Bad Faith Insurance Complaint

SUPERIOR COURT OF NEW JERSEY

[COUNTY] COUNTY – LAW DIVISION

CIVIL ACTION

[PLAINTIFF FULL LEGAL NAME],
Plaintiff,

v.

[DEFENDANT INSURANCE COMPANY LEGAL NAME],
Defendant.

Docket No.: [___]
Civil Action

COMPLAINT FOR BREACH OF CONTRACT, BAD-FAITH INSURANCE PRACTICES, AND RELATED RELIEF
JURY TRIAL DEMANDED

TABLE OF CONTENTS

I. Document Header & Caption...............................................1
II. Preliminary Statement...................................................2
III. Definitions.............................................................2
IV. Parties.................................................................3
V. Jurisdiction, Venue & Governing Law.....................................3
VI. Factual Allegations.....................................................4
VII. Causes of Action........................................................7
Count I – Breach of Contract...........................................7
Count II – Breach of Implied Covenant / Common-Law Bad Faith..........10
Count III – Statutory Bad Faith (N.J. Stat. Ann. §§ 17:29BB-1 et seq.)13
Count IV – Declaratory Judgment.......................................15
VIII. Prayer for Relief.....................................................17
IX. Jury Demand............................................................18
X. Certification of Counsel (Rule 4:5-1)..................................18
XI. Verification (if required).............................................19

II. PRELIMINARY STATEMENT

1. Plaintiff brings this action to recover contractual benefits wrongfully withheld by Defendant, and to obtain compensatory, consequential, and punitive damages resulting from Defendant’s bad-faith refusal to honor its obligations under the Policy (defined below), in violation of New Jersey common law and statutory insurance standards.
2. Plaintiff further seeks attorneys’ fees and costs pursuant to N.J. Ct. R. 4:42-9(a)(6) and all other applicable authority, together with pre- and post-judgment interest.

III. DEFINITIONS

For purposes of this Complaint, the following terms have the meanings set forth below. Capitalized terms apply throughout unless context indicates otherwise.
A. “Claim” means the first-party insurance claim submitted by Plaintiff to Defendant on or about [DATE] arising from [brief description of loss].
B. “Policy” means Insurance Policy No. [___] issued by Defendant to Plaintiff, with effective dates [DATE] through [DATE].
C. “Coverage Amount” means the full amount of insurance benefits owed under the Policy for the Claim, including but not limited to [list coverages].
D. “Defendant,” “Insurer,” or “Carrier” means [DEFENDANT LEGAL NAME] and all parents, subsidiaries, affiliates, agents, claims personnel, and adjusters acting on its behalf.
E. “Bad Faith” includes any act or omission by Defendant that is unreasonable, unfair, or without proper cause and performed knowingly or recklessly in disregard of Plaintiff’s rights to receive benefits under the Policy, consistent with New Jersey standards for first-party insurance claims.

IV. PARTIES

3. Plaintiff, [PLAINTIFF FULL LEGAL NAME], is a citizen of the State of New Jersey residing at [ADDRESS] and is the named insured under the Policy.
4. Defendant, [DEFENDANT INSURANCE COMPANY LEGAL NAME], is an insurance company authorized to transact business in New Jersey, with its principal place of business at [ADDRESS], and issued the Policy to Plaintiff.

V. JURISDICTION, VENUE & GOVERNING LAW

5. This Court has subject-matter jurisdiction under N.J. Const. art. VI, § 3, and N.J. Stat. Ann. §§ 2A:3-1 et seq.
6. Venue is proper in this County under N.J. Ct. R. 4:3-2(a) because the cause of action arose here and the insured risk is located here.
7. The Policy provides no mandatory arbitration clause, or, to the extent any arbitration provision exists, Plaintiff hereby elects to pursue this action in court pursuant to the optional forum selection set forth in the Policy.
8. New Jersey law governs all claims pursuant to the Policy’s choice-of-law clause and, independently, under New Jersey’s significant-relationship test.

VI. FACTUAL ALLEGATIONS

9. Plaintiff purchased the Policy from Defendant in consideration of premium payments totaling $[___].
10. On [DATE OF LOSS], Plaintiff sustained [describe covered loss] (“Loss”). The Loss is a covered peril under the Policy.
11. Plaintiff promptly notified Defendant of the Loss and fully complied with all Policy conditions precedent.
12. Defendant acknowledged the Claim on [DATE] and assigned Claim No. ☐.

13. Despite receiving complete proof of loss and repeatedly confirming coverage in principle, Defendant:
    a. Failed to conduct a prompt, fair, and thorough investigation;
    b. Unreasonably delayed payment with no legitimate factual or legal basis;
    c. Misrepresented pertinent Policy provisions; and
    d. Forced Plaintiff to retain counsel and commence litigation.

14. Defendant’s conduct violates applicable standards set forth in N.J. Stat. Ann. § 17:29B-4(9) and related regulations.

15. As a direct and proximate result of Defendant’s acts and omissions, Plaintiff has suffered:
    a. Unpaid Policy benefits in the amount of $[___];
    b. Consequential damages, including [additional losses];
    c. Emotional distress; and
    d. Attorneys’ fees, costs, and interest.

16. Defendant’s refusal to pay was intentional, willful, wanton, and undertaken with reckless disregard for Plaintiff’s rights, warranting punitive damages under N.J. Stat. Ann. §§ 2A:15-5.9 – 5.17.

VII. CAUSES OF ACTION

COUNT I – BREACH OF CONTRACT

17. Plaintiff realleges paragraphs 1–16 as if fully set forth herein.
18. The Policy constitutes a valid, enforceable contract.
19. Plaintiff fully performed all obligations under the Policy.
20. Defendant breached the Policy by failing to pay the Coverage Amount and by otherwise refusing to honor contractual duties.
21. Plaintiff suffered damages as a result of Defendant’s breach.

WHEREFORE, Plaintiff demands judgment against Defendant for:
a. The Coverage Amount;
b. Consequential damages;
c. Pre- and post-judgment interest; and
d. Such other relief as the Court deems just and equitable.

COUNT II – BREACH OF THE IMPLIED COVENANT OF GOOD FAITH & FAIR DEALING (COMMON-LAW BAD FAITH)

22. Plaintiff realleges paragraphs 1–21.
23. New Jersey law implies a covenant of good faith and fair dealing in every insurance contract.
24. Defendant violated that covenant by intentionally delaying and denying benefits without a fairly debatable basis, compelling litigation to secure amounts undeniably due.
25. Defendant’s conduct was malicious or in reckless disregard of Plaintiff’s rights.
26. Plaintiff suffered damages, including unpaid benefits, emotional distress, and attorneys’ fees.

WHEREFORE, Plaintiff demands:
a. Compensatory damages;
b. Consequential and extra-contractual damages;
c. Punitive damages under N.J. Stat. Ann. §§ 2A:15-5.9 – 5.17;
d. Attorneys’ fees and costs pursuant to N.J. Ct. R. 4:42-9(a)(6); and
e. Any further relief deemed appropriate.

COUNT III – STATUTORY BAD FAITH (N.J. STAT. ANN. §§ 17:29BB-1 ET SEQ.)

27. Plaintiff realleges paragraphs 1–26.
28. Defendant’s failure to make timely, fair, and equitable payment of the Claim, after receiving satisfactory proof of loss, constitutes an “unreasonable delay or denial” under the New Jersey Insurance Fair Conduct Act (“IFCA”), N.J. Stat. Ann. §§ 17:29BB-1 et seq.
29. Plaintiff provided written notice pursuant to IFCA on [DATE], more than 45 days before filing this action.
30. Defendant’s violations entitle Plaintiff to:
    a. Actual damages;
    b. Treble damages in the Court’s discretion; and
    c. Reasonable attorneys’ fees and litigation costs.

WHEREFORE, Plaintiff demands the statutory remedies set forth above.

COUNT IV – DECLARATORY JUDGMENT

31. Plaintiff realleges paragraphs 1–30.
32. An actual controversy exists regarding Defendant’s obligations to indemnify Plaintiff for the Loss.
33. Pursuant to N.J. Ct. R. 4:42-1 and the Declaratory Judgment Act, N.J. Stat. Ann. §§ 2A:16-52 et seq., Plaintiff is entitled to a judgment declaring that the Policy affords coverage and that Defendant must pay all amounts owed.

WHEREFORE, Plaintiff seeks a declaration consistent with the foregoing, as well as ancillary relief.

VIII. PRAYER FOR RELIEF

Plaintiff respectfully requests that the Court enter judgment in Plaintiff’s favor and against Defendant, awarding:

1. Compensatory damages in an amount to be proven at trial;
2. Consequential and extra-contractual damages;
3. Punitive damages as permitted by N.J. Stat. Ann. §§ 2A:15-5.9 – 5.17;
4. Attorneys’ fees and costs under N.J. Ct. R. 4:42-9(a)(6) and IFCA;
5. Pre- and post-judgment interest;
6. Declaratory and injunctive relief compelling immediate payment of Policy benefits; and
7. Such other and further relief as the Court deems just and proper.

IX. JURY DEMAND

Pursuant to N.J. Ct. R. 4:35-1, Plaintiff demands a trial by jury on all issues so triable.

X. CERTIFICATION OF COUNSEL (RULE 4:5-1)

I, [ATTORNEY NAME], counsel for Plaintiff, certify that:
a. The matter in controversy is not the subject of any other pending action in any court;
b. No other action or arbitration proceeding is contemplated; and
c. There are no other parties who should be joined in this action at this time.
I recognize my continuing obligation to file and serve an amended certification if facts change.

Date: __________ ________________________________
[ATTORNEY NAME], Esq.
[NJ Attorney ID No.]
[LAW FIRM NAME]
[ADDRESS]
Phone: [___] | Email: [___]
Attorney for Plaintiff

XI. VERIFICATION

[OPTIONAL – include if necessary for statutory claim]
I, [PLAINTIFF NAME], being duly sworn, verify that the factual allegations contained in this Complaint are true and correct to the best of my knowledge, information, and belief. I understand that if any of these statements are willfully false, I may be subject to punishment.

Date: __________ ________________________________
[PLAINTIFF NAME]

Notary Public:____________________ My Commission Expires:________