Ohio Bad Faith Insurance Complaint (Civil Action)

COMPLAINT FOR BREACH OF INSURANCE CONTRACT AND COMMON-LAW BAD FAITH — OHIO

TABLE OF CONTENTS

1. Caption
2. Parties, Jurisdiction, and Venue
3. General Allegations
4. Claims Handling Timeline
5. Count I — Breach of Insurance Contract
6. Count II — Common-Law Bad Faith (Hoskins/Zoppo)
7. Count III — Punitive Damages and Attorney's Fees
8. Damages
9. Prayer for Relief
10. Demand for Trial by Jury
11. Reservation of Rights
12. Signature Block
13. Verification
14. Certificate of Service
15. Ohio Practice Notes
16. Sources and References

1. CAPTION

IN THE COURT OF COMMON PLEAS

[COUNTY NAME] COUNTY, OHIO

CIVIL DIVISION

CASE NO. [________________________________]

JUDGE [________________________________]

COMPLAINT FOR BREACH OF INSURANCE CONTRACT, COMMON-LAW BAD FAITH, PUNITIVE DAMAGES, AND ATTORNEY'S FEES

JURY DEMAND ENDORSED HEREON

Plaintiff, complaining of Defendant, alleges and says as follows:

2. PARTIES, JURISDICTION, AND VENUE

2.1. Plaintiff [PLAINTIFF NAME] ("Plaintiff" or "Insured") is a natural person residing in [COUNTY] County, Ohio, and was so at all times material to this action.

2.2. Defendant [INSURER NAME] ("Defendant" or "Insurer") is a [insurance company / mutual / reciprocal] organized under the laws of [STATE OF DOMICILE], authorized by the Ohio Department of Insurance to transact insurance in Ohio, and may be served through its statutory agent at [ADDRESS].

2.3. The amount in controversy exceeds the jurisdictional minimum of this Court, exclusive of interest and costs.

2.4. This Court has subject-matter jurisdiction under R.C. § 2305.01 (general jurisdiction of courts of common pleas).

2.5. Venue is proper in [COUNTY] County under Ohio R. Civ. P. 3(C) because [the contract was made / the loss occurred / Defendant conducts substantial business / Plaintiff resides] in this county.

3. GENERAL ALLEGATIONS

3.1. The Policy. At all relevant times, Defendant issued and Plaintiff was the named insured under Policy No. [POLICY NUMBER] (the "Policy"), with effective dates [__/__/____] through [__/__/____]. A true and correct copy of the Policy is attached as Exhibit A and incorporated by reference.

3.2. Premiums. Plaintiff paid all premiums due under the Policy and otherwise complied with all conditions precedent to coverage.

3.3. The Loss. On [__/__/____], Plaintiff suffered a covered loss consisting of [describe loss — e.g., fire, theft, water damage, auto collision, disability, death] at [LOCATION] (the "Loss").

3.4. Notice of Loss. Plaintiff promptly reported the Loss to Defendant on [__/__/____] and was assigned Claim No. [CLAIM NUMBER].

3.5. Cooperation. Plaintiff cooperated fully with Defendant's investigation, including by providing [proof of loss, documents, recorded statements, examinations under oath, inspections, medical records, and other requested information].

3.6. Defendant's Coverage Position. On or about [__/__/____], Defendant [denied coverage / partially denied coverage / unreasonably delayed payment / offered $______ against a documented loss of $______] by letter attached as Exhibit B.

3.7. Stated Grounds for Denial. Defendant's stated grounds for its position were: [summarize denial grounds].

3.8. Lack of Reasonable Justification. Defendant's stated grounds were not predicated upon circumstances that furnish reasonable justification, in that, among other things:

• (a) The Policy language plainly covers the Loss;
• (b) No exclusion cited by Defendant applies on the facts;
• (c) Defendant ignored, misrepresented, or selectively quoted record evidence supplied by Plaintiff;
• (d) Defendant relied on incomplete, biased, or result-oriented investigation;
• (e) Defendant failed to investigate readily available facts that would have confirmed coverage;
• (f) Defendant's interpretation of the Policy is contrary to its plain language and to Ohio rules of insurance-policy construction;
• (g) [other facts demonstrating the absence of reasonable justification].

4. CLAIMS HANDLING TIMELINE

5. COUNT I — BREACH OF INSURANCE CONTRACT

5.1. Plaintiff realleges and incorporates Paragraphs 2.1 through 4 as if fully set forth.

5.2. The Policy is a valid and enforceable written contract of insurance between Plaintiff and Defendant.

5.3. Plaintiff performed all conditions precedent under the Policy, including timely payment of premiums, prompt notice of loss, submission of a sworn proof of loss, cooperation in investigation, and submission to examination under oath where requested.

5.4. The Loss is covered under the Policy's insuring agreement, and no exclusion applies.

5.5. Defendant breached the Policy by [failing to pay / underpaying / unreasonably delaying payment of] benefits owed.

5.6. As a direct and proximate result of Defendant's breach, Plaintiff has sustained damages in an amount exceeding $[________________________________], plus pre-judgment interest under R.C. § 1343.03.

6. COUNT II — COMMON-LAW BAD FAITH (HOSKINS/ZOPPO)

6.1. Plaintiff realleges and incorporates the preceding paragraphs.

6.2. Under Ohio law, an insurer owes its insured a duty of good faith in the handling and payment of claims. Hoskins v. Aetna Life Ins. Co., 6 Ohio St. 3d 272, 452 N.E.2d 1315 (1983). Breach of that duty is an independent tort.

6.3. An insurer breaches the duty of good faith when "its refusal to pay the claim is not predicated upon circumstances that furnish reasonable justification therefor." Zoppo v. Homestead Ins. Co., 71 Ohio St. 3d 552, 644 N.E.2d 397 (1994), syllabus.

6.4. Defendant's refusal to pay the Loss in full was not predicated upon circumstances that furnish reasonable justification, as set forth in Paragraph 3.8 above and as further demonstrated by:

• (a) Defendant's failure to conduct a reasonable investigation;
• (b) Defendant's reliance on a strained or pretextual interpretation of Policy language;
• (c) Defendant's disregard of evidence provided by Plaintiff;
• (d) Defendant's violation of one or more provisions of Ohio Admin. Code 3901-1-54 (or 3901-1-07 for life/health), pleaded here as evidence of unreasonable conduct and not as an independent statutory cause of action;
• (e) Defendant's failure to communicate timely and meaningfully with Plaintiff regarding the status of the claim;
• (f) [other facts].

6.5. As a direct and proximate result of Defendant's bad-faith conduct, Plaintiff has suffered damages distinct from contract damages, including but not limited to consequential economic loss, additional living expenses, lost business income, financing costs, credit injury, attorney's fees, and emotional distress.

7. COUNT III — PUNITIVE DAMAGES AND ATTORNEY'S FEES

7.1. Plaintiff realleges and incorporates the preceding paragraphs.

7.2. Defendant's conduct was undertaken with actual malice, fraud, or insult within the meaning of Hoskins and Zoppo, in that Defendant acted with a conscious disregard for the rights of Plaintiff that had a great probability of causing substantial harm. R.C. § 2315.21(B); Preston v. Murty, 32 Ohio St. 3d 334 (1987).

7.3. Specifically, Defendant [committed institutional bad-faith conduct, including: deliberately constructing a denial pretext; ignoring or burying evidence supporting coverage; pursuing a low-pay strategy with knowledge of policyholder economic vulnerability; engaging in a pattern of similar conduct toward other Ohio insureds; etc.].

7.4. Punitive damages should be awarded to punish and deter such conduct, subject to the cap of R.C. § 2315.21(D)(2) (the lesser of two times compensatory damages, or, if Defendant qualifies, ten percent of net worth up to $350,000).

7.5. Because punitive damages are warranted, Plaintiff is entitled to recover reasonable attorney's fees as compensatory damages. Zoppo, 71 Ohio St. 3d at 558; Digital & Analog Design Corp. v. N. Supply Co., 44 Ohio St. 3d 36 (1989).

8. DAMAGES

8.1. Contract damages. Unpaid Policy benefits in an amount of approximately $[________________________________], plus pre-judgment interest under R.C. § 1343.03.

8.2. Consequential / extra-contractual damages. Including but not limited to: additional living expenses; lost business income and profits; financing and borrowing costs; credit injury; mitigation costs; and emotional distress.

8.3. Punitive damages in an amount permitted by R.C. § 2315.21(D), to be determined by the jury after a bifurcated proceeding under R.C. § 2315.21(B).

8.4. Attorney's fees as recoverable compensatory damages following a punitive award.

8.5. Costs of this action.

9. PRAYER FOR RELIEF

WHEREFORE, Plaintiff respectfully demands judgment against Defendant as follows:

• A. Compensatory damages on Count I (Breach of Contract) in an amount in excess of $[________________________________], plus pre-judgment and post-judgment interest;
• B. Compensatory damages on Count II (Common-Law Bad Faith) in an amount to be proven at trial;
• C. Punitive damages on Count III in an amount permitted by R.C. § 2315.21(D);
• D. Reasonable attorney's fees as compensatory damages under Zoppo;
• E. Costs of this action; and
• F. Such further legal and equitable relief as the Court deems just.

10. DEMAND FOR TRIAL BY JURY

Plaintiff hereby demands a trial by jury on all issues so triable as a matter of right pursuant to Ohio R. Civ. P. 38(B).

11. RESERVATION OF RIGHTS

Plaintiff reserves the right to amend this Complaint to add additional claims, parties, or theories as discovery may reveal, including without limitation claims for breach of fiduciary duty (where applicable), declaratory relief, and additional consequential damages. Ohio R. Civ. P. 15(A).

12. SIGNATURE BLOCK

Date: [__/__/____]

Respectfully submitted,

[LAW FIRM NAME]

By: [________________________________]

[ATTORNEY NAME] (0[####])

Counsel for Plaintiff

[STREET ADDRESS]

[CITY, OH ZIP]

Telephone: [NUMBER]

Email: [EMAIL]

13. VERIFICATION

STATE OF OHIO

COUNTY OF [COUNTY]

I, [PLAINTIFF NAME], being first duly sworn, depose and say that I am the Plaintiff in the foregoing action; that I have read the foregoing Complaint and know the contents thereof; and that the same is true to my own knowledge except as to those matters stated upon information and belief, and as to those I believe them to be true.

[________________________________]

[PLAINTIFF NAME]

Sworn to and subscribed before me this [____] day of [_______________], 20[____].

[________________________________]

Notary Public

(My Commission Expires: [_______________])

14. CERTIFICATE OF SERVICE

I hereby certify that on [__/__/____], the foregoing COMPLAINT was filed electronically with the Clerk of the Court of Common Pleas via the Court's e-filing system, and a true and correct copy will be served on Defendant with the summons issued by the Clerk pursuant to Ohio R. Civ. P. 4 and 4.1.

[________________________________]

[ATTORNEY NAME] (0[####])

15. OHIO PRACTICE NOTES

• Common-law tort, not statute. Ohio bad faith is a judge-made tort (Hoskins, 1983) refined by Zoppo (1994). Do not plead "violation of R.C. § 3901.21" as a stand-alone count — Strack v. Westfield Cos., 33 Ohio App. 3d 336 (9th Dist. 1986), holds there is no private right of action under that statute or its administrative-code rules. Plead statutory and regulatory violations as evidence of the absence of reasonable justification, embedded within the common-law tort count.
• The Zoppo standard is objective. It does not require subjective intent to deny a valid claim; an objectively unreasonable denial is actionable. Subjective bad intent strengthens the case for punitive damages but is not required for tort liability.
• Punitive damages cap. R.C. § 2315.21(D)(2) caps punitives at the lesser of (i) two times compensatory damages or (ii) ten percent of the defendant's net worth up to $350,000. The 10%/$350,000 sub-cap applies only to "small employers" (50 or fewer employees) and individuals; for large insurers the 2x-compensatory ceiling controls. R.C. § 2315.21(D)(2)(b), (D)(6). Always verify defendant size and current statutory text before pleading a specific dollar prayer.
• Bifurcation. R.C. § 2315.21(B) requires bifurcation of compensatory and punitive phases on motion of any party; this is not discretionary. Plan discovery and motions in limine accordingly.
• Standard of proof. Punitive damages require clear-and-convincing evidence of actual malice, fraud, or insult. R.C. § 2315.21(D)(4); Preston v. Murty, 32 Ohio St. 3d 334 (1987).
• Statute of limitations. Bad-faith tort — four years under R.C. § 2305.09(D). Breach of written insurance contract — six years under R.C. § 2305.06 (effective for accruals on or after June 14, 2021; eight-year period applies to earlier accruals). The contract limitations period runs from breach, generally the date of denial.
• Discovery of the claim file. Under Boone v. Vanliner Ins. Co., 91 Ohio St. 3d 209 (2001), claim-file materials created prior to denial are generally discoverable in a bad-faith action notwithstanding attorney-client and work-product objections. After-denial materials may remain privileged. Move early to compel claim-file production.
• Excess-judgment (third-party) bad faith. Ohio also recognizes third-party bad faith arising from an insurer's refusal to settle within limits, exposing the insured to an excess judgment. Hoskins extends to that context. Different damages model — coordinate with the insured's assigned-judgment counsel where applicable.
• DOI complaint as parallel remedy. Plaintiff may file a parallel complaint with the Ohio Department of Insurance, Office of Consumer Services, 50 W. Town Street, Third Floor, Suite 300, Columbus, OH 43215; phone 1-800-686-1526; online portal at https://gateway.insurance.ohio.gov/. The DOI cannot award damages but may impose administrative penalties and produce useful investigative records.
• Notice pleading. Ohio R. Civ. P. 8(A) requires only a "short and plain statement" of the claim, but allege enough facts — particularly facts negating "reasonable justification" — to defeat a 12(B)(6) motion under Iqbal/Twombly-influenced state-court practice.
• Removal risk. If Defendant is non-Ohio and the amount in controversy exceeds $75,000, expect removal to federal court under 28 U.S.C. § 1441. Plead and brief accordingly; consider whether a non-diverse co-defendant (e.g., a resident adjuster) is properly joinable.

16. SOURCES AND REFERENCES

• Ohio Rev. Code § 3901.21 (Unfair and deceptive acts or practices in insurance) — https://codes.ohio.gov/ohio-revised-code/section-3901.21
• Ohio Rev. Code § 2315.21 (Punitive or exemplary damages) — https://codes.ohio.gov/ohio-revised-code/section-2315.21
• Ohio Rev. Code § 2305.06 (Limitation — written contracts) — https://codes.ohio.gov/ohio-revised-code/section-2305.06
• Ohio Rev. Code § 2305.09 (Limitation — certain torts) — https://codes.ohio.gov/ohio-revised-code/section-2305.09
• Ohio Admin. Code 3901-1-54 (Unfair property/casualty claims settlement practices) — https://codes.ohio.gov/ohio-administrative-code/rule-3901-1-54
• Ohio Admin. Code 3901-1-07 (Unfair life and health claims settlement practices) — https://codes.ohio.gov/ohio-administrative-code/rule-3901-1-07
• Hoskins v. Aetna Life Ins. Co., 6 Ohio St. 3d 272 (1983) — https://www.leagle.com/decision/19832786ohiost3d2721216
• Zoppo v. Homestead Ins. Co., 71 Ohio St. 3d 552 (1994)
• Strack v. Westfield Cos., 33 Ohio App. 3d 336 (9th Dist. 1986)
• Boone v. Vanliner Ins. Co., 91 Ohio St. 3d 209 (2001) — https://www.supremecourt.ohio.gov/rod/docs/pdf/0/2001/2001-Ohio-27.pdf
• Preston v. Murty, 32 Ohio St. 3d 334 (1987)
• Ohio Department of Insurance, Office of Consumer Services — https://insurance.ohio.gov/
• Ohio Rules of Civil Procedure — https://www.supremecourt.ohio.gov/LegalResources/Rules/

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