present conduct which is outrageous enough to rise to the level required by this tort appears to be a question of law.6 This court has recently recognized the tort but held the factual scenario insufficient. Campbell v. Prudential Insurance Co., 480 So. 2d 666 (Fla. 5th DCA 1985); Food Fair, Inc. v. Anderson, 382 So. 2d 150 (Fla. 5th DCA 1980). In Campbell we held the insurance company’s “mere negligence” in failing to pay a claim was not adequately outrageous, and in Anderson we emphasized that the wrong…
  • Blue Cross/Blue Shield OF Fla., Inc. v. Weiner, 543 So. 2d 794 (Fla. 4th DCA 1989)
    …or recovery on this tort. See Metropolitan Life Insurance Co. v. McCarson; Swinarski v. Keller, 529 So. 2d 1208 (Fla. 4th DCA 1988); Davis v. Gulf Life Insurance Co., 502 So. 2d 1012 (Fla. 3d DCA 1987). See also Campbell v. Prudential Insurance Co., 480 So. 2d 666 (Fla. 5th DCA 1985). Cf. Dominguez v. Equitable Life Assurance Society of the United States, 438 So. 2d 58 (Fla. 3d DCA 1983). Therefore as to Florida, we conclude that the trial court erred in denying Florida’s motion for directed verdict as to th…

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