Articles Posted in Claims Denial

Claims against adjusters for violations of the Texas Insurance Code must be very specific.  This is illustrated in a 2021, opinion from the Eastern District of Texas.  The opinion is styled, Fred Vernon, II v. Palomar Specialty Insurance Company, Wellington Claim Services, Inc., One Call Claims, David Cardenas, and Tanya Spalding.

This case was filed in State Court and Palomar caused the case to be removed to Federal Court asserting that the adjusting companies were improperly joined in an effort to defeat diversity jurisdiction.  Vernon filed a motion to remand which is the subject of this opinion.

Pursuant to 28 U.S.C., Section 1332, in removed cases where, as here, there is no suggestion that a federal question is involved, subject matter jurisdiction exists only if there is complete diversity among the parties and the amount in controversy exceeds $75,000.00.

Here is an insurance policy case from the Tyler Court of Appeals issued in October 2021.  The opinion is styled Irajabedinia v. Lighthouse Property Insurance Company.
This is a homeowners claim for coverage after Hurricane Harvey.  The damage occurred on August 28, 2017.  The claim was timely filed and Lighthouse paid in a letter dated October 13, 2017.  Plaintiff believed the claim was underpaid but did not do anything else until January 28, 2019, when a letter was sent to Lighthouse pursuing the claim further.  On March 14, 2019, Lighthouse responded saying the claim had already been paid and the file was closed.  Later, on October 1, 2019, Plaintiff’s attorney sent a more formal demand for coverage.
On December 3, 2019, Plaintiff demanded an umpire be appointed which was done on December 9, 2019.  Lighthouse refused to participate, stating that limitations had passed on October 14, 2019.  Plaintiff filed suit on December 30, 2019.

Here is a case that originated in a Fort Worth State District Court that insurance attorneys need to read.  The opinion is from the Northern District of Texas, Fort Worth Division.  It is styled, Yolonda Carney v. Allstate Vehicle And Property Insurance Company et al.

The facts of the case are undisputed.  This is claim by a homeowner, Yolonda, against her insurance company, Allstate, for hail damage.  Yolonda sued Allstate and the adjuster, after Allstate failed to respond to respond to a demand letter.  Yolonda filed a lawsuit against both of them in the Fort Worth State Court.  Allstate removed the case to this Federal Court and simultaneously elected to assume the adjuster’s liability in connection with insurance code claims against him.  Allstate contends that the adjuster is improperly joined due to Allstate accepting liability for the adjuster.

Title 28 U.S.C. Section 1441(a) permits the removal of “any civil action brought in a state court of which the district courts of the United States have original jurisdiction.”

Insurance lawyers learn real quick the difference between a case being litigated in Federal Court versus State Court.  This is illustrated in a 2021 opinion from the Western District of Texas, San Antonio Division.  It is styled, Craig Janssen v. Allstate Vehicle & Property Insurance Company.

This is a claim for damages to Janssen’s property caused by a hailstorm.  Janssen asserts that he suffered damages, that Allstate is his insurer, and that after filing a claim, Allstate failed to properly inspect, investigate, and assess damages and wrongfully denied and underpaid the covered damages.  Janssen filed a lawsuit in State Court for various violations, including damages under the Texas Insurance Code, Section 541.060 and Section 542.  Allstate had the lawsuit removed to Federal Court.

Federal Rule of Civil Procedure 8, requires that a Defendant be given fair notice of the claim and the grounds upon which the plaintiff relies.  To satisfy this pleading requirement, at a minimum, a plaintiff must provide a short and plain statement of each cause of action asserted to show entitlement to relief under Rule 8(a)(2). This pleading standard does not require detailed factual allegations but does demand more than conclusory allegations of wrongdoing.

Insurance lawyers can listen to a client’s perspective on what happened in a claim but often times will not understand the extent of wrong doings by an insurer until a lawsuit has been filed and the discovery process completed.  In this regard, exactly what is discoverable in a lawsuit?

The areas and information that can be discovered in a lawsuit will vary with each situation.  The Beaumont Court of Appeals issued an opinion in 2021, that touches on this issue of “what is discoverable.”  The opinion is styled, In Re Liberty Insurance Corporation.

In the lawsuit, the insureds, Michael and John Young, sued their insurer, Liberty Insurance Corporation, for various violations of the Texas Insurance Code arising out of a pipe burst that caused damage to their home.

Insurance lawyers can read this opinion to find out, exactly what Not to do in a trial.  This 2021, opinion is from the San Antonio Court of Appeals.  The opinion is styled, Sarah Friend Neutze v. Texas Farmers Insurance Company and James ‘Doug’ Wasson, II.

What this case teaches is what Not to do.  That is, do not waive the right you to have a record made of the proceeding.

Neutze sued Farmers on a homeowners claim concerning tornado damage to to her property.  Farmers is alleged to have delayed in making payments and refused to make some payments.  Neutze eventually sued alleging breach of contract, violations of the Texas Insurance Code and violations of the Texas Deceptive Trade Practices Act.

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.

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