From a statistical point of view, less than 2% of all lawsuits result in an actual trial. They either get thrown out of court on a motion for summary judgment or they they get settled. Most get settled. For the cases that go to trial, the public hears about the “million dollar” wins. What is not reported are the day in and day out loses that occur. It is important to understand why they lost.
Here is a 2023 opinion from the San Antonio Court of Appeals wherein the case appealed had been lost at trial and the insured filed the appeal. The opinion is styled, Brian Jones v. Allstate Vehicle And Property Insurance Company.
Brian sued Allstate on a claim resulting from a 2016 hail storm. He sued for breach of the insurance contract and unfair settlement practices.
One thing to note here. This case involved a loss that Brian claimed totaled $45,880.02. What is noteworthy is that Allstate probably paid over $100,000.00 in attorney fees and court costs to keep from paying this claim.
Here is some background:
After Brian property sustained damage in the storm, he filed a claim with Allstate. After an initial inspection of the house, Allstate estimated $4,840.62 in covered damage to a metal patio roof, turbine vents, and metal flashing. After applying a two-thousand-dollar deductible, Allstate paid Brian $2,840.62. Upon a second inspection, Allstate paid an additional $425.26. Allstate, however, maintained that the roof sustained no covered damage, and it refused to pay for the roof’s replacement. Approximately sixteen months after the hailstorm, Brian sued Allstate.
At trial, Brian’s wife Ronda, testified that she was in the family’s home when the storm hit. Ronda estimated that the storm lasted approximately fifteen minutes, and it broke the kitchen window. After the storm, Ronda filed a property damage claim with Allstate. She also contacted roofers for repair estimates. Within a month, an inspector affiliated with Allstate conducted an approximately thirty-minute inspection of the property’s roof. Afterwards, Allstate remitted a check for $2,840.62, which represented its estimation of the damage less Brian’s two-thousand- dollar deductible. Dissatisfied, Ronda and Brian sought a second opinion from a roofer, and they asked Allstate for an additional inspection. During the second inspection, the inspector ascended onto the roof while Ronda remained inside her home with the children. After the second inspection, Allstate remitted a check for $425.29. On cross examination by Allstate, Ronda could not recall the age of the property’s roof or seeing any water leaks in the home’s interior since the storm. When asked whether Ronda knew how many shingles on the roof were damaged by hail, she answered, “I’ve never been on the roof.”
Brian testified that, before Allstate issued a property insurance policy, it insisted on having the property inspected. After the initial inspection, Allstate requested, according to Brian, that tree limbs near the roof be removed. Brian complied, Allstate arranged for a second inspection, and Allstate issued a property insurance policy for Brian’s home in December 2015.
Brian testified that, during the storm, he heard a “boom.” As Brian’s attorney handed him a golf ball and a racquetball, Brian described the hailstones as ranging in size between the two. Similar to Ronda’s testimony, Brian recalled that Allstate coordinated two inspections of the property, and he had not observed any interior water leaks that could be attributed to the roof failing to prevent water intrusion since the storm. Brian contended that Allstate provided him with no photographs of damage from the storm. For Brian’s part, he offered into evidence only one photograph depicting storm damage that was taken in 2016. In addition to the cost of replacing the roof, Brian maintained that he deserved to be compensated for attorney time that he expended “due to obstruction by Allstate]and its attorneys.” He referenced Allstate’s removal of the case to federal court and the filing of an “appeal” regarding a discovery dispute as evidence of obstructionism. Allstate’s refusal to pay for a new roof prompted Brian to hire Earl Stigler, a claims adjuster, in 2018. In 2021, Brian paid to replace the roof.
Stigler testified that he inspected the Jones’s roof in February 2018. After reviewing meteorological reports, Stigler opined that the April 2016 hailstorm produced hard — as opposed to “soft” — hailstones that were larger than a golf ball. Soft hailstones more often “pop . . . like a water balloon” and do not cause damage. Hard hailstones, according to Stigler, “will really make some damage.” Stigler testified that he examined three “test squares” and observed hail “hits” on all of them: seven hits on the left slope of the roof, eight hits on the back slope, and five hits on the front slope. Stigler opined that the roof, several windows, and some of the siding were damaged because of the storm. Stigler estimated that the total cost of repairs from the storm was $45,880.02.
The jury was charged with two liability theories. First, the jury was asked whether Allstate failed “to comply with the insurance policy provisions to pay for physical loss to property owned by Brian A. Jones caused solely by covered events in April of 2016, if any, that you find did occur at the residence?” Second, the jury was asked whether Allstate engaged in any unfair or deceptive act or practice that caused damages to Brian. It defined “unfair or deceptive act or practice” as either failing to attempt in good faith to effectuate a prompt, fair, and equitable settlement of a claim under one portion of a policy, for which the insurer’s liability has become reasonably clear, or refusing to pay a claim without conducting a reasonable investigation of the claim. The jury answered “no” to both liability questions. The trial court signed a take-nothing judgment in Allstate’s favor. Thereafter, Brian filed motions for a judgment notwithstanding the verdict and for a new trial. Both were denied by operation of law. Brian timely appealed from the final judgment.
The remainder of the opinion discusses the role of the Court in reviewing the case and how these situations are examined by the Court. It is good reading for an attorney having to do an appeal. This Court ultimately sided with Allstate.