Hail Damage Claims

Here is an interesting case dealing with hail damage.  This is a 2021, case from the San Antonio Court of Appeals.  It is styled, Allstate Vehicle And Property Insurance Company v. Peter Reininger.  The opinion is an appeal from a jury trial in favor of Reininger.

The opinion is lengthy and discusses several legal issues.  However, the facts of the case are pointed out here because the facts are similar to situations many other homeowners face themselves.

Reininger’s home had previously been covered by a policy issued by Liberty Mutual and that policy covered cosmetic hail damage to his metal roof.  When Reininger began looking for a new policy in 2015, he contacted Justin Losoya, an Allstate agent.  Reininger told Losoya he wanted a policy that was “apples to apples” with his Liberty Mutual policy, and Losoya stated Allstate could provide that. Reininger also asked Losoya, “If I have any bad weather, hail or any type of hail and it damaged my roof, am I covered?”  Losoya answered, “Yes, sir, Mr. Reininger, you are.  You pay a 1 percent deductible.”  Losoya did not mention any exclusions on coverage for the roof, and Reininger did not make any further inquiries about exclusions.

Reininger purchased the Allstate policy and Losoya sent Reininger an email with the subject line “Allstate Insurance Policies.”  The “Reininger Peter_Home Policy” attachment was a six-page document that contained a policy number and listed coverage amounts, deductibles, discounts to be applied to Reininger’s policy, and information about Reininger’s property.  Other than specifying the monetary limits of the coverage, it did not identify any coverage exclusions.  However, it stated, “Any insurance bound hereunder shall otherwise be subject in all respects to the terms and conditions of the regular policy forms of the Company at present in use and to the statements in this application.”  It also contained a “Binder Provision” providing that Allstate, “in reliance on the statements in this application and subject to the terms and conditions of the policy authorized for Allstate’s issuance to the applicant, binds the insurance applied for.”  Allstate internally refers to a document like this one as a “binder.”

Reininger believed the “Reininger Peter_Home Policy” attachment was his homeowners’ insurance policy, and he paid his premium after he reviewed that document.  After Reininger paid his premium, Allstate created the policy.  In contrast to the six-page binder, the policy was a document of approximately sixty pages.  Unlike the Liberty Mutual policy, the Allstate policy contained a “metal roof surfaces cosmetic damage exclusion endorsement” providing the policy did not cover “cosmetic damage caused by hail to a metal roof surface, including but not limited to, indentations, dents, distortions, scratches, or marks, that change the appearance of a metal roof surface.”  The policy also explained, “We will not apply this exclusion to sudden and accidental direct physical damage to a metal roof surface caused by hail that results in water leaking through the metal roof surface.” Both Reininger and his wife, Nancy, contend the only homeowners’ policy document they ever received from Allstate was the six-page binder.

A hail storm struck the Reininger home and they made a claim for damages.  A claims adjuster, Phillips, inspected the home.  Reininger did not report interior damage and Phillips only inspected the roof.After surveying the roof, Phillips told Reininger the storm had caused only cosmetic damage that was not covered by the policy. Both Reininger and Nancy testified that this was the first time they learned about the cosmetic damage exclusion, and both testified that they would not have purchased the policy if they had known about that exclusion.

Shortly after Phillips’s inspection, Reininger and Nancy noticed water leaks inside their home.  Because they had not experienced any interior leaks before the hailstorm, they requested a further inspection of their roof, and Allstate scheduled a second inspection with a different claims adjustor.  However, Reininger cancelled it after the second adjustor told him, without first inspecting the property, that “he didn’t think he was going to find anything worse than Phillips did.”  Although Allstate’s claim file indicated Reininger had stated he wanted to reschedule the second inspection, Allstate closed the file two days later.

This lawsuit resulted.

The relevance of the facts in this case is that they are similar to what many people experience.  If a claim is denied, an Experienced Insurance Lawyer must be contacted.

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