Bad Faith Insurance Complaint - District of Columbia

COMPLAINT FOR BREACH OF CONTRACT, BREACH OF THE IMPLIED COVENANT OF GOOD FAITH AND FAIR DEALING, AND VIOLATIONS OF THE D.C. CONSUMER PROTECTION PROCEDURES ACT — DISTRICT OF COLUMBIA

TABLE OF CONTENTS

1. Caption
2. Introduction
3. Parties, Jurisdiction, and Venue
4. Factual Allegations
5. Count I — Breach of Contract
6. Count II — Breach of the Implied Covenant of Good Faith and Fair Dealing
7. Count III — Violation of the D.C. Consumer Protection Procedures Act
8. Count IV — Declaratory Judgment
9. Damages
10. Prayer for Relief
11. Demand for Jury Trial
12. Signature and Service Blocks
13. Certificate of Service
14. District of Columbia Practice Notes
15. Sources and References

1. CAPTION

SUPERIOR COURT OF THE DISTRICT OF COLUMBIA

CIVIL DIVISION

Case No. [________________________________]

COMPLAINT (BREACH OF CONTRACT; BREACH OF IMPLIED COVENANT; D.C. CPPA)

JURY TRIAL DEMANDED

2. INTRODUCTION

1.1. This action arises out of Defendant [INSURER]'s wrongful denial of insurance benefits owed to Plaintiff [POLICYHOLDER] under Policy No. [POLICY NUMBER] (the "Policy"), and out of Defendant's unfair, unreasonable, and deceptive conduct in handling the underlying claim.

1.2. Plaintiff seeks compensatory contract damages, consequential damages, treble damages and attorney's fees under the District of Columbia Consumer Protection Procedures Act ("CPPA"), D.C. Code § 28-3901 et seq., punitive damages where supported by independent tortious conduct, and declaratory relief.

3. PARTIES, JURISDICTION, AND VENUE

2.1. Plaintiff [POLICYHOLDER] is a [natural person residing / corporation organized] in the District of Columbia at all times relevant to this Complaint.

2.2. Defendant [INSURER] is a [State of incorporation] insurance company licensed by the D.C. Department of Insurance, Securities and Banking ("DISB") to transact insurance business in the District of Columbia, with its principal place of business at [ADDRESS].

2.3. This Court has subject-matter jurisdiction pursuant to D.C. Code § 11-921 (Superior Court general jurisdiction).

2.4. Personal jurisdiction is proper under D.C. Code § 13-423 because Defendant transacts business and contracts to insure persons, property, or risks located in the District of Columbia.

2.5. Venue is proper because the Policy was issued and delivered in, and the events giving rise to this action occurred in, the District of Columbia.

4. FACTUAL ALLEGATIONS

A. The Insurance Policy

3.1. On or about [POLICY INCEPTION DATE], Defendant issued the Policy to Plaintiff covering [describe coverage — e.g., dwelling at 1234 X St. NW, contents, loss of use; or commercial property/liability coverage] with policy limits of [$AMOUNT].

3.2. Plaintiff paid all premiums when due. The Policy was in full force and effect at all relevant times.

B. The Loss and Claim

3.3. On or about [DATE OF LOSS], Plaintiff suffered a covered loss when [DESCRIBE LOSS — e.g., a burst pipe caused water damage; a fire damaged the insured premises; theft of insured personal property] (the "Loss").

3.4. Plaintiff timely reported the Loss to Defendant on [DATE OF NOTICE] (Claim No. [CLAIM NUMBER]) and cooperated fully with all reasonable investigation requests, including [examination under oath / sworn proof of loss / production of records].

3.5. The amount of the Loss is no less than [$AMOUNT], supported by [appraisals, contractor estimates, inventories, expert reports].

C. Defendant's Wrongful Conduct

3.6. Despite Plaintiff's full compliance with the Policy's conditions, Defendant [denied the claim in full / paid only $AMOUNT, far below the documented loss / unreasonably delayed adjustment for AMOUNT months].

3.7. Defendant's stated grounds for denial included [QUOTE OR PARAPHRASE DENIAL LETTER LANGUAGE], which [misstates the policy provisions / ignores material evidence / applies an inapplicable exclusion].

3.8. Defendant engaged in one or more of the following practices listed in D.C. Code § 31-2231.17. Plaintiff alleges, if supported by discovery, that the conduct occurred with such frequency as to indicate a general business practice:

• knowingly misrepresenting Policy provisions relating to the claim;
• refusing to pay the claim without conducting a reasonable investigation;
• failing to acknowledge and act reasonably promptly upon claim communications;
• failing to adopt or follow reasonable standards for the prompt investigation of claims;
• failing to affirm or deny coverage within a reasonable time after proof of loss;
• failing to attempt in good faith to effectuate a prompt, fair, and equitable settlement when liability had become reasonably clear;
• compelling Plaintiff to institute litigation by offering substantially less than amounts ultimately recoverable;
• failing to provide a reasonable, accurate explanation for denial or compromise offers.

3.9. As a direct and proximate result of Defendant's conduct, Plaintiff has suffered economic loss, including unpaid policy benefits, consequential damages, additional living expenses or business interruption losses, and attorney's fees and costs.

3.10. On [DATE], Plaintiff filed a complaint with DISB regarding Defendant's conduct, [Complaint No. ______, current status].

5. COUNT I — BREACH OF CONTRACT

4.1. Plaintiff incorporates Paragraphs 1.1 through 3.10 as if fully set forth herein.

4.2. The Policy is a valid and enforceable contract between Plaintiff and Defendant.

4.3. Plaintiff fully performed all conditions precedent, including timely premium payment, prompt notice of loss, submission of proof of loss, and cooperation with Defendant's investigation.

4.4. Defendant materially breached the Policy by failing and refusing to pay benefits owed, by denying the claim on pretextual or legally insufficient grounds, and by failing to honor its coverage obligations.

4.5. As a direct and proximate result, Plaintiff has been damaged in an amount to be proven at trial, including but not limited to the unpaid policy benefits and consequential damages reasonably foreseeable at the time of contracting.

6. COUNT II — BREACH OF THE IMPLIED COVENANT OF GOOD FAITH AND FAIR DEALING

5.1. Plaintiff incorporates Paragraphs 1.1 through 4.5 as if fully set forth herein.

5.2. Under District of Columbia law, every contract carries an implied covenant that neither party will do anything to destroy or injure the other party's right to receive the fruits of the contract. Allworth v. Howard Univ., 890 A.2d 194 (D.C. 2006); Paul v. Howard Univ., 754 A.2d 297 (D.C. 2000).

5.3. Defendant breached the implied covenant by, inter alia: (a) conducting an inadequate or biased investigation; (b) constructively denying coverage through unreasonable delay; (c) misapplying or distorting policy language to manufacture a denial; (d) demanding duplicative or burdensome documentation in bad faith; and (e) offering a settlement so far below documented loss as to compel litigation.

5.4. As a direct and proximate result, Plaintiff has suffered damages reasonably foreseeable at the time of contracting, including the unpaid policy benefits, consequential losses, and other damages flowing from Defendant's conduct.

7. COUNT III — VIOLATION OF THE D.C. CONSUMER PROTECTION PROCEDURES ACT

6.1. Plaintiff incorporates Paragraphs 1.1 through 5.4 as if fully set forth herein.

6.2. Plaintiff satisfies D.C. Code § 28-3901(a)(2)'s noun definition of "consumer" because, other than for resale, Plaintiff [purchased / leased / received / supplied economic demand for] the Policy or covered service. If relying on the adjective definition of "consumer," state the personal, household, or family use facts separately: [DETAILS]. Do not select status from an individual-versus-business label alone.

6.3. Defendant is a "merchant" within D.C. Code § 28-3901(a)(3) only if, in the ordinary course of business, it sells, leases, transfers, or supplies the goods or services that are or would be the subject of the alleged trade practice. The supporting facts are: [DETAILS].

6.4. Defendant violated D.C. Code § 28-3904 by, among other things:

• misrepresenting a material fact in a manner tending to mislead (§ 28-3904(e));
• failing to state material facts where such failure tended to mislead (§ 28-3904(f));
• using innuendo or ambiguity as to a material fact (§ 28-3904(f-1));
• misrepresenting a material fact relating to the goods or services (§ 28-3904(e));
• making or enforcing an unconscionable term or provision of a sale or lease, evaluated under subsection (r)'s factors (§ 28-3904(r));
• representing that the subject of a transaction was supplied in accordance with a previous representation when it was not (§ 28-3904(u)).

6.5. Defendant's conduct corresponds to practices listed in D.C. Code § 31-2231.17. A violation of that section requires proof that the listed conduct occurred with such frequency as to indicate a general business practice. Any CPPA claim must independently satisfy D.C. Code §§ 28-3904 and 28-3905.

6.6. Pursuant to D.C. Code § 28-3905(k)(2), Plaintiff is entitled to recover:

• treble damages or $1,500 per violation, whichever is greater;
• reasonable attorney's fees;
• punitive damages;
• injunctive relief; and
• such additional relief as the Court deems proper.

8. COUNT IV — DECLARATORY JUDGMENT

7.1. Plaintiff incorporates Paragraphs 1.1 through 6.6 as if fully set forth herein.

7.2. An actual, justiciable controversy exists between Plaintiff and Defendant concerning the parties' respective rights and obligations under the Policy.

7.3. Plaintiff seeks a judicial declaration pursuant to D.C. Code § 16-2501 et seq. that: (a) the Loss is a covered loss under the Policy; (b) Defendant is obligated to pay Plaintiff the full amount of the Loss up to applicable policy limits; and (c) any exclusions or conditions invoked by Defendant do not apply or have been waived.

9. DAMAGES

8.1. Contract Damages (Count I): unpaid Policy benefits in an amount no less than [$AMOUNT], plus pre-judgment interest at the legal rate from the date payment was due.

8.2. Consequential Damages (Counts I and II): additional living expenses, business interruption, costs of substitute repairs/replacement, mitigation costs, and other foreseeable losses, in an amount to be proven at trial.

8.3. Statutory Damages (Count III): treble damages or $1,500 per violation, whichever is greater, plus reasonable attorney's fees, costs, and punitive damages, pursuant to D.C. Code § 28-3905(k)(2).

8.4. Declaratory Relief (Count IV): a binding declaration of coverage.

10. PRAYER FOR RELIEF

WHEREFORE, Plaintiff respectfully requests judgment against Defendant as follows:

• A. Compensatory contract and consequential damages in an amount to be proven at trial, but not less than [$AMOUNT];
• B. Treble damages or statutory damages of $1,500 per violation, whichever is greater, under D.C. Code § 28-3905(k)(2);
• C. Reasonable attorney's fees and costs;
• D. Punitive damages where supported by the evidence;
• E. Pre-judgment and post-judgment interest at the maximum rate allowed by law;
• F. A declaration that the Loss is covered and that Defendant must pay benefits up to policy limits;
• G. Such other and further relief as the Court deems just and proper.

11. DEMAND FOR JURY TRIAL

Plaintiff demands a trial by jury on all issues so triable as a matter of right, pursuant to D.C. Super. Ct. Civ. R. 38.

12. SIGNATURE AND SERVICE BLOCKS

Date: [DATE]

Respectfully submitted,

[LAW FIRM NAME]

By: [________________________________]

[ATTORNEY NAME], D.C. Bar No. [####]

Counsel for Plaintiff

[STREET ADDRESS]

[CITY, STATE ZIP]

Telephone: [NUMBER]

Email: [EMAIL]

13. INITIAL SERVICE CHECKLIST

☐ Deliver a prepared summons for each defendant to the Clerk when filing.

☐ Serve the issued summons with the Complaint, Initial Order, any addendum, and every other filing-time order under D.C. Superior Court Civil Rule 4.

☐ Select the current Rule 4 recipient and method for each insurer or other defendant; do not use a later-paper certificate or e-filing as a substitute for original process.

☐ Record the defendant, authorized recipient, method, date, and proof or acknowledgment: [DETAILS].

14. DISTRICT OF COLUMBIA PRACTICE NOTES

• No tort of insurance bad faith. The District of Columbia Court of Appeals expressly declined to recognize a stand-alone tort of bad faith breach of an insurance contract in Choharis v. State Farm Fire & Cas. Co., 961 A.2d 1080 (D.C. 2008). The court reasoned that insurance disputes are properly governed by contract principles (including the implied covenant of good faith and fair dealing), and that any expansion of remedies beyond contract should come from the legislature, not the courts. Pleading "Tort of Bad Faith" as a separate count invites Rule 12(b)(6) dismissal.
• Implied covenant is a contract claim. D.C. recognizes the implied covenant of good faith and fair dealing in every contract, including insurance contracts. Allworth v. Howard Univ., 890 A.2d 194 (D.C. 2006); Paul v. Howard Univ., 754 A.2d 297 (D.C. 2000); Washington Properties, Inc. v. Chin, Inc., 760 A.2d 546 (D.C. 2000). But damages on this theory are contract damages — punitive damages require an independent tort or a CPPA claim.
• CPPA requires a complete gate. Determine the noun/adjective consumer definition, merchant status, goods or services, trade practice, exact § 28-3904 prohibition, plaintiff capacity, causation, and § 28-3905 remedy before pleading the count. A commercial-policy or small-business label alone neither establishes nor defeats coverage.
• DISB administrative complaint. D.C. Code § 31-2231.17 is enforced administratively by DISB; it does not itself create a private right of action, and its listed conduct must occur with such frequency as to indicate a general business practice. A DISB complaint may create an evidentiary record and may lead to administrative enforcement. Do not plead a CPPA claim solely by relabeling an alleged § 31-2231.17 violation; independently plead the elements of D.C. Code §§ 28-3904 and 28-3905.
• ERISA preemption. If the policy is an employee-benefit plan governed by ERISA (e.g., employer-sponsored disability or health), state-law claims (including CPPA) are preempted. Use the disability appeal template instead.
• Statute of limitations. Section 12-301(7) gives a simple contract three years from accrual; subsection (8) gives a three-year residual period only where no other limitation is specially prescribed. Do not treat subsection (8) as a blanket statutory-claim or CPPA rule. Classify each count and confirm its governing period, accrual rule, and tolling.
• Forum. D.C. Superior Court, Civil Division. Small Claims Branch handles cases up to $10,000.
• Pure contributory negligence. D.C. is one of five jurisdictions retaining pure contributory negligence (with AL, MD, NC, VA). Generally inapposite to first-party coverage but relevant to companion negligence theories or third-party liability disputes.
• Pleading punitive damages. Punitive damages on a contract theory are unavailable absent an independent tort. Choharis, 961 A.2d at 1090. Punitives are available under the CPPA, § 28-3905(k)(2)(D), and through any pleaded independent tort (fraud, negligent misrepresentation).

15. SOURCES AND REFERENCES

• D.C. Code § 28-3901 et seq. (CPPA) — https://code.dccouncil.gov/us/dc/council/code/titles/28/chapters/39/
• D.C. Code § 28-3904 (unlawful trade practices) — https://code.dccouncil.gov/us/dc/council/code/sections/28-3904
• D.C. Code § 28-3905(k) (private right of action) — https://code.dccouncil.gov/us/dc/council/code/sections/28-3905
• D.C. Code § 31-2231.17 (unfair claim settlement practices) — https://code.dccouncil.gov/us/dc/council/code/sections/31-2231.17
• D.C. Code § 12-301 (statutes of limitation) — https://code.dccouncil.gov/us/dc/council/code/sections/12-301
• Choharis v. State Farm Fire & Cas. Co., 961 A.2d 1080 (D.C. 2008) — https://caselaw.findlaw.com/court/dc-court-of-appeals/1029758.html
• Washington Properties, Inc. v. Chin, Inc., 760 A.2d 546 (D.C. 2000)
• Allworth v. Howard Univ., 890 A.2d 194 (D.C. 2006)
• D.C. Department of Insurance, Securities and Banking — https://disb.dc.gov
• DISB Consumer Complaint Form — https://disb.dc.gov/service/file-complaint-or-report-fraud
• D.C. Superior Court Civil Division — https://www.dccourts.gov/superior-court/civil-division

Disclaimer: This template is provided for informational purposes only and does not constitute legal advice. An attorney licensed in the District of Columbia must review and customize this document before filing. Laws, citations, and court rules change frequently; verify all authorities before use.