Clark v. National Union Fire ( 1999 )

F I L E D
United States Court of Appeals
Tenth Circuit
UNITED STATES COURT OF APPEALS
JUL 23 1999
FOR THE TENTH CIRCUIT
PATRICK FISHER
Clerk
WILLIAM NEAL CLARK; BILLIE
CLARK, as co-guardian of William
Neal Clark,
Plaintiffs-Appellants, No. 98-6312
(D.C. No. CIV 97-1390-M)
v. (W.D. Okla.)
NATIONAL UNION FIRE
INSURANCE COMPANY; CLAIMS
MANAGEMENT, INC.,
Defendants-Appellees.
ORDER AND JUDGMENT *
Before ANDERSON and KELLY , Circuit Judges, and BROWN , ** Senior
District Judge.
*
This order and judgment is not binding precedent, except under the
doctrines of law of the case, res judicata, and collateral estoppel. The court
generally disfavors the citation of orders and judgments; nevertheless, an order
and judgment may be cited under the terms and conditions of 10th Cir. R. 36.3.
**
Honorable Wesley E. Brown, Senior District Judge, United States District
Court for the District of Kansas, sitting by designation.
After examining the briefs and appellate record, this panel has determined
unanimously to grant the parties’ request for a decision on the briefs without oral
argument. See Fed. R. App. P. 34(f); 10th Cir. R. 34.1(G). The case is therefore
ordered submitted without oral argument.
Plaintiffs William Neal Clark and Billie Clark, as co-guardian of William
Neal Clark, appeal from a jury’s verdict finding that defendants 1
National Union
Fire Insurance Co. and Claims Management, Inc. (collectively National) were not
guilty of bad faith breach of contract in regard to the payment of medical
expenses incurred by William Neal Clark following an on-the-job injury.
We affirm.
Plaintiffs commenced this action in state court. National removed the
action to federal district court on the grounds of diversity. The parties are
familiar with the facts and we will relate them only as necessary to our
disposition. William Neal Clark, an employee of Wal-Mart, was driving a
Wal-Mart van when he struck a semi-truck head on. He was seriously injured
and filed a claim for workers’ compensation benefits. The workers’
compensation court determined that the accident arose out of and in the course
of Clark’s employment. The court held that National should provide Clark
1
Defendant National Union Fire Insurance Co. is the workers’ compensation
insurance carrier for William Neal Clark’s employer, Wal-Mart Stores, Inc.
Claims Management, Inc. is National Union’s agent.
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“reasonable and necessary medical treatment, care and attention.” App. Vol. 1,
at 14 (June, 1995 Workers’ Compensation Court order at 2).
Clark commenced this action for bad faith breach of contract alleging that
National had failed to meet their obligations as ordered. Clark alleged that none
of his medical bills or prescription and transportation costs had been paid.
On appeal, Clark raises issues concerning the district court’s evidentiary
rulings and the jury instructions. Clark contends the district court erred in not
admitting (1) testimony of his treating physician regarding his organic brain
damage and treatment, (2) documents necessary for him to show National had
notice of his medical bills and their duty to pay those bills, (3) billing records of
his health providers, and (4) expert testimony that the insurance adjuster was
inadequately trained. He also argues that the court erred in giving a jury
instruction which placed the burden on him to prove he was covered by workers’
compensation without allowing him to introduce workers’ compensation records
or, in the alternative, instructing the jury that he was covered by workers’
compensation insurance. He also argues the district court should have given his
requested jury instructions.
We review the trial court’s evidentiary rulings for abuse of discretion. See
Gust v. Jones , 162 F.3d 587, 592 (10th Cir. 19 98). Further, “ [i]f we find error in
the admission of evidence, we will set aside a jury verdict only if the error
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prejudicially affects a substantial right of a party.” Coletti v. Cudd Pressure
Control , 165 F.3d 767, 776 (10th Cir. 19 99) (quotation omitted).
The testimony of Clark’s treating physician was properly excluded. Such
testimony was sought by way of depositions the physician had given in the
workers’ compensation case, prior to the time Clark’s allegations of bad faith
arose and, thus, are irrelevant to Clark’s claim that National had failed to pay
bills submitted after the date of the workers’ compensation order.
An insurer has the “right to contest questionable claims” and, therefore,
legitimate litigation conduct is not evidence of bad faith. Timberlake Constr. Co.
v. U.S. Fidelity & Guar. Co. , 71 F.3d 335, 341 (10th Cir. 19 95). Thus, the fact
that bills were submitted but not paid prior to the entry of final judgment on his
workers’ compensation case is irrelevant to the issues here. Clark has not set
forth any claim that the litigation in his workers’ compensation case was not
legitimate. Further, National’s policy of requiring that medical bills be
resubmitted after liability is established is reasonable. Clark’s argument that an
insurer can only have this policy if mandated by statute is without merit.
We decline to address Clark’s argument that he should have been permitted
to introduce an expert to testify that the insurance adjustor was inadequately
trained. Clark did not develop this argument in his brief. See American Airlines
v. Christensen , 967 F.2d 410, 415 n.8 (10th Cir. 19 92).
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Clark argues that the district court erred in refusing to give his proffered
jury instructions.
In a diversity case, the substance of a jury instruction is
a matter of state law, but the grant or denial of a
tendered instruction is governed by federal law. We
review a district court’s decision whether to give a
tendered instruction for an abuse of discretion. When,
as here, a party has objected to instructions at trial, then
we conduct a de novo review to determine whether, as a
whole, the instructions correctly stated the governing
law and provided the jury with an ample understanding
of the issues and applicable standards.
Wiles v. Michelin N. Am., Inc. , 173 F.3d 1297, 1304 (10th Cir. 19 99) (quotations
and citation omitted).
First, Clark argues the court should not have instructed the jury that he
carried the burden of proving he was covered by workers’ compensation without
permitting him to introduce his workers’ compensation records or instructing the
jury that he had met that element. Instruction No. 13 correctly stated the essential
elements of a bad faith failure to pay claims which includes proof that the
claimant was covered by a workers’ compensation liability policy and that
National was required to pay his claims. However, Instruction No. 2 states that
“Clark received a workers’ compensation award for his injuries.” App. Vol. 1,
at 95. Our review of the instructions as a whole and the evidence presented at
trial does not persuade us that the jury could have erroneously thought that Clark
had failed to show these elements. Although Clark’s proposed amendment to the
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instruction may have been helpful to the jury, the court’s failure to amend the
instruction is, at best, harmless error.
Clark also contends the court should have given his requested instructions.
Clark has failed to show how the district court’s failure to give his requested
instructions prejudiced him. The instructions as given properly guided the jury
and correctly stated the controlling law.
The judgment of the United States District Court for the Western District
of Oklahoma is AFFIRMED.
Entered for the Court
Paul J. Kelly, Jr.
Circuit Judge
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