The duty to cooperate with the insurance company investigation of a claim is something a lot of people don’t realize. When it is your own insurance company, the insurance contract requires the insured to cooperate with the insurance company investigation of the claim.
This issue was the point of contention in a 2024 opinion from the Southern District of Texas, Houston Division. The opinion is styled, Raymond Funes v. Allstate Vehicle And Property Insurance Company.
In this case, the facts are generally undisputed. Plaintiff filed a claim in or around February 2021 for broken pipes at his property that was insured by Defendant. He withdrew the claim in March 2021, but then retained an attorney and pursued the claim with Defendant in February 2023. Defendant inspected the property and found that the home had been re-piped. It requested the plumbing report and or invoice for the re-piping, but Plaintiff failed to oblige. As such, Defendant denied the request for appraisal for “lack of cooperation by the insured.” Subsequently, Plaintiff brought this suit.
Now, Plaintiff seeks to compel appraisal and abate the suit because “completion of appraisal in accordance with Defendant’s policy is a condition precedent to filing suit on the insurance contact. According to Defendant, however, cooperation with the insurer, too, is a condition precedent. The policy specifically states:
In the event of a loss to any property that may be covered by this policy, you must … d) give us all accounting records, bills, invoices and other vouchers, or certified copies, which we may reasonably request to examine and permit us to make copies …
We have no duty to provide coverage under this section if you, an insured person, or a representative of either fail to comply with items a through g) above, and this failure to comply is prejudicial to us.
Plaintiff has failed to provide the plumbing report or invoices when requested and, as far as the Court is aware, continuing to balk at providing this information.
The Court acknowledges that the plumbing system in question had already been replaced and cutouts were done. That, of course, does not necessarily absolve Plaintiff or Defendant of their policy obligations, even if that means they must compare the plumbing report, photographs, and or invoices to the current state of the pipes. Moreover, Defendant’s contention that the “nature of the repairs makes it impossible to determine what damage was caused by a covered loss versus what was caused by non-covered events such as long-term deterioration of the pipes,” may or may not be meritorious given the law.
The result is that Plaintiff’s motion to compel appraisal is denied until such information is provided.