Articles Posted in Claims Denial

Insurance lawyers and lawyers who practice law in Federal Court know the requirements for a case to be in Federal Court.  Most of the time, lawyers representing clients who are suing an insurance company try to stay out of Federal Court.

Pursuant to 28 U.S.C., Section 1332(a), for an insurance company to have a case be tried in Federal Court it must be proven that the parties are citizens of different states and the amount in controversy exceeds $75,000, exclusive of interest and costs.  When a case is removed premised upon diversity jurisdiction, courts determine the amount in controversy in light of “the claims in the state court petition as they existed at the time of removal.”  As a general rule, the amount in controversy alleged in the State Court petition determines the amount in controversy so long as it was pled in good faith.

This issue arose in a case in the Southern District of Texas, Houston Division.  The case is styled, Nicolas Martinez v. Liberty Insurance Corporation.

Insurance property claims are a very big part of claims made against insurance companies.  As part of those property claims that get denied, it is important to properly prove the property damages by attaching a dollar value to them.  One way of proving the dollar value of these property damages is through the use of expert testimony.  Proving property damages by way of expert was a recent topic in a 2019, opinion from the Eastern District of Texas, Sherman Division.  This opinion is styled, Brandy Ventures, LLC v. Mesa Underwriters Specialty Insurance Company.

This case arises from alleged water damage resulting from a broken pipe on commercial property owed by Brandy Ventures and insured by Mesa.  Brandy alleges Mesa unfairly denied the claim and filed this lawsuit.

Brandy appointed Roy Young of YPA Public Adjusters, LLC, to testify regarding water damage.  Mesa filed a motion to strike any testimony of Young.

Here is another case wherein there was a failure to properly stipulate to the amount of damages involved in the case and thus, ended up having to litigate his case in Federal Court, rather than the State Court in which the lawsuit was filed.

The case is from the Southern District of Texas, Houston Division, and is styled, Olga Rodriguez v. State Farm Lloyds.

Olga filed her claim against State Farm in State District Court and State Farm timely removed the case to Federal Court.

As stated before, insurance companies prefer to litigate cases in federal court, whereas, lawyers suing insurance companies prefer to litigate in state court.  The laws are such that the insurance companies get their way most of the time.  However, one of the ways to keep a case in state court involves properly stipulating to the amount of damages at issue in the case.

This issue is discussed in the 2019, Southern District of Texas, Houston Division, opinion styled, Osiel Rubio v. State Farm Lloyds.

Rubio filed suit arising out of an insurance claim against State Farm in state court.  State Farm timely removed the case to federal court.  Rubio filed a Motion to Remand which was denied.

As is acknowledged in the following case, the federal courts are mixed as to their rulings on the timing of when an insurance company adjuster is sued and how that affects diversity cases.

This case is from the Western District of Texas, San Antonio Division.  It is styled, Bexar Diversified MF-1, LLC v. General Star Indemnity Company, Paul R. White And Company Inc.

Bexar had an insurance policy with General Star.  Bexar suffered a weather related loss and reported it to General Star.  General Star assigned White, a company, to adjust the claim.  Bexar was dissatisfied with the way the claim was handled and sued General Star and White in state court for violations of the Texas Insurance Code, Sections 541 and 542.

When insurance lawyers file a lawsuit that ends up in federal court, they have to make sure that the pleadings in the complaint will satisfy federal court pleading guidelines or they will end up being kicked out of court.  This is illustrated in a case from the Southern District of Texas, Houston Division.  It is styled, 9520 Homestead, LLC v. Westchester Surplus Lines Insurance Company.

This lawsuit arises from an allegation by 9520 that Westchester’s adjuster conducted a substandard investigation and inspection of 9520’s property after the property was damaged in a hurricane.  Based on the substandard investigation, the adjuster’s report undervalued the claim and failed to include all of the damages and thus, Westchester violated various sections of the Texas Insurance Code.

Under Rule 8 of the Federal Rules of Civil Procedure, a pleading must contain “a short and plain statement of the claim showing that the pleader is entitled to relief.”  The complaint need not contain detailed factual allegations, but it must include more than an unadorned, the-defendant-unlawfully-harmed-me accusation.

Insurance disputes involving smaller claims can properly be handled in a State or County courts if the insurance lawyer knows how to keep the case from being removed to Federal court.  This is illustrated in the 2019, opinion styled, Michael Ihekoronye v. United Property & Casualty Insurance Company.  Plaintiff, Michael Ihekoronye, filed the case in State court and United removed the case to Federal court.  Plaintiff filed a motion to remand the case back to the State court.

Pursuant to 28 U.S.C., Section 1332(a), Federal district courts have original jurisdiction over civil actions between citizens of different states where the amount in controversy exceeds $75,000, exclusive of interest and costs.  A state-court plaintiff seeking to avoid federal jurisdiction may do so by filing a binding stipulation with the original complaint that limits recovery to an amount below the jurisdictional threshold.

In this case, United argues that removal was proper because the parties are completely diverse and the amount in controversy exceeds $75,000.  Plaintiff seeks remand based on a stipulation attached as Exhibit E to the state court petition, which states that “the total sum or value in controversy in this cause of action does not exceed $75,000 exclusive of interest and costs” and that “neither Plaintiff nor his/her attorney will accept an amount that exceeds $75,000 exclusive of interest and costs.”

Insurance lawyers may not be perfect in all their actions but if a person wishes to sue an insurance company, get an insurance lawyer, don’t do it yourself.  This is illustrated in a recent Fifth Circuit opinion styled, Thomas Petty v. Great West Casualty Company.

This is an appeal resulting from the district court’s dismissal of Petty’s claim with prejudice after Petty, a commercial truck driver sued Great West pro se.

Petty contends he was involved in two accidents involving fatalities and he suffers from ongoing mental trauma that prevents him from being able to operate a commercial truck.  As a result, he seeks monetary relief for lost business earnings and mental distress/anguish.

Here is a situation not discussed before and one that rarely happens.  However, it does discuss law that may be relevant to insurance lawyers in other cases.   The case is from the Southern District of Texas, Houston Division.   It is styled, Randy Randel and Debra Randel v. Travelers Lloyds of Texas Insurance Company.

The Randels experienced a fire loss to their home and made a claim against their homeowners policy with Travelers.  Travelers paid on the claim but the Randels allege they were underpaid.  The Randels sought to have the claim appraised and Travelers refused, stating the case was closed.

The Randels filed a declaratory judgment action against Travelers seeking the Court to Order Travelers to appraise the claim.  Travelers agreed to appraisal and the Randels dismissed their lawsuit with Prejudice to refiling the claim.

Here is a case involving a plumbing leak.  What is a little unusual about this case is the insurance company is attempting to sue Texas Insurance Code, Section 542A.006(c), to have this case heard in Federal Court rather than the State Court in which the case was filed.  The style of the case is James A. Macari, et al. v. Liberty Mutual Insurance Company, et al.  The case is from the Southern District of Texas, Houston Division.

Liberty had issued a homeowners insurance policy to Macari.  Macari experienced a plumbing leak and damage from the leak.  Macari made a claim against the Liberty policy and Liberty assigned adjuster David Meaders to adjust the claim.  The claim was denied and Macari sued Liberty and Meaders.  This lawsuit was filed in State Court and then removed by Liberty to Federal Court.

After the lawsuit was filed, Liberty gave written notice pursuant to Chapter 542A of the Insurance Code assuming any liability Meaders might have to Macari.