Asserting A Claim Against The Adjster

Asserting a claim against an insurance adjuster must be done properly if the goal is to keep the adjuster in the case.

Often times suing the insurance company for the acts of the adjuster is good enough to properly maintain a lawsuit.  Other times the adjuster needs to be brought into the lawsuit.  This is particularly important when the insured wishes to maintain the case in State Court rather than litigating the case in Federal Court.

One example of properly suing the adjuster was discussed in the 2020 opinion, Hill Country Villas Townhome Owners’ Association, Inc. v. Everest Indemnity Insurance Company, et al.  This opinion is from the Western District of Texas, San Antonio Division.

This is a property damage claim made by Hill Country against their insurer, Everest.  The lawsuit was filed in State Court.  Everest had the case removed to Federal Court based on their assertion that Everest is a diverse party and that the adjuster who was also sued, is a non-diverse party who was only sued in an effort to defeat diversity jurisdiction under 28 U.S.C., Section 1441(a).

Everest asserts that Hill Country in unable to establish a cause of action against the non-diverse party, the adjuster.

It is clear that Texas law permits actions against adjusters and are subject to liability under Chapter 541 of the Texas Insurance Code.

Hill Country asserts claims against the adjuster for unfair settlement practices under Section 541.060.

This Court finds that Hill country’s allegations under Section 541.060(a)(2) are acceptable using a Rule 12(b)(6) type of analysis.

Hill Country alleges the adjuster did not conduct his own independent investigation of the insurance claim, but instead inspected the property with a biased engineer so as to justify the initial denial of coverage.  It further alleges the adjuster participated in a telephone call in which he and the engineer agreed to have a follow-up conversation; the adjuster stated that those three would discuss an estimate; and Everest would then respond within two weeks, but forty-nine days later the two adjusters declined coverage in a three-page letter that rubber stamped prior findings.

Hill Country also alleges specific claims against the adjuster, i.e., Hill Country has alleged that the adjuster inspected the property; ignored covered damage and refused to address all damages caused by the loss; used a biased engineer instead of conducting an independent investigation; withheld a supplemental report without approval from the insurance company; made a statement during the above-mentioned telephone call that led Hill Country to believe the adjusterss were attempting to amicably resolve the insurance claim by providing an estimate of damages; delayed a declination letter; and failed to request information, adequately investigate the claim, respond to requests for information, and timely and properly estimate the claim and report to and make recommendations to Everest.

The Court found these allegations to be sufficient and granted the remand.