Clarifying Claims Against Adjusters

Claims against insurance adjusters need to be specific.  This is exemplified in a case from the Southern District of Texas, McAllen Division.  The opinion is styled, Jorge Vallejo v. Allstate Vehicle and Property Insurance Company, et al.

Vallejo filed suit in State Court suing Allstate and the adjusters, asserting claims for violations of the Texas Insurance Code.  Vallejo alleges Allstate assigned dates of loss of February 6, 2016 and May 31, 2016 to the claims.  Jeff Doll was assigned to the February claim and Doll sent a letter to Vallejo on June 17, 2016 but did not schedule an inspection until July 11.  As of July 28, 2016, the claim was still not processed.

Vallejo also alleges Ronald Sledge erroneously estimated the value of the claim and that his estimate failed to fully quantify Vallejo’s damages, thus demonstrating that Sledge did not conduct a thorough investigation of the claim.

Allstate removed the case to Federal Court asserting that the joinder of Doll and Sledge was solely to defeat diversity jurisdiction and that the claims against them cannot withstand scrutiny.

The Court did an analysis to determine whether or not a claim has been properly asserted against Doll and Sledge and began by noting that both were sued under Sections 541 and 542 of the Insurance Code and that a cause of action under 542 only applies to insurance companies, not adjusters.

As to Section 541, Vallejo alleges Doll and Sledge violated 541.060(a)(1) by “misrepresenting to Plaintiff material facts relating to coverage at issue.”  This is a mere tracking of the statutory language and is insufficient to survive the Rule 12(b)(6) legal standard.  The Court found that the misrepresentation claims fail to provide enough facts and is conclusory.

Vallejo’s causes of action pursuant to sections 541.060(a)(2), (a)(3), and (a)(4) likewise fail to survive the Rule 12(b)(6) legal standard because these sections only apply to insurance companies, not adjusters.  However, even if this Court determined that these sections do apply to adjusters, Vallejo’s allegations nevertheless fail to state a claim.  Vallejo’s only support for his Section 541.060(a)(2) allegation is that “Defendants failed to make an attempt to settle Plaintiff’s claim in a fair manner, although Defendants were aware of their liability to Plaintiff under the Policy.”  Not only does Vallejo fail to differentiate between Allstate and the in-state Defendants, but he also offers no facts to bolster his claim that the in-state Defendants were aware of liability to Vallejo or that they are even potentially responsible parties under Section 541.060(a)(2).

The Court similarly disposed of the claims under Sections (a)(3) and (a)(4).

Vallejo’s final Section 542 cause of action is for an alleged violation of 541.060(a)(7).  Specifically, Vallejo claims that Doll and Sledge violated the Insurance Code by “refusing to pay Plaintiff’s claim without conducting a reasonable investigation.”  The complaint is void of any factual enhancement to support the claim.

Accordingly, the case remained in Federal Court and Doll and Sledge were dismissed from the lawsuit.