Articles Posted in Insurance Adjusters

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.

For insurance attorneys handling hail damage claims, the Northern District, Dallas Division, issued an opinion worth reading.  The opinion is styled, Ronald E. Cohen, et al v. Seneca Insurance Co., Inc., J.S. Held, Inc., Haag Engineering Co., and R. Kean Jenner.

This is a case of an insurance claim denial after a wind and hail storm in Dallas County.  The adjuster, Jenner, was the only non-diverse defendant.  The lawsuit for denial of policy benefits was filed in Dallas County Court and removed to Federal Court by the other defendants claiming that Jenner was improperly joined in an effort to defeat diversity jurisdiction.  Cohen filed a Motion to Remand based on his assertion that Jenner was not improperly joined.

The sole issue in this case is whether the joinder of Jenner was proper under Texas law.  If the court finds a reasonable basis to predict that Plaintiffs can potentially recover on one of the causes of action asserted against Jenner, the court must remand the entire case.

A 2017, opinion from the Northern District, Dallas Division, is an example of how not to sue an adjuster to keep a case out of Federal Court.  The opinion is styled, Hutchins Warehouse Limited Partners, v. American Automobile Insurance Company, et al.

Hutchins sued American and their adjuster in State Court after their claim for benefits was not properly paid.  The allegations against the adjuster, McMillan, were that he made numerous errors in his estimate, which resulted in American underpaying and partially denying Hutchins’s claims.

28 U.S.C., 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.  The statute allows a defendant to remove a state court action to federal court only if the action could have originally been filed in federal court.

Any insurance lawyer who has filed very many lawsuits knows that one key to helping their client have a good result is to be able to keep their case out of Federal Court.  One way of doing this is by properly suing the claim adjuster.  One successful way of doing this is illustrated in a Northern District of Texas, Amarillo Division opinion.  The opinion is styled, Sparky’s Storage Solutions Ltd. v. Lexington Insurance Company, et al.

Sparky’ sued Lexington and their adjuster, Tim Fitzgerald for violations of the Texas Deceptive Trade Practices Act (DTPA) and Insurance Code violations.  The suit was filed in State District Court.  Lexington and Fitzgerald had the case removed to Federal Court due to the amount in controversy and alleging that Fitzgerald was improperly joined in the lawsuit in order to prevent diversity of citizenship which is required pursuant to 28 U.S.C. 1332(a).

Sparky’s filed a motion to remand the case back to the State District Court asserting that the joinder of Fitzgerald was proper.

Grand Prairie insurance lawyers need to read this case for seeing one way to properly sue an insurance company adjuster.  The case is from the U.S. Western District, Del Rio Division.  It is styled, Alfonso Gaytan and Tere Gaytan v. State Farm Lloyds and Alberto Garza.

This litigation arises out of storm that hit Eagle Pass, Texas, in April 2014.  The Plaintiffs submitted a claim for repairs under the State farm policy and Garza was the adjuster assigned to handle the claim.  Garza’s inspection was unacceptable to Plaintiffs and a lawsuit was filed in State Court and State Farm had the case removed to Federal Court based on 28 U.S.C. Section 1441(a).

Plaintiff’s filed a motion to remand and there was an argument about the 30 day deadline imposed by 28 U.S.C. Section 1447.  The Plaintiffs prevailed on this argument.