Reasons For An Insurance Lawyer

Dallas / Fort Worth insurance lawyers need to know how to properly plead a lawsuit and here is a case worth reading.
The case is styled Radenbaugh v. State Farm Lloyds. It is a 2013, opinion from the U.S. District Court, Northern District, Fort Worth Division.
The case tells us Radenbaugh initiated this action in State District Court by the filing of a complaint asserting five causes of action against State Farm–breach of contract, violations of the Texas Insurance Code, breach of duty of good faith and fair dealing, bad faith, and violations of the Texas Deceptive Trade Practices-Consumer Protection Act (“DTPA”). State Farm removed the case to this Federal Court. The Federal Court ordered that the pleading be amended to comply with Rule 8 of the Federal Court of Civil Procedure and Rule 9, if applicable.
Radenbaugh filed an amended complaint and the court pointed out that the amended complaint still did not comply with the Rules and State Farm filed its motion to dismiss for failure to state a claim upon which relief may be granted.
Citing case law, the court pointed out to survive a motion to dismiss for failure to state a claim, the facts pleaded must allow the court to infer that the plaintiff’s right to relief is plausible. To allege a plausible right to relief, the facts pleaded must suggest liability; allegations that are merely consistent with unlawful conduct are insufficient. “Determining whether a complaint states a plausible claim for relief … is a context-specific task that requires the reviewing court to draw on its judicial experience and common sense.”
Harbaugh’s breach of contract claim is his First Cause of Action, read as follows:
24. The Plaintiff PHILLIP N. RADENBAUGH and the Defendant STATE FARM LLOYDS entered into an insurance contract for the property in question.
25. The Defendant breached the insurance contract.
26. The breach by the Defendants [sic] has caused substantial harm to the Plaintiff.
Standing alone, the breach of contract allegations obviously do not satisfy the Rule 8 pleading standards. There simply is no factual specificity, such as specificity as to the kind of insurance contract at issue, the pertinent provisions of the contract at issue, the conduct on the part of State Farm that constituted a breach of a contractual provision, or any specific harm suffered by Radenbaugh from such a breach. The court then turned to the “Factual Background” section of the amended pleading (set forth here) …
7. More specifically, on or about April 18, 2011 PHILLIP N. RADENBAUGH’S house located at 1003 Red Bud Point, Graford, Texas 76449 (The Property) received extensive smoke and ash damage from the Bastrop Wildfires.
8. The Plaintiff filed an insurance claim with the Defendant for the extensive damage caused by the fires.
9. The Defendant assigned the Plaintiff Claim No.: 43- 059X-942.
10. On or around December 5, 2011, Defendant composed a letter and estimate to RADENBAUGH for the cleaning of The Property in the amount of $15,199.09.
11. Defendant’s letter to Plaintiff regarding the estimate and payment only spoke to the reasons for receiving the amount for cleaning, not at how Defendant came to the conclusion that no other repairs were necessary to The Property.
12. On or around January 17, 2012, Defendant received a letter by fax from RADENBAUGH’S representative (Insurancebusters.net) stating the remaining issues needing to be addressed in regards to The Property.
13. The letter contained all remaining issues with The Property, as well as, what would be needed to alleviate them and place Plaintiff back into pre-loss condition.
14. The letter received by Defendant also had a study by the I.I.C.R.C. (Institute of Inspection, Cleaning and Restoration Certification) attached.
15. The Letter put forth the suggested standard of safe removal of the soot as well as the standard to safely remove the odor as well.
16. Defendant received an Exactimate® estimate from Plaintiff’s representative (Insurancebusters.net) showing that the cost of repairs for The Property were $142,609.24 after Defendant had tendered an estimate of only $15,199.09 for merely cleaning services.
17.Uponinformationandbelief,discoveryisexpected to reveal that the Defendant paid multiple claims for damages and not merely cleaning services to other insured within The Property’s immediate proximity.
18. Defendants [sic] received an attachment produced by the I.I.C.R.C. regarding the dangers and effects of prolonging the exposure to the smoke and soot, yet did not take the necessary steps to have the problems remedied.
19. Defendants received an Exactimate® estimate from Plaintiff’s representative (Insurancebusters.net) showing that the cost of properly repairing The Property to a safe inhabitable dwelling was $142,609.24 after Defendant had tendered an estimate of only $15,199.09 for merely cleaning services.
20. The Defendant has completely failed to fairly, adequately and promptly adjust the Plaintiff’s claim.
21. Defendant has failed to properly handle the claim in accordance with the laws enumerated in the Texas Insurance Code as well as the customary standards utilized in the insurance industry.
22. The Defendant’s complete failure to properly handle the claim has caused the Plaintiff to suffer serious damages.
to determine whether the missing breach of contract factual allegations can be found there and discussed at length what the court believed to be inadequate there, pointing out as follows:
Radenbaugh never alleges that defendant issued an insurance policy to him, much less that he had any particular kind of insurance coverage under any policy issued by defendant. Paragraph 17 of the Factual Background suggests that perhaps Radenbaugh’s real complaint is that he has learned that other persons received payments of some kind from State Farm that Radenbaugh did not receive and that Radenbaugh, therefore, thinks he should receive payments that State Farm is not willing to make to him. There is no allegation of the existence of any insurance policy contract between Radenbaugh and State Farm that provides that Radenbaugh has the contractual right to whatever he says he should receive from State Farm.
No plausible cause of action for breach of contract can be stated unless there is an allegation as to the exact nature of the contract, including a statement as to State Farm’s obligations under the contract, how State Farm failed to comply with its contractual obligations, and how that damaged Radenbaugh. Radenbaugh’s pleading fails to include a statement of any of those facts.
The opinion goes on to undermine almost all of the pleading set out by Radenbaugh in his amended pleading. The ultimate decision rendered by this court was the dismissal of the lawsuit.
A reading of this opinion is a must for insurance attorneys as a guide for what should and should not be included in these types of claims.