Articles Posted in Claims Denial

For lawyers who handle claims against insurance companies, here is a case regarding a claim against a homeowners policy and a water leak.  The case is from the Western District of Texas, San Antonio Division.  The case is styled, William Burman v. State Farm Lloyds.  It is a partial summary judgment case.

Burman had a homeowners policy of insurance with State Farm.  Burman experienced a water leak and filed a claim.  State Farm retained an engineer, Lara, to determine whether the leak caused the foundation to move.  Lara’s report stated “that the observed foundation movements are primarily the result of seasonal moisture changes, and vegetation effects.  Also, that a line identified by American Leak Detection was leaking and exacerbated the foundation movements in an isolated area of the residence.

The area effected by the leak was paid for by State Farm but the claim for other areas was denied asserting the foundation problems predated the leak and the leak damage did not warrant underpinning.

Most insurance lawyers understand the distinction between “personal jurisdiction” and “subject matter jurisdiction”.  A recent case from the Northern District of Texas, Dallas Division, explained the difference.  The case is styled, Yakimas Payne, Carmenisha Payne, and Mar’Keyona Ford v. Government Employees Insurance Company.

The Plaintiffs sued GEICO in State Court for uninsured motorist benefits.  GEICO removed the case to Federal Court and the Plaintiffs filed a motion to remand, arguing that diversity jurisdiction existed but that GEICO had “continuous and systematic contacts with the state of Texas sufficient to establish general jurisdiction.

GEICO argued that Plaintiffs have confused personal jurisdiction with diversity jurisdiction.  The Court set forth standards for the two types of jurisdiction.

Insurance attorney need to stay current on the ways the Judges interpret the law and how that law is applied to the facts in a case.

When dealing with insurance contracts and the “covered and non-covered cause of loss” issue, this 2019, Northern District of Texas, Dallas Division opinion is worth reading.  It is styled, 2223 Lombardy Warehouse, LLC, et al. v. Mount Vernon Fire Insurance Company.

The policy language at issue in this case read:

Insurance attorneys get another favorable ruling in a case.  The case is from the Western District of Texas, Austin Division.  It is styled, River of Life Assembly of God v. Church Mutual Insurance Company and Jim Turner Harris.

River of Life suffered storm related damage and made a claim against Church.  Church assigned adjuster Harris to the claim.  When the claim was denied, River of Life sued Church and Harris.

Church elected to take responsibility for Harris arguing that Harris was improperly joined and removed the case to Federal Court citing Texas Insurance Code, Section 542A.006(c) which allowed them to do so since having only Church as a defendant, diversity jurisdiction would not be defeated.

Insurance lawyers need to read this recent opinion from the Southern District of Texas, McAllen Division.  It is styled, Federico Flores Cazares, et al v. Allstate Vehicle And Property Insurance Company.

This case / claim arises out of a claim for property damage made by plaintiffs against Allstate.  Allstate sent an adjuster who concluded the property damage was not storm related which would be covered by the policy, rather the damage was wear/tear, and deterioration that occurred over a period of time and not covered by the policy.

Plaintiff’s filed suit in State Court and Allstate had the case removed to Federal Court.

The Penn Record published an article on March 18, 2019, discussing changes in insurance law in Texas.  The article is titled “Texas Lawmakers Say The ALI’s Insurance Law Project Not Worthy Of Recognition By The Courts“.

Legislation has recently been filed by Texas legislators to discourage Texas courts from relying on the controversial passage of the American Law Institute’s Restatement of the Law of Liability Insurance.

Philadelphia based, ALI has a history of publishing Restatements with the goal of providing summaries to judges who deal with these types of legal issues.  People question whether the group has started proposing new laws rather than restating existing ones.  As a result the Texas legislature has filed three measures this year in response.

When a claim is denied and the insured has to file a lawsuit against the insurance company, most insurance lawyers prefer to litigate cases in the State or County courts while insurance companies prefer to litigate the cases in Federal Court.

When the insurance company is sued in State Court, the attorney for the insured will also sue the adjuster in an effort to beat the required “diversity jurisdiction” of the Federal Court which is found at 28 U.S.C., Section 1332(a).

This issue was the topic in the 2019, Western District of Texas, Austin Division, opinion styled, Susan Swire and Philip Swire v. Alyssa Kempf f/k/a Alyssa Hodge and Geico County Mutual Insurance Company.  The case was filed in State Court and then removed to Federal Court based on diversity jurisdiction.  The Swire’s argued that Kempf is in fact a Texas citizen and therefore, removal is improper.

Insurance companies prefer to litigate cases in Federal Court.  Insurance lawyers representing insureds prefer to litigate their cases in State Court.  In the appropriate situation, here is a way to stay in State Court.

This is from the Southern District of Texas, Houston Division, and the case is styled, WEN WIRELESS, INC. d/b/a Cell Spot, Kick Back Wireless v. Amguard Insurance Company.

Wen sued Amguard in County Court and Amguard timely removed the case to Federal Court based on diversity jurisdiction.  Wen filed a Motion for Remand under 28 U.S.C., Section 1441(a) asserting that the Court did not have federal jurisdiction.

The Southern District of Texas, Houston Division issued an opinion in an unusual case in February 2019.  The case is styled, Patricio Delgado v. Allstate Texas Lloyds.

The case had been removed to federal court based on diversity jurisdiction.  Four parties sued Allstate on four properties in four states.  Allstate asked that the improperly joined parties by dismissed and the case severed into four separate lawsuits.  The Judge has found that the four claims are “factually unrelated” and severed the claims.  The Judge ordered that each plaintiff file an amended compliant related solely to his or her claims.  The Judge also ordered that each of the cases be remanded.

Allstate argues that the remand is improper because of the amount in controversy exceeding $75,000, because the amount originally sought by Delgado and the others exceeded $200,000.

Most insurance attorneys try to stay out of federal court.  Here, a pro se plaintiff filed his case in federal court.  The case is from the Eastern District of Texas, Sherman Division.  It is styled, Marlon Green v. Covenant Transportation Group, Inc., et al.  The case was dismissed because Green failed to properly plead his case.

Green does not enumerate any specific cause of action or claims, but rather broadly states that “administrative abuses are covered by The Civil Rights Act, and American with Disability Act Rights.”  In the most recent amended complaint, Green alleges that the Court has subject matter jurisdiction over this matter pursuant to 28 U.S.C. Section 1332, but avers the claim is less than $75,000.  Green also states “federal law violations include.”  The Court finds, upon review, that Green’s claims should be dismissed for lack of subject matter jurisdiction, and for failing to provide addresses for the preparation of service of process on Defendants, as ordered by the Court.

Federal courts are courts of limited jurisdiction and must have statutory or constitutional power to adjudicate a claim.  Federal courts have subject matter jurisdiction and are authorized to entertain a cause of action only where a question of federal law is involved or where there is diversity of citizenship between the parties and the amount in controversy exceeds $75,000.