Hail Claims

Proper Claims Against The Adjuster

December 16, 2017 | Mark S. Humphreys

Too many times, the claims against an adjuster fail when those claims are removed to Federal Court. There was a successful claim recently in the Southern District, Houston Division. It is styled, Lillie Jean Hooper v. Allstate Texas Lloyd’s, et al.

Hooper suffered storm damage and submitted a claim to Allstate for severe damage to her roof and home, and water damage.

The adjusters assigned to the claim were Katherine Hernandez and Joe Bobbitt. They conducted a assessment and later a second assessment of the claims submitted by Hooper. Hooper alleges the adjusters intended to deny her claim and fabricated explanations of the visible damage that attributed them to causes not covered by the policy. Hooper own evaluator estimated the damage at $26,459.86.

Proof Of Loss Requirement

December 12, 2017 | Mark S. Humphreys

Probably all homeowner policies require a “Proof Of Loss” (POL) be filed before a lawsuit be filed against the insurance company. This issue is addressed in the Northern District, Dallas Division opinion, Gwendolyn Pamphile v. Allstate Texas Lloyds.

Before the Court was a motion to dismiss filed by Allstate. This arose out of an insurance dispute wherein Pamphile suffered hail damage during a storm and made a claim to Allstate for benefits. Allstate assigned an adjuster who evaluated the claim and Allstate made payment based on the adjusters evaluation. Unsatisfied with the payment Pamphile submitted a POL form with her own repair estimate and one day later, filed suit against Allstate. Allstate removed the case to federal court and filed their motion to dismiss.

Federal courts can adjudicate claims only when subject matter jurisdiction is expressly conferred and must otherwise dismiss for lack of subject matter jurisdiction.

Fort Worth Claims

November 14, 2017 | Mark S. Humphreys

Fort Worth lawyers who end up in Federal Court need to read this opinion from the Northern District, Fort Worth Division, Judge McBride. The opinion is styled, Antonio Perez v. Allstate Vehicle and Property Insurance Company, et al.

Perez initiated this action by filing a lawsuit in State District Court. Allstate removed the action to Federal Court, alleging diversity of citizenship and the required amount in controversy. This Court Ordered Perez to replead so that his pleadings complied Federal Court pleading standards found in Rule 8(a) and 9(b) of the Federal Rules of Civil Procedure, and directed Perez to file an amended complaint that complied with those requirements.

Perez filed his amended complaint. Despite the warning provided in the order for repleading, Perez’s complaint as amended was, with few exceptions, basically a repeat of his state court pleadings, alleging, in a conclusory way, violations of sections of the Texas Insurance Code, fraud, and conspiracy to commit fraud, breach of contract, and breach of the duty of good faith and fair dealing.

Getting The Insurance Adjuster Sued Is Important

November 5, 2017 | Mark S. Humphreys

Getting the insurance adjuster served with legal papers in a lawsuit is important and for some reason, overlooked. This is illustrated in an Eastern District, Sherman Division case styled, Robert Crawford v. Allied Property and Casualty Insurance Company, Laura Jones.

Crawford, a citizen of Texas, sued Allied, an Iowa Company and Jones, who is a Texas resident in State District Court. The suit arises out of the Defendant’s alleged improper handling of an insurance claim. Crawford suffered extensive damage to his property during a storm. Allied was Crawford’s insurer. Jones was hired by Allied to inspect and adjust Crawford’s loss. Thereafter, it is alleged that Jones conducted a substandard investigation and inspection of the property, prepared a report that failed to include all of the damages that she noted during the inspection, and undervalued the damages she observed during the inspection, all of which resulted in Allied denying Crawford adequate coverage under the policy. Crawford sued for breach of contract and sued Allied and Jones for violations of the Texas Insurance Code.

Allied and Jones removed the case to Federal Court based on diversity jurisdiction, alleging that Jones was improperly joined to defeat diversity jurisdiction.

Lawsuits In Federal Court – It Has To Be Right

November 2, 2017 | Mark S. Humphreys

Insurance attorneys with much experience learn real quick that the insurance companies prefer to litigate cases in Federal Court. The reason is that Federal Court is much less forgiving of mistakes and the Federal Courts look for reasons to dispose of a case. This authors opinion is that many of the Federal Courts put a priority on technical rules rather than substance. This authors opinion is bolstered by the fact that an insurance company will always attempt to get a lawsuit against them in State Court, removed to Federal Court.

This is illustrated in a 2017, opinion from the Southern District of Texas, McAllen Division. The case is styled, Maria Abdon v. State Farm Lloyds.

In this case, the court is considering State Farm’s motion for partial dismissal on the pleadings, as well as Abdon’s response and alternative motion for leave to amend. The Court granted State Farm’s motion for partial dismissal and denied Abdon’s motion for leave to amend.

Jurisdiction And Insurance Cases

August 27, 2017 | Mark S. Humphreys

This is a case from the Northern District, Dallas Division, dealing with which court is proper to litigate the case. The case is styled, Hutchins Warehouse Limited Partners v. American Automobile Insurance Company et al.

A court may sua sponte raise the issue of its jurisdiction at any time during the course of litigation.

28 U.S.C. Section 1441(a) permits the removal of any civil action brought in a state court of which the Federal Courts have original jurisdiction. However, the removal statue must be strictly construed because removal jurisdiction raises significant federalism concerns. Therefore, any doubts concerning removal must be resolved against removal and in favor of remanding the case back to state court.

Suing The Engineer / Adjuster

August 24, 2017 | Mark S. Humphreys

A case from the Southern District, Laredo Division has an interesting twist for insurance lawyers to know about. The case is styled, Luis Gonzalez v. State Auto Property & Casualty Insurance Company, et al.

A hailstorm caused damage to the roof on Luis home and he submitted a claim to State Auto. State Auto hired Haag Engineering, one of the defendants in this case, to help inspect the roof damage. Haag prepared an engineering report that State Auto relied upon when it adjusted and allegedly undervalued Luis roof damage.

Luis filed suit in State Court. The defendants removed the case to Federal Court alleging that Haag was improperly joined for the purpose of defeating diversity jurisdiction under 28 U.S.C. Section 1441.

Hail Damage Lawsuit And Abatement

August 13, 2017 | Mark S. Humphreys

The Northern District of Texas, Dallas Division issued an opinion dealing with hail damage and abatement of the case to compel appraisal. This is becoming more and more common in hail damage claims. The case is Nabors v. American Reliable Insurance Company, et al.

This claim arises out of water and hail damage to Nabors home. The insurance company is American. It is a declaratory judgment action regarding the scope of the policy’s coverage as well as damages for breach of contract and violations of the Texas Insurance Code against American. American filed a motion to abate the proceeding and compel appraisal.

In this case, there was also a dispute over whether or not the adjuster assigned to the claim by American was properly joined as a defendant in this lawsuit or whether the joinder was merely an effort to defeat diversity jurisdiction in order to have the case remanded to State Court. As in other cases in this blog, the examination by the Court was in favor of American.

Prompt Payment And Appraisal

August 3, 2017 | Mark S. Humphreys

What is the result oi an insurance company pays a claim after an appraisal even if you don’t agree with the appraisal? This issue is addressed in a Houston Court of Appeals [14th Dist.] opinion. It is styled, National Security Fire & Casualty Co. v. Hurst.

This is an appeal from a jury trial in favor of Hurst against National. This appeals court reversed the jury trial results.

Dissatisfied with the initial estimate and payment, Hurst sued National and others for claims arising out of a wind and hail storm damage to his home. This lawsuit also claimed violations of the Texas Prompt Payment of Claims Act. National hired adjusters who assessed the damage and paid Hurst $3,524.56 (accounting for the $1,000 policy deductible), which Hurst accepted. Hurst proceeded to file suit on September 7, 2010.

Segregation Of Damages – Property Damage Claims

July 20, 2017 | Mark S. Humphreys

Lawyers who handle property damage claims learn real fast that the damages that exist on the property have to be properly segregated when making an insurance claim. What does this mean? The most common situation that arises is after a hail and wind storm. An insured discovers damage to his home and makes a claim. Nest, the insurance company says that all the damage is not covered. A law suit results.

The law is clear that an insured has the burden of proving what damages occurred, when they occurred, and how they occurred. Often times there is damage from a hail storm but some of the damage may have occurred in at a different time and in a different storm. When this happens, it it he responsibility of the insured, not the insurance company to explain and prove when and how the damage occurred.

This is discussed in a 2006, Northern District of Texas case, styled, Atwill v. State Farm Lloyds.