Articles Posted in Insurance Adjusters

The United States District Court, Northern District, Dallas Division, issued an opinion in April 2018, titled, Grand Hotel Hospitality LLC d/b/a Grand Hotel Dallas v. Certain Underwriters at Lloyd’s of London et al.

This is a breach of contract case where Grand Hotel suffered a fire damage and sued Lloyd’s and the adjuster assigned to handle the claim.  There were allegations for violation of the Texas Insurance Code, Section 541.060, made against the adjuster, Brandon Weir.

The lawsuit was filed in State Court and the Defendants caused the case to be removed to Federal Court alleging the joinder of Weir was fraudulent in order to beat diversity jurisdiction under 28 U.S.C. Section 1332.

Most Dallas insurance lawyers in Dallas and Fort Worth know the ways agents and adjusters can liable for their actions in selling a policy or handling a claim.

Just as an insurance company is liable for its own misconduct, so too agents may be personally liable for their misdeeds, even when acting on an insurer’s behalf.  In general, an agent is individually liable for his or her own tort or statutory violation .  This has been made clear in numerous Texas cases including the Texas Supreme Court in its 1985 opinion, Weitzel v. Barnes.

Ordinarily, an agent is not liable for breach of contract based on the insurance policy, because the contract of insurance is not between the insured and the agent.

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.

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.

Insurance adjusters who are inexperienced and do not know what they are doing can hurt insureds who just want their claim paid.  Reuters ran a story on September 11, 2017, dealing with the shortage of trained and experienced insurance adjusters after Hurricanes Harvey and Irma.  The story is titled “Insurers Ache For Qualified Inspectors After U.S. Hurricanes”.

Insurance companies were scrambling to find adjusters in Texas and Florida after hurricanes Harvey and Irma hit within two weeks of each other, causing tens of billions of dollars’ worth of property damage.

Although insurance companies maintain a number of adjusters across the U.S. year round, there is a need to redeploy staff from other areas or hire contract adjusters to fill gaps when catastrophes like Harvey and Irma hit.  It is important that these adjusters get deployed quickly because payments on claims is critical to residents and business owners awaiting these insurance payments.

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.

A successful pleading against an insurance adjuster was found in a Western District, Austin Division opinion issue in May 2017.  The opinion is styled, Affordable Portable Structures, Inc. and JFJ Group, Inc. v. The Cincinnati Insurance Company and Alfred Gray.

Affordable was insured by Cincinnati when a storm caused damage to property owned by Affordable.  Cincinnati hired Alfred Gray to adjust the claim, who hired Rimkus Consulting Group, to prepare a report.  According to Affordable, Rimkus is known to provide results oriented reports that are favorable to insurance companies and minimize damage estimates.

Affordable hired a consultant who estimated Affordable’s damages at $698,111.69.  Gray turned in an estimate for $25,935.38 — less than 3.5% of the figure that Affordable’s consultant estimated.  Affordable alleged that Gray is an inexperienced adjuster and, as such, knew or should have known that the Rimkus report vastly underestimated the amount of damage caused to the property.  Accordingly, Gray’s decision to conduct no further investigation was unreasonable and did not constitute a good faith attempt to effectuate a prompt, fair, and equitable settlement.

Claims against insurance adjusters need to be specific.  This is exemplified in a case from the Southern District of Texas, McAllen Division.  The opinion is styled, Jorge Vallejo v. Allstate Vehicle and Property Insurance Company, et al.

Vallejo filed suit in State Court suing Allstate and the adjusters, asserting claims for violations of the Texas Insurance Code.  Vallejo alleges Allstate assigned dates of loss of February 6, 2016 and May 31, 2016 to the claims.  Jeff Doll was assigned to the February claim and Doll sent a letter to Vallejo on June 17, 2016 but did not schedule an inspection until July 11.  As of July 28, 2016, the claim was still not processed.

Vallejo also alleges Ronald Sledge erroneously estimated the value of the claim and that his estimate failed to fully quantify Vallejo’s damages, thus demonstrating that Sledge did not conduct a thorough investigation of the claim.

Tarrant County insurance attorneys will learn real fast that when asserting a claim against an insurance adjuster, the claim needs to be pled with specificity.  This is illustrated in a recent case from the Southern District, McAllen Division.  The opinion is styled, Ada Elizondo v. Great Lakes Insurance SE. et al.

This is an insurance case for damages to Ada’s property allegedly caused by a storm.  Dissatisfied with the adjustment and payment of her insurance claim, Ada filed suit against Great Lakes and their adjuster Jose Lopez.  The case was filed in state court and promptly removed to federal court based on diversity jurisdiction.  Lopez then filed a motion to dismiss and Ada filed a motion to remand.  Both motions concern whether Lopez is a proper party to this suit.

Under Federal Rule 15(a), Ada needs the consent of Lopez to amend her pleading and that is not given.  Thus, she must seek approval from the Court.  However, she did not attach a proposed amendment to her motion to amend.  The purpose of the amendment appears to be to defeat diversity jurisdiction and for that reason the Court will not allow amendment.

Most Llano insurance lawyers would prefer to stay out of Federal Court because Federal Courts tend to be more favorable to insurance companies.  Suing the insurance company adjuster is one way to stay out of Federal Court.   A Western District, Waco Division opinion shows one way to NOT sue the adjuster.  The opinion is styled, Spring Street Apts Waco, LLC v. Philadelphia Indemnity Insurance Company and Crawford & Company.

Spring Street suffered hail and wind damage.  Their insurance coverage was with Philadelphia, who hired Crawford to investigate the claim.

Spring Street filed suit in State Court for DTPA violations and Insurance Code violations and Philadelphia promptly had the case removed to Federal Court based on lack of diversity jurisdiction under 28 U.S.C. 1332, claiming that Crawford was improperly joined in the lawsuit.  Crawford filed a Rule 12(h)(2) motion to dismiss for failure to state a claim upon which relief can be granted.