Articles Posted in Insurance Adjusters

Insurance lawyers in the Dallas / Fort Worth area can tell you that when alleging fraud against an insurance company, agent, or adjuster, that the allegations for Federal Court have to be very specific. These specifics are discussed in a recent opinion from the U.S. District Court, Western District of Texas, Austin Division. The style of the case is, Bige, Inc. v. Penn-America Insurance Company; Specialty Insurance Managers, Inc.; Eric Kehs. When the allegations are not properly pleaded in the lawsuit papers, the insurance attorneys will seek the Federal Court to dismiss the lawsuit in what is called a Rule 12(b)(6) motion. In discussing the requirements in Federal Court for allegations of Fraud, the opinion said the following:

When evaluating a motion to dismiss for failure to state a claim under Rule 12(b)(6) the complaint must be liberally construed in favor of the plaintiff and all facts pleaded therein must be taken as true. Although Federal Rule of Civil Procedure 8 mandates only that a pleading contain a “short and plain statement of the claim showing that the pleader is entitled to relief,” this standard demands more than unadorned accusations, “labels and conclusions,” “a formulaic recitation of the elements of a cause of action,” or “naked assertions” devoid of “further factual enhancement.” Rather, a complaint must contain sufficient factual matter, accepted as true, to “state a claim to relief that is plausible on its face.” The Supreme Court has made clear this plausibility standard is not simply a “probability requirement,” but imposes a standard higher than “a sheer possibility that a defendant has acted unlawfully.” The standard is properly guided by “two working principles.” First, although “a court must accept as true all of the allegations contained in a complaint,” that tenet is inapplicable to legal conclusions” and “threadbare recitals of the elements of a cause of action, supported by mere conclusory statements, do not suffice.” Second, “determining whether a complaint states a plausible claim for relief will . . . be a context-specific task that requires the reviewing court to draw on its judicial experience and common sense.” Thus, in considering a motion to dismiss, the court must initially identify pleadings that are no more than legal conclusions not entitled to the assumption of truth, then assume the veracity of well-pleaded factual allegations and determine whether those allegations plausibly give rise to an entitlement to relief. If not, “the complaint has alleged-but it has not ‘shown’-‘that the pleader is entitled to relief.'”

Pleading fraud as a cause of action requires pleading “with particularity” pursuant to Federal Rule of Civil Procedure 9(a). Fifth Circuit precedent interprets Rule 9(b) strictly, requiring the plaintiff to “specify the statements contended to be fraudulent, identify the speaker, state when and where the statements were made, and explain why the statements were fraudulent.”

Haltom City insurance lawyers need to know about a 1986, Texas Supreme Court case. The case is styled, Turbodyne Corporation et al. v. The Honorable Wyatt H. Heard. This case allows a claimant to have access to the file investigating the claim of an insured that is put together by the adjuster and the company.

Turbodyne filed this original mandamus action to order Judge Hyatt Heard of Harris County to rescind his order denying discovery of 39 documents from Travelers Insurance Company. Travelers contends that these documents are privileged under Texas Rules of Civil Procedure 166b. This Court held that the trial court abused its discretion in denying discovery, and conditionally grant the writ.

A fire and explosion occurred at Texas City Refining. Turbodyne was the manufacturer of a part of a catalytic cracking unit involved in that fire. Texas City’s casualty insurer, Travelers, initiated an investigation into the causes and damages of the accident. Approximately nine months after the accident, on July 30, 1980, Travelers and Texas City reached a settlement on the coverage. On October 30, 1981, Travelers and Texas City filed a subrogation suit against Turbodyne and other manufacturers. Turbodyne filed a motion to compel production of 39 documents prepared by employees of Travelers or experts employed by Travelers. Travelers asserts that all documents but one were prepared prior to the date Travelers settled with Texas City, July 30, 1980.

Dallas insurance lawyers have to know how to properly sue an insurance adjuster. This is important in many cases so that a case can be maintained in a State Court rather than being litigated in a Federal Court. A 2015, U.S. District Court case from the Northern District of Texas, Dallas Division, provides guidance for doing this properly. The style of the case is, Linron Properties, Ltd. v. Wausau Underwriters Insurance Company and Sara Springman.

Linron Wausau and adjuster Springman for the improper handling of an insurance claim under a Commercial Property Policy, which Linron purchased from Wausau. After a storm caused damage to the insured property, Linron sought coverage for the cost of repairs under the terms of the Policy and Wausau hired Springman to serve as the adjuster for Plaintiff’s claim. Linron asserts that Springman “conducted an outcome-oriented investigation and also hired experts she knew would under-scope Plaintiff’s damages in order to allow Wausau to avoid payment on the claim.” As a result of Wausau’s and Springman’s actions, Linron claims that it has been wrongfully denied full coverage for the damages sustained to the property.

Linron sued Wausau and Springman in State Court asserting claims for breach of contract and various violations of chapters 541 and 542 of the Texas Insurance Code.

Adjusters in Grand Prairie, Dallas, Irving, Richardson, Garland, Mesquite, Carrollton, Farmers Branch, Duncanville, or anywhere else in Texas, who make a mistake in their job that costs an insurance customer money, can be sued for what he cost the insurance customer. The tricky thing is doing it in the most advantageous manner.

Usually the individual adjuster does not have to be sued. Suing his employer, the insurance company, is often times just as good. But sometimes there is a legal advantage to suing the adjuster and the company. Often times, if just the company is sued, the case can be removed from the State Court in which it was filed, to a Federal Court. There are advantages to the insurance company for doing a removal. That is why they do it.

One way of defeating the attempt at removal is by suing the insurance adjuster and not just the insurance company. However, doing it this way must be done correctly.

When an adjuster in Grand Prairie, Arlington, Fort Worth, Burleson, Crowley, Lake Worth, Grandview, Benbrook, Britton, Joshua, or anywhere else in Texas commits a wrong, can the insurance company be held responsible?

That question was answered in 1936, by the Beaumont Court of Appeals in the case, Love et al. v. Aetna Casualty & Surety Co. et al. Here are some facts in the case.

Tom Love, Victoria Houston, and Cora Davis were a brother and sisters of Orange Love, deceased. They brought this lawsuit to recover damages for the mutilation and unlawful dissection and autopsy performed without there knowledge or consent in and upon the dead body of their brother, Orange Love.