Hail Claims

Going For Bad Faith

November 1, 2016 | Mark S. Humphreys

Garner insurance lawyers who know insurance law, know that actually prevailing in a bad faith claim is difficult. Getting the insurance company to pay what they should is not hard but getting the extra money for bad faith in Texas is difficult because of the way Texas Courts interpret the law. An Appeals Court in Corpus Christi was making it easier in a 2016 opinion styled, In Re State Farm Lloyds. This is a mandamus opinion dealing with discovery issues.

Angelica Gongora’s home was damaged in hailstorms. She submitted a claim with State Farm. The adjuster, Sylvia Garza, inspected Gongora’s home and asserted that the damage did not exceed the deductible and therefore did not pay the claim. Gongora sued State Farm stating that Garza failed to include all of the damages in her estimate and that Garza grossly undervalued the damages and failed to include adequate funds in the estimate to cover the costs of repairs.

Gongora subsequently invoked the appraisal clause in her homeowner’s policy and the appraisal came back at more than ten times the amount Garza had estimated. State Farm paid the appraisal amount. In the lawsuit Gongora propounded discovery to State Farm seeking production of:

Insurance Claims And Statute Of Limitiations

October 27, 2016 | Mark S. Humphreys

The Statute of Limitations for insurance claims will vary with the facts of the case. In general this limitation begins to run once a claim is denied. A Southern District , Galveston Division case arose in 2016, that is a good read. The case is styled, Linda Grayson v. Lexington Insurance Company.

The case was a summary judgment decided in favor of Lexington.

On September 22, 2009, Grayson’s home was damaged by fire resulting from a lightning strike. The house was insured for $370,000.00. As Lexington began to adjust the claim, Grayson expressed concern about the potential for lingering smoke odor. Lexington determined the damage could be repaired and all smoke odor could be eliminated by a process of “encapsulation.” Grayson decided to insist that the entire house be demolished and rebuilt.

Suing The Agent When A Claim Is Denied

October 15, 2016 | Mark S. Humphreys

Insurance lawyers in the Dallas and Fort Worth area know that insurance companies prefer to litigate cases in Federal Court while the opposite is true for lawyers representing an insured. A recent Northern District, Dallas Division case deals with suing the agent in Federal Court. The case is styled, B&B Car Wash and Mini Storage v. State Automotive Mutual Insurance Company, Jennifer Caldwell, and Danny Duncan d/b/a Duncan Insurance Agency.

This is a case about State Auto allegedly denying coverage for B&B’s wind and hail damaged storage facility. B&B owns a car wash, five storage buildings, and an RV shed. B&B purchased a State Auto policy from agents Jennifer Caldwell and Danny Duncan. The parties dispute the extent of coverage provided by that policy. B&B says it covers the entire complex and the defendants disagree.

After B&B filed its complaint, State Auto removed the case to Federal Court, arguing that, because B&B is a Texas citizen and State Auto is an Ohio citizen, complete diversity exists, and thus, federal jurisdiction. The next day, B&B amended its complaint to add Caldwell and Duncan as additional defendants, based on the fact that they sold the policy in question. Thus, because Caldwell and Duncan are both Texas residents, B&B filed a motion to remand the case to State Court since diversity jurisdiction no longer existed.

False Statements By Insurance Company

October 9, 2016 | Mark S. Humphreys

A Houston Division opinion discusses how to properly plead a lawsuit when an insurance company makes false statements. The opinion is styled, Mt. Olive Missionary Baptist Church v. Underwriters at Lloyds.

Mt. Olive alleges a storm caused damage to the Church including damage to the roof, HVAC, windows, exterior, interior, ceilings, furnishings, and more. After the storm a claim was filed under its insurance policy. A third party adjuster, Herring, was assigned to investigate and adjust the claim. Mt. Olive alleges that Herring failed to perform a thorough investigation of the claim, failed to prepare any estimates reflecting wind damage, and misrepresented that there was no damage to the Church. The claim was denied.

Mt. Olive sued in state court and the case was removed to federal court.

Specific Acts Of Adjuster Have To Be Detailed

September 22, 2016 | Mark S. Humphreys

When an insurance attorney is representing someone suing an adjuster, there have to be specific acts alleged against the adjuster and those acts have to be detailed. This is illustrated in a Southern District, Houston Division opinion. The opinion is styled, Gregory Young v. Travelers Personal Security Insurance Company and Robert Finley.

This a hail / storm damage claim wherein Young was insured by Travelers and the adjuster assigned to the claim was Finley.

The case was filed in State Court but Travelers had the case removed to Federal Court alleging that Finley was improperly joined in the case in order to defeat diversity jurisdiction. Travelers claims that the allegations against Finley do not meet pleadings standards and thus Finley should be dismissed and the Federal Court has jurisdiction over the case.

Suing Adjusters In Hail Claims

September 20, 2016 | Mark S. Humphreys

Insurance lawyers in Irving who sue for hail claims need to know the best ways to stay out of Federal Court, unless of course that is where they want to be.

This is illustrated in a Sherman Division case styled, Lillian Elizondo v. Metropolitan Lloyds Insurance Company of Texas, Tailored Adjustment Services, Inc. and Brad Conrad.

This is a dispute that arises out of a claim for hail and wind storm damages sustained by Plaintiff, Elizondo. The insurer is Metropolitan. The adjuster is Conrad who worked for Tailored.

Appealing Appraisal Awards

September 11, 2016 | Mark S. Humphreys

Palo Pinto County insurance lawyers know that it is very difficult to appeal appraisal findings. A hail damage case from the Sherman Division, Eastern District illustrates this. The opinion is styled, Ronald Studer v. State Farm Lloyds.

The issue before the Court was whether the appraisal award should be set aside due to mistake. Plaintiff’s home was damaged due to hail stones during a storm. Plaintiff filed a claim for damage to his roof, gutters, siding, windows, skylight, and glass solarium with State Farm. State Farm hired Rimkus Engineering to inspect the solarium and give a cause of loss. This report is contained in the courts’ opinion.

A lawsuit filed by Studer resulted and State Farm invoked the appraisal provision in the insurance contract. An appraisal was conducted that was adverse to Studer and he filed a motion to set aside the appraisal and State Farm filed a motion for summary judgment based on the appraisal.

Hail Claims And Staying Out Of Federal Court

August 23, 2016 | Mark S. Humphreys

Lawyers who handle hail claims know the insurance companies prefer to fight lawsuits in Federal Court. Hail claims lawyers know one way of defeating the insurance company desire to be in Federal Court is by suing the adjuster. The Sherman Division, Eastern District issued an opinion illustrating how to Not file a lawsuit against an adjuster. The style of the opinion is Walters v. Metro. Lloyds Ins. Co.

The Walters residence sustained hail damage. The insurance company, Metropolitan, assigned Buchanan to adjust the claim. The claim was denied and Walters sued Metropolitan and Buchanan in State Court and the case was then moved to Federal Court by Metropolitan and Buchanan.

The only question at this point in the case is whether or not Buchanan was improperly joined as a defendant to defeat diversity jurisdiction.

Motion To Remand – Water Damage

August 21, 2016 | Mark S. Humphreys

Insurance lawyers would prefer to fight their cases in State Court rather than Federal Court. The opposite is true for insurance companies. Unfortunately, the insurance companies win most these battles for which court the case should be contested. A U.S. District Court, Galveston Division opinion illustrates some of the arguments. The case is styled, Lopez v. United Prop. & Cas. Ins. Co.

Lopez sued United in State Court alleging his home sustained water damage and that United failed to fully cover the damages. Suit was filed for violations of the Sections 541 and 542 of the Texas Insurance Code.

In order to defeat diversity jurisdiction, Lopez sued the adjuster, Bibiana Aguilar, assigned to handle the claim also.

You’ve Got To Sue The Adjuster Properly

August 18, 2016 | Mark S. Humphreys

For Mansfield insurance adjusters, a 2016 opinion from the U.S. District Court, Houston Division, is an example of one way to properly sue an adjuster. The style of the case is, Robinson v. Allstate Tex. Lloyds & Timothy James Wesneski.

Robinson, a Texas citizen is insured with Allstate. She alleges she filed a claim with Allstate after her house was damaged during a storm on November 25, 2015. She alleges Wesneski, a Texas citizen and the adjuster Allstate hired to investigate the claim, conducted a substandard investigation. She alleges that Wesneski’s inadequate investigation caused her claim to be improperly evaluated and underpaid. Wesneski found that the amount of damage to Robinson’s property at $484.93, below the amount of the policy deductible. Robinson hired a private adjuster, who estimated the damage caused by the storm to be $25,818.77.

Robinson filed this lawsuit in Texas state court, naming Allstate and Wesneski as defendants. Robinson asserted that Wesneski violated the Texas Insurance Code and the Texas DTPA. She alleges Wesneski failed to conduct a reasonable and adequate investigation, which caused Allstate to undervalue her insurance claim. Allstate caused the case to be removed to Federal Court based on Allstate not being a Texas citizen and that Wesneski was joined just to defeat diversity jurisdiction and Robinson filed a Motion to Remand.