Articles Posted in Hail Claims

Here is a 2022, opinion from the Northern District of Texas, Lubbock Division, that deals with recovery of attorney fees under Section 542A of the Texas Insurance Code.  The opinion is styled, Mario Rodriguez v. Safeco Insurance Company of Indiana.

This is a decision based on Safeco’s motion for summary judgment.

At issue is whether payment of an appraisal award, plus payment of estimated interest due under the Prompt Payment Act, entitle an insurer to summary judgment on an insured’s claim
under the Prompt Payment Act.  If so, then the insurer is absolved from paying attorney’s fees
that otherwise would be due under the Prompt Payment Act.  No issue of material fact is present to prevent the entry of summary judgment.  As the Parties have recognized, this is purely a matter of law.  After careful review of the arguments and authority cited by the Parties, the Court finds that Defendant’s position is meritorious.  Although the issue presents policy factors that weigh in favor of each possible outcome, the Court finds that pursuant to 542A.007(a), the legislature’s intent appears clear when enacting Chapter 542A of the Texas Insurance Code to limit attorney’s fees.  It must be presumed that the legislature was aware of the conflict Chapter 542A would have with the Prompt Payment Act and chose to limit attorney’s fees anyway.  It is logical that attorney’s fees are not recoverable when the computation of fees as set forth in Chapter 542A.007(a) lead to zero because the apparent purpose is to curb abusive hailstorm claims.

Hail damage claims have few unique aspects to themselves.  One of those unique aspects is that an insurance company claims the damage to a roof is the result of something other than the recent hail storm a homeowner is claiming, then the homeowner has to properly present the claim to be able to make a recovery.  The most common reason an insurance company denies the claim is that their position that the damage to the roof is the result of wear and tear.

Here is a 2022 opinion from the Northern District of Texas, Dallas Division, that deals with this issue.  The opinion is styled, John Garcia v. State Farm Lloyds.

Garcia had a homeowners policy with State Farm.  After  a hail storm Garcia made a claim for hail damage to his roof.  State Farm sent out an adjuster who asserted the damage was mainly due to wear and tear and that the damage from the hail was minimal to the extent that it did not meet Garcia’s deductible.  Garcia hired an expert that said the damage was in excess of $70,000 and was solely the result of the hail.

Insurance attorneys who get involved in very many lawsuits will have situations where an expert is required.  When that happens, it is vital to understand what the courts will accept and not accept as it relates to experts.  This is discussed in a 2022, opinion from the Northern District of Texas, Dallas Division.  The opinion is styled, Richard Kim D/B/A Centre Cleaners v. Nationwide Mutual Insurance Company.

Plaintiff had an insurance policy with Nationwide that covers hail damage claims.  Plaintiff filed a claim asserting that his roof had been damaged by hail.  Nationwide denied the claim.  Plaintiff had an expert and named his as someone who would testify in the lawsuit and filed the appropriate experts’ report.  Nationwide filed a motion to strike the expert.  The Court granted Nationwide’s motion.

Under Rule 26(a)(2)(B)(i) and (ii), the disclosures of an expert witnesses who is retained or specially employed to provide expert testimony in the case or whose duties as the party’s employee regularly involve giving expert testimony must be accompanied by a written report that contains “a complete statement of all opinions the witness will express and the basis and reasons for them” and “the facts or data considered by the witness in forming them.”  The Advisory Committee’s Note to Rule 26 provides that expert witnesses “must prepare a detailed and complete written report, stating the testimony the witness is expected to present during direct examination, together with the reasons therefor.  These Notes also explain that the purpose of the reports is to avoid the disclosure of ‘sketchy and vague’ expert information, as was the practice under the former rule.  The purpose of a ‘detailed and complete’ expert report as contemplated by Rule 26(a) . . . [is to] prevent an ambush at trial.  The test of a report is whether it was sufficiently complete, detailed and in compliance with the Rules so that surprise is eliminated, unnecessary depositions are avoided, and costs are reduced.

A frequent insurance problem in Texas is damage alleged to have been caused by a hail or wind storm.  This issue is even confusing for the Courts.  Here is a case discussing this issue and in the opinion, the United States Fifth Circuit is asking the Texas Supreme Court on guidance for resolving the Texas “concurrent causation doctrine.”  The style of the case is, Harold Franklin Overstreet v. Allstate Vehicle and Property Insurance Company.

This case is about a leaky roof.  Overstreet says the leak was caused by a strong hailstorm that hit his neighborhood shortly after he purchased the policy.  Allstate argues that almost all the roof damage was due to uncovered causes, namely a combination of wear and tear and earlier hailstorms that hit the roof before Overstreet purchased the policy.  The district court granted summary judgment to Allstate because Overstreet did not prove what damages were solely attributable to the covered storm.

Overstreet bought a home insurance policy from Allstate that covered damage from wind and hail.  Overstreet’s roof was about three years old when he purchased the policy.  On June 6, 2018 a wind and hail storm hit the area where he lived, allegedly damaging his roof.  Overstreet reported a loss to Allstate, whose adjuster estimated the value of the loss at only $1,263.23.  Because this amount was less than the deductible, Allstate paid Overstreet nothing.

To show an insurance company has acted in “bad faith” an insured must first show that the insurance company has breached the insurance contract.  This is discussed in a 2022, opinion from the Western District of Texas, San Antonio Division opinion.  The opinion is styled, Rosemarie Wheeler v. Safeco Insurance Company of Indiana.

Wheeler had her home insured through Safeco.  Wheeler contends her home was damaged in a hail storm that occurred on or about May 28, 2020.  The claim was reported on May 30, 2020, and Safeco scheduled an inspection on June 13, 2020.  The adjuster, Doug Lehr, determined that there was hail damage but that most of the damage was cosmetic.  A small check was issued for the damage determined to be non-cosmetic.

Wheeler hired a public adjuster, Elvis Spoon, who prepared an estimate that totaled $140,617.62.  Spoon disagreed the roof damage was cosmetic but did not provide any additional information to dispute Lehr report.

To show an insurance company has acted in “bad faith” an insured must first show that the insurance company has breached the insurance contract.  This is discussed in a 2022, opinion from the Western District of Texas, San Antonio Division opinion.  The opinion is styled, Rosemarie Wheeler v. Safeco Insurance Company of Indiana.

Wheeler had her home insured through Safeco.  Wheeler contends her home was damaged in a hail storm that occurred on or about May 28, 2020.  The claim was reported on May 30, 2020, and Safeco scheduled an inspection on June 13, 2020.  The adjuster, Doug Lehr, determined that there was hail damage but that most of the damage was cosmetic.  A small check was issued for the damage determined to be non-cosmetic.

Wheeler hired a public adjuster, Elvis Spoon, who prepared an estimate that totaled $140,617.62.  Spoon disagreed the roof damage was cosmetic but did not provide any additional information to dispute Lehr report.

Hail damage claims, like a lots of other types of claims, have their own nuances that an insurance attorney needs to be prepared to address.

Here is a 2022, opinion from the Northern District of Texas, Fort Worth Division, that addresses a hail damage claim and the assertion that that the insurer made, that at least part of the hail damage, while real, occurred at a time when the policy was not in effect.  The style of the case is, Leo Parrish, et al. v. State Auto Insurance Company.

Parish had a policy with State Auto that covered the period November 2, 2019, to November 2, 2020.  The policy has a hail damage deductible of $5,921.  In March 2020, Parrish noticed neighbors receiving new roofs and subsequently had a neighbors roofer inspect his roof.  Parrish was told that his roof was also damaged and then Parrish made a claim against State Auto.

The Amarillo Court of Appeals issued an opinion on February 2, 2022, that is important as it relates to cases involving hail and wind damages to roofs of structures.  This opinion has a bit less to do with insurance and more to do with the roofing contractor business as it is regulated by the Texas Department of Insurance.  The opinion is styled, Stonewater Roofing, Ltd. Co. v. Texas Department of Insurance et al.

Here is some background.

In 2005, the Texas Legislature enacted provisions under the insurance code
regulating “public insurance adjusting.” Public insurance adjusters are frequently hired by an insured to help resolve and settle insurance claims.  The enacted provisions, Texas Insurance Code, Sections 4102.051, provide that a public insurance adjuster must be licensed in order to adjust insurance claims on an insured’s behalf.  Under these provisions, pursuant to Code Section, 4102.163, any person or entity defined as a contractor is prohibited from adjusting insurance claims for properties at which the contractor is, or will be, providing contracting services.  Likewise, licensed public insurance adjusters are prohibited from providing any contracting services on property at which they are, or will be, providing public insurance adjusting services.  In other words, acting as a public insurance adjuster and a contractor on the same claim is a statutorily
defined conflict of interest according to Section 4102.158(a)(1).