Articles Posted in Claims Denial

Claims denial attorneys usually see situations where a claim is denied and it was the adjuster who acted improperly in his handling of the claim.

Allegations that the adjuster acted improperly were alleged in this 2021, opinion from the Northern District of Texas, Dallas Division.  The opinion is styled, Beverly Oderbert v. State Farm Lloyds and Richard Kundee.

Oderbert had a plumbing issue wherein she made a claim against her home insurer, State Farm.  State Farm assigned as the adjuster, Kundee.

Here is another case illustrating that when suing an insurance company adjuster that it is vital to properly plead the case against the adjuster.  This 2021, opinion is styled, Detavia Wilson v. State Farm Mutual Automobile Insurance Company, Robert Nash, and Yulonda Jones.  The opinion is from the Northern District of Texas, Dallas Division.

Wilson was injured in a hit-and-run vehicle collision.  Wilson recovered from the third-party tortfeasor and sought under-insured motorist coverage from State Farm.

Wilson sent documents to State Farm to evaluate the claim.  The adjusters, Nash and Jones, sent requests for more records to Wilson.  After this request, Wilson sued State Farm, Jones, and Nash for violations of the Texas Insurance Code in State Court.

Insurance lawyers time and time again have a difficult time properly suing insurance adjusters when their case is in Federal Court.  This is illustrated in a June 16, 2021, opinion from the Northern District of Texas, Dallas Division.  The opinion is styled, Thomas Paredes and Kerry Paredes v. The Cincinnati Insurance Company and John Schuster.

The Paredes had their property insured through Cincinnati.  They incurred a hail storm loss properly reported it.  Cincinnati assigned adjuster, Schuster to the claim.  The Paredes were dissatisfied with the way the claim was handled and filed the present suit.  The lawsuit was timely removed to Federal Court on the basis that Schuster (the Adjuster) was improperly joined and that without the Adjuster, diversity jurisdiction existed.  The Paredes filed a motion to remand which is the subject of this opinion.

Cincinnati says the Adjuster was improperly joined in the lawsuit because the Paredes have not stated a cause of action against him.

Here is an unusual situation from the Northern District of Texas, Dallas Division.  The opinion is styled, Barry Green, Individually and as Attorney in Fact for Billie Green and Billie Green, Individually v. Allstate Texas Lloyds, Inc.

If the unusual aspect of this case is not pointed out in the beginning, some will miss it.  The Plaintiffs sued Allstate Texas Lloyds, Inc., rather than the insurance company Allstate Texas Lloyds.

The Plaintiffs had homeowners insurance coverage and sued Allstate Inc. in State Court.  Allstate Inc. then removed the case to Federal Court citing that the wrong entity had been sued and that Allstate Inc. was a Texas Company but Allstate Lloyds was not a Texas company and thus, the correct party, Allstate Lloyds created diversity jurisdiction, making removal proper.

The Northern District of Texas, Fort Worth Division, decided a case in 2021 wherein the lawyer for insured did a good job of pleading his case.  The strange thing about this case is that it was filed in 2021, well after the new section of the Insurance Code was in effect, that being section 542A.  In section 542A, suing the adjuster has essentially been made something of the past, with rare exceptions.  However, it is not the issue in this case but the case still serves as a good example on how to name the insurance adjuster in such a way as to keep the case in State Court rather than being removed to Federal Court.

The style of the case is, Paradise Villas HOA, Inc. v. Amguard Insurance Company and Todd Anthony Gilmore.  Paradise is the insured, Amguard is the insurer, and Gilmore is the adjuster.

Paradise suffered alleged hail damage and properly reported the claim to Amguard.  Gilmore, a Texas Citizen, was assigned to adjust the claim and according to Paradise, Gilmore greatly under estimated the value of the claim.  A lawsuit was filed in State Court and Amguard caused the case to be removed to Federal Court alleging that Gilmore was improperly named in an effort to defeat diversity jurisdiction and asserting that the causes of action asserted against Gilmore could not stand.  Paradise filed a motion to remand which is the cause of this opinion.

Here is a 2021, case from Southern District of Texas, McAllen Division, that discusses how courts are to review motions for summary judgment.  The opinion is styled, Saul Cantu v. United Property And Casualty Insurance Company.

The dispute revolves around a homeowners claim where Cantu suffered alleged damage to his property and then made a claim against his insurance company, United Property.  United Property subsequently denied the claim and eventually filed a motion for summary judgment.

Reading the opinion will set up the facts of this case, however, the focus here is the analysis by the court in this summary judgment opinion.

Insurance lawyers keeping up with the relatively new Insurance Code Section, 542A.006 election need to read this well reasoned case from the Northern District of Texas, Fort Worth Division.  The opinion is styled, Leonard D. Morgan, et al. v. Chubb Lloyds Insurance Company of Texas.

In this a homeowner’s claim for damage due to a storm.  Plaintiff’s sued their insurance company, Chubb, and the adjuster handling the claim.  The lawsuit was filed in State Court wherein a claim was made against the insurer and the adjuster.  At the time the lawsuit was filed in State Court, Chubb had not exercised the 542A.006 election, to take responsibility for it’s adjuster.

After the lawsuit was filed, Chubb moved to accept responsibility for the adjuster and have the adjuster dismissed from the lawsuit.  The State Court allowed the election and once this was complete, Chubb removed the case to Federal Court and this motion to remand was filed by Plaintiffs.

Fortunately, most insurance claims do not require expert testimony to prove a claim.  However, in those situations where an expert is required, a 2021 opinion from the Southern District of Texas, Houston Division, is a good case for guidance on experts.  The opinion is styled, Roy P. Labourdette Jr. v. State Farm Lloyds.

In this case, State Farm insured Roy’s home.  Roy had made a claim for hail storm damage to State Farm and State Farm denied the claim and asserted the damage to Roy’s roof was the result of wear, tear, and deterioration, rather than a covered cause of loss.  Roy filed a lawsuit in State Court and State Farm had the case removed to Federal Court.

Roy had hired an expert roofer to testify about the roof damage.  State Farm in response filed papers with the Court to have the testimony of the expert excluded.  After considering the motion and response from Roy, this Court denied State Farms motion.  The Court then explained it’s ruling.

Insurance Lawsuits, like many other claims, result in other persons or entity’s being added to the lawsuit.  The relevance here is that often times an adjuster or the agent who sold the policy may need to be part of the lawsuit.

A 2021, opinion from the Northern District of Texas, Dallas Division, analysis how this is done.  The opinion is styled, Nova Casualty Company v. Jose E. Guzman and Rito Sosa.

For the facts that occurred in this case, the opinion should be read.  Here is the legal aspect of the case.

Life insurance lawyers deal with many situations and reasons that life insurance companies use for denying a claim for benefits.  A twist to not paying is where the insurance company does not technically deny the claim, rather the company rescinds the policy.

As a general legal principle, prior to a loss an insurance company has the right to rescind the policy procured through mutual mistake or fraud.  This was stated in a 1931, Amarillo Court of Appeals opinion styled, Forrester v. Southland Life Insurance Company.

The benchmark case on this issue was issued by the Texas Supreme Court in 1980, in an opinion styled, Mayes v. Massachusetts Mutual Life Insurance Co.  In Mayes, the court stated that an insurance company may rescind a policy based on the insured’s misrepresentation, if the insurer pleads and proves the following elements:

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