Claims Denial

Insurance Company Denies Claim And Wins At Trial – Recourse?

December 13, 2021 | Mark S. Humphreys

The vast majority of insurance claims that get denied are settled. Less than 2% of these cases actually result in trial. When there is a trial, the odds are typically with the insurance company prevailing. That is what happened in this 2021, verdict in a case from the Southern District of Texas, Houston Division. The case is styled, Shane and Shannon Richardson v. Liberty Insurance Co.

The Richardson’s claimed damage to their roof and part of the interior of their home from a storm. Liberty inspected the damage and denied the claim based on their assertion that the covered damages were less than the deductible.

The case was tried to a jury and the jury found in favor of Liberty on the breach of contract damages but found that Liberty engaged in “false, misleading and deceptive acts or practices in the business of insurance in this case” and “misrepresented to the Richardsons the scope or cause of the damage from wind or hail,” in violation of the Texas Insurance Code, Section 541.001 et seq. The jury awarded no damages for any claim, but, based on finding that Liberty’s violation of the Insurance Code was “knowing,” the jury awarded the Richardson’s $7,082.54 in “additional” damages.

Suing Wrong Insurance Company – Removal

December 11, 2021 | Mark S. Humphreys

Here is an insurance law situation not seen very often. This is a 2021, opinion from the Western District of Texas, San Antonio Division. It is styled, Amali Obaya v. Allstate Vehicle & Property Insurance Company.

Obaya owned property in San Antonio that was insured by a policy of insurance, when the property was damaged in a wind/hailstorm. A claim was submitted. Obaya asserts that her claim was unreasonably investigated, improperly adjusted, and that the Defendant wrongfully denied the claim. Obaya sued Allstate Vehicle and Property Insurance Company for violations of the Texas Insurance Code, DTPA, breach of contract, and other causes of action. The lawsuit was filed in State Court. No claims were asserted against Allstate Texas Lloyd’s in State Court, nor did Allstate Texas Lloyd’s utilize procedural means to become an actual party to the lawsuit.

Allstate Texas Lloyd’s removed the case to this Federal Court. Plaintiff timely moved to remand, arguing that Allstate Texas Lloyd’s was not an actual party to the state court action and thus lacked the power to remove the case to federal court.

Insurance Denial Based On Segregating Damages

December 4, 2021 | Mark S. Humphreys

Here, an insurance company refused to pay a claim based on their assertion that the insured customer failed to segregate damages. The Judge agreed with the insurance company. The opinion is from the Northern District of Texas, Dallas Division. It is styled, Svetlin Tchakarov and Popova Rossitza v. Allstate Indemnity Company.

The plaintiffs filed suit to recover damages from Allstate for wind and hair damage to the roof of their property. Allstate moved for summary judgment based on Allstate’s assertion that Plaintiff’s have not provided evidence that would allow a jury to reasonably apportion the harm from the covered and non-covered causes of loss.

The relevant portion of the policy reads:

Claims That The Adjuster Did His Job Wrong

November 29, 2021 | Mark S. Humphreys

Claims against adjusters for violations of the Texas Insurance Code must be very specific. This is illustrated in a 2021, opinion from the Eastern District of Texas. The opinion is styled, Fred Vernon, II v. Palomar Specialty Insurance Company, Wellington Claim Services, Inc., One Call Claims, David Cardenas, and Tanya Spalding.

This case was filed in State Court and Palomar caused the case to be removed to Federal Court asserting that the adjusting companies were improperly joined in an effort to defeat diversity jurisdiction. Vernon filed a motion to remand which is the subject of this opinion.

Pursuant to 28 U.S.C., Section 1332, in removed cases where, as here, there is no suggestion that a federal question is involved, subject matter jurisdiction exists only if there is complete diversity among the parties and the amount in controversy exceeds $75,000.00.

Insurance Claims And Limitations

November 27, 2021 | Mark S. Humphreys

Here is an insurance policy case from the Tyler Court of Appeals issued in October 2021. The opinion is styled Irajabedinia v. Lighthouse Property Insurance Company.

This is a homeowners claim for coverage after Hurricane Harvey. The damage occurred on August 28, 2017. The claim was timely filed and Lighthouse paid in a letter dated October 13, 2017. Plaintiff believed the claim was underpaid but did not do anything else until January 28, 2019, when a letter was sent to Lighthouse pursuing the claim further. On March 14, 2019, Lighthouse responded saying the claim had already been paid and the file was closed. Later, on October 1, 2019, Plaintiff’s attorney sent a more formal demand for coverage.

On December 3, 2019, Plaintiff demanded an umpire be appointed which was done on December 9, 2019. Lighthouse refused to participate, stating that limitations had passed on October 14, 2019. Plaintiff filed suit on December 30, 2019.

Fort Worth Insurance Denial Case

November 6, 2021 | Mark S. Humphreys

Here is a case that originated in a Fort Worth State District Court that insurance attorneys need to read. The opinion is from the Northern District of Texas, Fort Worth Division. It is styled, Yolonda Carney v. Allstate Vehicle And Property Insurance Company et al.

The facts of the case are undisputed. This is claim by a homeowner, Yolonda, against her insurance company, Allstate, for hail damage. Yolonda sued Allstate and the adjuster, after Allstate failed to respond to respond to a demand letter. Yolonda filed a lawsuit against both of them in the Fort Worth State Court. Allstate removed the case to this Federal Court and simultaneously elected to assume the adjuster’s liability in connection with insurance code claims against him. Allstate contends that the adjuster is improperly joined due to Allstate accepting liability for the adjuster.

Title 28 U.S.C. Section 1441(a) permits the removal of “any civil action brought in a state court of which the district courts of the United States have original jurisdiction.”

Insurance Claims Denial – Federal Court

November 1, 2021 | Mark S. Humphreys

Insurance lawyers learn real quick the difference between a case being litigated in Federal Court versus State Court. This is illustrated in a 2021 opinion from the Western District of Texas, San Antonio Division. It is styled, Craig Janssen v. Allstate Vehicle & Property Insurance Company.

This is a claim for damages to Janssen’s property caused by a hailstorm. Janssen asserts that he suffered damages, that Allstate is his insurer, and that after filing a claim, Allstate failed to properly inspect, investigate, and assess damages and wrongfully denied and underpaid the covered damages. Janssen filed a lawsuit in State Court for various violations, including damages under the Texas Insurance Code, Section 541.060 and Section 542. Allstate had the lawsuit removed to Federal Court.

Federal Rule of Civil Procedure 8, requires that a Defendant be given fair notice of the claim and the grounds upon which the plaintiff relies. To satisfy this pleading requirement, at a minimum, a plaintiff must provide a short and plain statement of each cause of action asserted to show entitlement to relief under Rule 8(a)(2). This pleading standard does not require detailed factual allegations but does demand more than conclusory allegations of wrongdoing.

Insurance Lawsuits – What Can You Learn?

October 16, 2021 | Mark S. Humphreys

Insurance lawyers can listen to a client’s perspective on what happened in a claim but often times will not understand the extent of wrong doings by an insurer until a lawsuit has been filed and the discovery process completed. In this regard, exactly what is discoverable in a lawsuit?

The areas and information that can be discovered in a lawsuit will vary with each situation. The Beaumont Court of Appeals issued an opinion in 2021, that touches on this issue of “what is discoverable.” The opinion is styled, In Re Liberty Insurance Corporation.

In the lawsuit, the insureds, Michael and John Young, sued their insurer, Liberty Insurance Corporation, for various violations of the Texas Insurance Code arising out of a pipe burst that caused damage to their home.

Insurance Trial Lawyer

October 11, 2021 | Mark S. Humphreys

Insurance lawyers can read this opinion to find out, exactly what Not to do in a trial. This 2021, opinion is from the San Antonio Court of Appeals. The opinion is styled, Sarah Friend Neutze v. Texas Farmers Insurance Company and James ‘Doug’ Wasson, II.

What this case teaches is what Not to do. That is, do not waive the right you to have a record made of the proceeding.

Neutze sued Farmers on a homeowners claim concerning tornado damage to to her property. Farmers is alleged to have delayed in making payments and refused to make some payments. Neutze eventually sued alleging breach of contract, violations of the Texas Insurance Code and violations of the Texas Deceptive Trade Practices Act.

Claims Denial And Suing The Insurance Adjuster

September 6, 2021 | Mark S. Humphreys

Claims denial attorneys usually see situations where a claim is denied and it was the adjuster who acted improperly in his handling of the claim.

Allegations that the adjuster acted improperly were alleged in this 2021, opinion from the Northern District of Texas, Dallas Division. The opinion is styled, Beverly Oderbert v. State Farm Lloyds and Richard Kundee.

Oderbert had a plumbing issue wherein she made a claim against her home insurer, State Farm. State Farm assigned as the adjuster, Kundee.