Articles Posted in Claims Denial

Here is an unusual situation from the Northern District of Texas, Dallas Division.  The opinion is styled, Barry Green, Individually and as Attorney in Fact for Billie Green and Billie Green, Individually v. Allstate Texas Lloyds, Inc.

If the unusual aspect of this case is not pointed out in the beginning, some will miss it.  The Plaintiffs sued Allstate Texas Lloyds, Inc., rather than the insurance company Allstate Texas Lloyds.

The Plaintiffs had homeowners insurance coverage and sued Allstate Inc. in State Court.  Allstate Inc. then removed the case to Federal Court citing that the wrong entity had been sued and that Allstate Inc. was a Texas Company but Allstate Lloyds was not a Texas company and thus, the correct party, Allstate Lloyds created diversity jurisdiction, making removal proper.

Here is a 2021, case from Southern District of Texas, McAllen Division, that discusses how courts are to review motions for summary judgment.  The opinion is styled, Saul Cantu v. United Property And Casualty Insurance Company.

The dispute revolves around a homeowners claim where Cantu suffered alleged damage to his property and then made a claim against his insurance company, United Property.  United Property subsequently denied the claim and eventually filed a motion for summary judgment.

Reading the opinion will set up the facts of this case, however, the focus here is the analysis by the court in this summary judgment opinion.

Fortunately, most insurance claims do not require expert testimony to prove a claim.  However, in those situations where an expert is required, a 2021 opinion from the Southern District of Texas, Houston Division, is a good case for guidance on experts.  The opinion is styled, Roy P. Labourdette Jr. v. State Farm Lloyds.

In this case, State Farm insured Roy’s home.  Roy had made a claim for hail storm damage to State Farm and State Farm denied the claim and asserted the damage to Roy’s roof was the result of wear, tear, and deterioration, rather than a covered cause of loss.  Roy filed a lawsuit in State Court and State Farm had the case removed to Federal Court.

Roy had hired an expert roofer to testify about the roof damage.  State Farm in response filed papers with the Court to have the testimony of the expert excluded.  After considering the motion and response from Roy, this Court denied State Farms motion.  The Court then explained it’s ruling.

Insurance Lawsuits, like many other claims, result in other persons or entity’s being added to the lawsuit.  The relevance here is that often times an adjuster or the agent who sold the policy may need to be part of the lawsuit.

A 2021, opinion from the Northern District of Texas, Dallas Division, analysis how this is done.  The opinion is styled, Nova Casualty Company v. Jose E. Guzman and Rito Sosa.

For the facts that occurred in this case, the opinion should be read.  Here is the legal aspect of the case.

Here is another lawsuit litigated under Texas Insurance Code, Section 542A.006.  The opinion is from the Western District of Texas, San Antonio Division, and is styled, Farzin Tabib and Shahla Afshar v. Metropolitan Lloyds Insurance Company Of Texas and John Crouch.

The Court is asked to consider two motion.  A Motion to Dismiss with Prejudice Pursuant to Texas Insurance Code, Section 542A.006, filed by Lloyds and Plaintiffs Motion to Remand.  This Court denied the Motion to Remand and dismisses Crouch without prejudice, and finds the motion to dismiss moot.

As long as a nondiverse party, Crouch, remains joined, the only issue the court may consider is that of jurisdiction itself.  Federal courts always have jurisdiction to determine their own jurisdiction.  This limited authority permits the court to grant a motion to remand if a nondiverse party is properly joined, while also permitting the court to deny such a motion if a party is improperly joined and, in so doing, to dismiss the party that has been improperly joined.

Insurance attorneys understand that when a claim gets denied that the majority of the time, the insured will either walk away or will hire an attorney to fight the claim denial.  When the claim is denied and an attorney is hired, the case is going to end up a lawsuit.  One weapon used by insurance companies in litigation is to litigate the case up to a point and then file a motion for summary judgement.

Understanding how the courts view motions for summary judgment is vital to being able to prepare for and handle these situations.  The motion for summary judgment standard is briefly discussed in a case from the Northern District of Texas, Wichita Falls Division.  The case is styled, Great Lakes Insurance SE v. Horton Family Trust, LLC.

The facts of this case can be read in the opinion.  The focus here is the way the courts look at motions for summary judgment.

Denied insurance claims can vary greatly in value.  Factors that figure into the value of the claim include, 1) the base amount of the claim, 2) exemplary damages, 3) Prompt Payment of Claims damages, and 4) attorney fees.

The goal of insurance companies is to litigate cases in Federal Court, while attorneys representing insured would rather litigate case in the State or County Courts.

There are two main issues the Courts look to for deciding whether a case which is removed to a Federal Court by an insurance company gets to be litigated in Federal Court or whether the case gets remanded to the State or County Court.