“In determining whether Defendant acted unreasonably, that is, without proper cause, you may consider whether the defendant did any of the following: (a) Misrepresented to Plaintiff relevant facts or insurance policy provisions relating to any coverage at issue; (b) Failed to acknowledge and act reasonably promptly after receiving communications about Plaintiff’s claim arising under the insurance policy; (c) Failed to adopt and implement reasonable standards for the prompt investigation and processing of claims arising under its insurance policies; (d) Failed to accept or deny coverage of claims within a reasonable time after Plaintiff completed and submitted
proof-of-loss requirements; (e) Did not attempt in good faith to reach a prompt, fair, and equitable settlement of Plaintiff’s claim after liability had become reasonably clear; (f) Required Plaintiff to file a lawsuit to recover amounts due under the policy by offering substantially less than the amount that he ultimately recovered in the lawsuit, even though Plaintiff had made a claim for an amount reasonably close to the amount ultimately recovered; (g) Attempted to settle Plaintiff’s claim for less than the amount to which a reasonable person would have believed Plaintiff was entitled by referring to written or printed advertising material accompanying or made part of the
application; (h) Attempted to settle the claim on the basis of an application that was altered without notice to, or knowledge or consent of, Plaintiff, his representative,
agent, or broker; (i) Failed, after payment of a claim, to inform Plaintiff at his request, of the coverage under which payment was made; (j) Informed Plaintiff of its practice of appealing from arbitration awards in favor of insureds or claimants for the purpose of forcing them to accept settlements or compromises less than the amount awarded in arbitration; (k) Delayed the investigation or payment of the claim by requiring Plaintiff, [or his physician], to submit a preliminary claim report, and then also required the submission of formal proof-of-loss forms, both of which contained substantially the same information; (l) Failed to settle a claim against Plaintiff promptly once its liability had become apparent, under one portion of the insurance policy coverage in order to influence settlements under other portions of the insurance policy coverage; (m) Failed to promptly provide a reasonable explanation of its reasons for denying the claim or offering a compromise settlement, based on the provisions of the insurance policy in relation to the facts or applicable law; (n) Directly advised Plaintiff not to hire an attorney; (o) Misled Plaintiff as to the applicable statute of limitations, that is, the date by which an action against Defendant on the claim had to be filed; (p) Delayed the payment or provision of hospital, medical, or surgical benefits for services provided with respect to acquired immune deficiency syndrome (AIDS) or AIDS-related complex for more than 60 days after it had received Plaintiff’s claim for those benefits, doing so in order to investigate whether Plaintiff had the condition before obtaining the insurance coverage. However, the 60-day period does not include any time during which Defendant was waiting for a response for relevant medical information from a healthcare provider. The presence or absence of any of these factors alone is not enough to
determine whether Defendant’s conduct was or was not unreasonable, that is, without proper cause. You must consider Defendant’s conduct as a whole in making this determination.”
[CACI Jury Instructions [citations omitted]]
