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Hanke v. American International South Insurance Co.
State: Illinois
Court: 5th District Appellate
Docket No: 5-01-0919 Rel
Case Date: 12/26/2002

Notice

Decision filed 12/26/02. The text of this decision may be changed or corrected prior to the filing of a Petition for Rehearing or the disposition of the same.

NO. 5-01-0919

IN THE

APPELLATE COURT OF ILLINOIS

FIFTH DISTRICT


KERRY HANKE, Individually and on ) Appeal from the
Behalf of All Others Similarly Situated, ) Circuit Court of
) Madison County.
              Plaintiff-Appellee, )
)
v. ) No. 01-L-851
)
AMERICAN INTERNATIONAL )
SOUTH INSURANCE COMPANY, )
Individually and on Behalf of Similarly )
Situated AIG Entities,  ) Honorable
) Nicholas G. Byron,
             Defendant-Appellant. ) Judge, presiding.

JUSTICE GOLDENHERSH delivered the opinion of the court:

Kerry Hanke (plaintiff) filed a class action lawsuit against American InternationalSouth Insurance Company (defendant) and alleged breach of contract and fraud claims. Plaintiff accuses defendant of engaging in a fraudulent scheme that included defendantcontracting with third-party vendors to provide defendant with biased, below-marketestimates of total-loss-vehicle values. A vehicle is declared a total loss if the cost to repairexceeds the actual cash value of the vehicle. Plaintiff claims that defendant used theseestimates, which were arrived at by using valuation reports generated by a computersoftware program that systematically undervalued the actual cash value of total-loss vehicles,to defraud its insureds in connection with the insureds' claims for the total loss of theirvehicles. Plaintiff charges defendant with intentionally reducing its overall total-loss claimspayouts at the expense of its insureds by using these biased reports, which at first blushappear independent and unbiased. According to plaintiff, defendant relies on these reportsto demonstrate the purported "reasonableness" of what it determines to be the actual cashvalue of the totaled vehicle so that the insureds either will not challenge the valuationamount or will settle for an amount greater than the valuation but less than the actual cashvalue of the vehicle. Plaintiff further alleges that a part of the fraudulent scheme includesa policy provision which requires the parties to submit to an appraisal if requested by eitherthe insured or the insurer.

Defendant filed a motion to compel an appraisal prior to proceeding with the lawsuit.Defendant argued that plaintiff's policy contains both an appraisal provision and a provisionstating that the insured must satisfy all the conditions of the policy prior to filing suit againstdefendant. The appraisal provision contained in the policy allows each side to select anappraiser who, in turn, selects an impartial umpire. If the appraisers fail to agree on theamount of loss, they submit their differences to the umpire. A decision agreed to by any twoof the three is then binding. The provision further provides that each party must pay itsappraiser and bear the expenses of the appraisal and the umpire equally. The trial courtdenied defendant's motion to compel an appraisal but stated in its order that defendant couldperform an appraisal for discovery purposes. Defendant filed a notice of interlocutoryappeal pursuant to Supreme Court Rule 307(a)(1) (188 Ill. 2d R. 307(a)(1)). The issue weare asked to address is whether the trial court erred in denying defendant's motion to compelan appraisal. We affirm.

BACKGROUND

Plaintiff purchased an automobile insurance policy from defendant. In January 2001plaintiff was involved in an automobile accident in Madison County while driving his 1991Dodge Ram truck. Plaintiff submitted a claim for property damage to defendant. Defendantdeclared plaintiff's vehicle a total loss and valued the vehicle at $4,500 based upon avaluation obtained from ADP Claims Solution Group. Plaintiff challenged defendant'svaluation on the basis that it was below the actual cash value of the vehicle. Plaintiffinformed the claims adjuster assigned to the case that the National Automobile Dealers'Association (NADA) website valued his vehicle at $6,300. The claims adjuster respondedby telling plaintiff that she had found NADA valuations of $4,200 for trade-in value and$5,850 for retail value. Plaintiff continued to dispute defendant's valuation and told theclaims adjuster that he had put a new engine in his truck. The claims adjuster told plaintiffthat he could get an appraisal based upon the appraisal provision set forth in the policy,which provides as follows:

"APPRAISAL

A. If we and you do not agree on the amount of loss, either may demand an appraisalof the loss. In this event, each party will select a competent appraiser. The twoappraisers will select an umpire. The appraisers will state separately the actual cashvalue and the amount of loss. If they fail to agree, they will submit their differencesto the umpire. A decision agreed to by any two will be binding. Each party will:

1. Pay its chosen appraiser; and

2. Bear the expenses of the appraisal and umpire equally."

Plaintiff responded by sending the claims adjuster documentation supporting his claim thatdefendant's valuation was too low.

On February 5, 2001, the claims adjuster received from plaintiff a copy of a KelleyBlue Book valuation in the amount of $6,805, a copy of a repair bill from Don Hemann(who had installed a new engine in plaintiff's truck), and a copy of a repair bill from amuffler shop (for the installation of heavy-duty shock absorbers on plaintiff's truck). Theclaims adjuster did not believe that these documents justified an increase in the valuation,and plaintiff was again offered the original settlement amount.

Plaintiff contacted a friend, John Gibbons, who is a lawyer. Gibbons is not aparticipant in the instant lawsuit. Gibbons sent the claims adjuster a letter on behalf ofplaintiff, notifying defendant that the offer was insufficient. The claim was reassigned toanother adjuster who is no longer employed by defendant. However, it is clear from therecord that the reassignment failed to resolve the matter. Plaintiff ultimately retained theattorneys of record in this case, and on May 15, 2001, plaintiff filed a class action on behalfof himself and others similarly situated.

The original complaint and the first amended complaint, filed on September 5, 2001,contained the following counts: count I, breach of contract; count II, statutory fraud; andcount III, common law fraud. On November 16, 2001, plaintiff filed a second amendedcomplaint, which left out count III. The gist of the claims of the class action, as previouslyset forth, is that defendant is engaged in a fraudulent scheme whereby it uses biasedvaluation reports to undervalue the actual cash value of vehicles which are declared totallosses and consistently underpays total-loss claims, thereby cheating its insureds andincreasing its own profits.

On September 17, 2001, defendant sent a new proposal of settlement to Gibbons,who was not the attorney of record, offering $5,850. Defendant also informed plaintiff thatif he refused to settle, defendant would invoke the appraisal provision. The letter requestedthat plaintiff respond by September 28, 2001. Plaintiff did not respond. On October 5,2001, defendant filed a demand for an appraisal and a motion to compel an appraisal andstay further court proceedings. On November 2, 2001, after briefing and argument, the trialcourt entered an order denying defendant's motion to compel an appraisal and stay furthercourt proceedings. Defendant filed a timely notice of interlocutory appeal.

ANALYSIS

We first address the standard of review to be applied in the case at bar. Defendant argues that the standard is de novo because the instant case requires us to construe aninsurance policy. Plaintiff, on the other hand, contends that the standard of review to beapplied in an interlocutory appeal is whether there is a sufficient showing to sustain the trialcourt's order denying the relief sought. Both parties make legitimate arguments; however,after careful consideration, we find that the de novo standard of review is appropriate. SeeTravis v. American Manufacturers Mutual Insurance Co., No. 5-02-0059 (December 24,2002). Like Travis, the only question before the trial court was whether the insurancecontract contained a mandatory appraisal clause that applied to the controversy at issuebetween the parties. This is a determination made as a matter of law subject to de novoreview.

Defendant contends that the plain and unambiguous language of the insurance policyrequires plaintiff to submit to an appraisal. Defendant insists that the damages claimed byplaintiff relate solely to a disagreement regarding the actual cash value of plaintiff's vehicleand that, therefore, the appraisal clause relates directly to this dispute. Defendant relies onBeard v. Mount Carroll Mutual Fire Insurance Co., 203 Ill. App. 3d 724, 561 N.E.2d 116(1990), in support of its proposition that the trial court erred in refusing to enforce theappraisal clause.

In Beard, the plaintiff sought to recover under her fire insurance policy with thedefendant after her rental house was totally destroyed by a fire. 203 Ill. App. 3d at 726, 561N.E.2d at 117. The policy contained an appraisal clause similar to the one before us. Beard,203 Ill. App. 3d at 726, 561 N.E.2d at 117. The defendant filed a motion to compel anappraisal, which the trial court denied on the basis that because the house was a total loss,the appraisal provision did not apply because there was nothing left to appraise. Beard, 203Ill. App. 3d at 727, 561 N.E.2d at 117-18. On appeal, this court concluded that there wasno ambiguity in the insurance policy and that, therefore, no matter how difficult it might beto appraise a total loss, an appraisal had to be conducted. Beard, 203 Ill. App. 3d at 729,561 N.E.2d at 119. We find that Beard is distinguishable from the case at bar because itdoes not address the heart of the issue raised by plaintiff's complaint herein.

Contrary to defendant's assertions, the analysis of the question presented by thisappeal does not end with whether or not an appraisal clause exists. A court must alsodetermine whether the parties' dispute is covered by the particular clause. Lundy v. FarmersGroup, Inc., 322 Ill. App. 3d 214, 219, 750 N.E.2d 314, 318 (2001). In Lundy, the plaintifffiled a class action lawsuit against her insurer after her car was damaged in a collision. Theplaintiff alleged that the insurer had acted fraudulently in requiring its authorized repairshops to use inferior replacement parts rather than more expensive original equipmentmanufacturer parts on automobiles that were covered under its insurance policies. Theplaintiff's second amended complaint included claims on behalf of herself and the allegedclass members and alleged, inter alia, fraud and breach of contract. Lundy, 322 Ill. App. 3dat 217, 750 N.E.2d at 317. The insurance contract in issue had an appraisal clause that wasnearly identical to the one before us. The insurer sought to enforce the clause. Lundy, 322Ill. App. 3d at 216, 750 N.E.2d at 316-17. In considering the plaintiff's fraud claims and theinsurer's appraisal request, the Second District specifically stated:

"[T]he appraisal process provided for in the policy was designed solely toresolve disputes over the amount of the loss. Farmers argues that the amount of theloss is the threshold issue for each of plaintiff's claims, but that argumentoversimplifies the issues raised in plaintiff's second amended complaint. Theresolution of plaintiff's claims will require a determination of whether Farmersmisrepresented to its policyholders the quality of repair parts that Farmers would payfor under its policies. This question requires an interpretation of the policy language,in particular, the phrase 'like kind and quality.' These issues cannot be resolvedthrough the appraisal process. Consequently, we agree with the trial court that theissues plaintiff raised in her second amended complaint were not subject to theappraisal clause." Lundy, 322 Ill. App. 3d at 219, 750 N.E.2d at 319.

Likewise, we find that the instant case presents much more than a disagreement between theparties concerning the actual cash value of plaintiff's truck.

Here, plaintiff contends that defendant is engaged in a fraudulent scheme toundervalue its insureds' vehicles that are declared a total loss, in order to increase its ownprofits. Plaintiff's claims focus upon whether defendant defrauded him and therebybreached the terms of the policy. Plaintiff's second amended complaint specifically focusesupon the appraisal provision and makes this claim: "[Defendant] inserts the appraisalprovision into its policy as one way to effectuate its wrongful scheme, because AIG knowsthat few (if any) insureds will (or can) pay the money required to obtain an appraisal of atotal loss claim, particularly because the way AIG has devised the scheme, the disputedamount is virtually always worth less than the appraisal costs." The second amendedcomplaint goes on to allege, "The appraisal clause is used to prevent plaintiff and the classfrom effectively vindicating their statutory and common law causes of action." Thislanguage clearly establishes that plaintiff's second amended complaint presents much morethan a disagreement between the parties concerning the actual cash value of the vehicle.

Defendant's argument that the instant case is nothing more than a disagreementbetween the parties concerning the value of plaintiff's loss misrepresents this controversy. If we followed defendant's logic, it would mean that plaintiff would have to go through theallegedly fraudulent appraisal process, expending more money than he could ever hope torecover, in order to file any complaint alleging fraud in that very same process. Thedamages in this case cannot be determined by invoking the appraisal provision, becauseplaintiff claims that the appraisal provision is a part of the fraud, in that the appraisalprovision requires plaintiff to pay for an appraisal and split the cost of an umpire in orderto recover an amount of money less than the appraisal process would cost. The issues raisedin the second amended complaint involve much more than the actual cash value of plaintiff'struck and cannot be resolved through the appraisal process.

We are well aware of and agree with the public policy of the State of Illinois favoringthe conservation of judicial resources through arbitration or appraisal. See Lundy, 322 Ill.App. 3d at 219, 750 N.E.2d at 319 (citing J. Wise Smith & Associates, Inc. v. NationwideMutual Insurance Co., 925 F. Supp. 528, 530 n.8 (W.D. Tenn. 1995)). However, we do notbelieve that the mere existence of an appraisal clause is enough to compel an appraisal underthe facts presented here. None of the Illinois cases cited by defendant present factsanalogous to the facts before us. Instead, all of the cases cited by defendant center upon anissue that could be resolved by determining an amount or value.

For example, Bailey v. Timpone, 75 Ill. 2d 539, 389 N.E.2d 1193 (1979), which isrelied upon by defendant, involved a dispute over the amount of rent to be paid on therenewal of a lease. The parties in that case agreed that if they could not concur on theamount of rent to be paid upon renewal, the issue would be submitted to binding arbitration. Bailey, 75 Ill. 2d at 541, 389 N.E.2d at 1194. The specific issue in that case concerned therole a court should play in interpreting the rent provision set by the arbitrators and involveda determination of the term "gross income" as used in the arbitration provision of the lease. The court concluded that the arbitrators were authorized to clarify the term. Since the partiesagreed that the arbitrators had "binding authority to conclusively and finally establish the faircash rental value of the premises," it was proper for the trial court to defer to the meaningthe arbitrators ascribed to the terms they used. Bailey, 75 Ill. 2d at 546, 389 N.E.2d at 1196. The Bailey court stated in pertinent part:

"This court has long approved lease agreements to submit questions ofvaluation to appraisement or arbitration and has refused to interfere with thearbitrators' valuation absent fraud or mistake, even though the agreements were nottechnically classified as arbitration agreements and were not governed by all the rulesapplicable to arbitration." (Emphasis added.) Bailey, 75 Ill. 2d at 545, 389 N.E.2dat 1196.

The case before us is clearly distinguishable because it specifically involves fraudallegations.

The instant lawsuit presents the classic class action lawsuit in which those allegedlyinjured would be economically prohibited from ever vindicating their rights in separatelawsuits. If plaintiff's fraud allegations cannot be proven, then the appraisal process wouldcertainly be appropriate. Until that time, we find that the trial court did not err in findingthat an appraisal was not a condition precedent to litigating the claims in this lawsuit. Moreover, we note that the trial court did not deprive defendant of its right to obtain anappraisal. The trial court specifically stated in its order that defendant could get an appraisalas a part of the discovery process. Under these circumstances, we find that the trial court'sorder denying defendant's motion to compel an appraisal and stay further court proceedingswas correct.

CONCLUSION

For the foregoing reasons, the judgment of the circuit court of Madison County ishereby affirmed. The cause is remanded for further proceedings consistent with thisopinion.

Affirmed; cause remanded.

HOPKINS, P.J., and WELCH, J., concur.

NO. 5-01-0919

IN THE

APPELLATE COURT OF ILLINOIS

FIFTH DISTRICT


KERRY HANKE, Individually and on ) Appeal from the
Behalf of All Others Similarly Situated, ) Circuit Court of
) Madison County.
              Plaintiff-Appellee, )
)
v. ) No. 01-L-851
)
AMERICAN INTERNATIONAL )
SOUTH INSURANCE COMPANY, )
Individually and on Behalf of Similarly )
Situated AIG Entities,  ) Honorable
) Nicholas G. Byron,
             Defendant-Appellant. ) Judge, presiding.

Opinion Filed: December 26, 2002


Justices: Honorable Richard P. Goldenhersh, J.

Honorable Terrence J. Hopkins, P.J., and

Honorable Thomas M. Welch, J.,

Concur


Attorneys Robert E. Gillespie, William P. Hardy, Andrew M. Ramage, Hinshaw & Culbertson,

for 400 So. Ninth, Suite 200, Springfield, IL 62701; John L. Gilbert, Hinshaw &

Appellant Culbertson, 521 W. Main, Suite 300, Belleville, IL 62222


Attorneys Paul M. Weiss, Phillip A. Bock, Tod A. Lewis, Freed & Weiss, LLC, 111 West

for Washington, Suite 1331, Chicago, IL 60602; L. Thomas Lakin, Bradley M.Lakin,

Appellee Jeffrey A. Millar, Gail G. Renshaw, The Lakin Law Firm, P.C., 301 Evans Avenue,

P.O. Box 229, Wood River, IL 62095-0229


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