Insurance Claim Denial – Proving The Claim

Here is a case from the Eastern District of Texas wherein the insureds did not show that the damages they received were the result of a covered damage.  The case is styled, Tim Whatley and Sheila Whatley v. Great Lakes Insurance, SE and McClelland & Hine, Inc.

In this case, the Whatleys are suing based on their assertion that they suffered damage to their home as a result of Hurricane Harvey.  The case was in Federal Court and had been referred to a Magistrate Judge, who issued a report granting Summary Judgment in favor of Great Lakes and McClelland.  The Whatley’s sought review of the finding made by the Magistrate Judge.

The Whatleys (Plaintiffs) presented four objections to the Report regarding their breach of contract claim.  First, Plaintiffs object “to the court’s finding and recommendation that there is no genuine issue of material fact to support the damage to ther oof and interior and interior of Plaintiffs’ home was caused by the windstorm conditions of Hurricane Harvey.”  Second, Plaintiffs “object to the court’s finding and recommendation that there are no genuine issues of fact to support the roof and interior home damage was caused by a covered peril.”  Third, Plaintiffs “object to the court’s finding and recommendation that there are no genuine issues of fact supporting causation; that the damage was caused by water through an opening created by the direct force of wind and hail.”  Finally, “Plaintiffs object to the court’s finding and recommendation that expert Lester Saucier’s opinions on causation are speculation.”

Plaintiffs point to a myriad of record citations to support these contentions.  Plaintiffs go on to state that Mr. Saucier’s opinions are enough to overcome the evidence presented by Defendant.

The Court disagrees.  The record citations simply support the contention that the roof was damaged and that there was a hurricane.  The citations do not indicate that the hurricane directly caused the damage to the roof or show that the roof was not damaged prior Hurricane Harvey.  Mr. Saucier stated he “assumed that the damage was done as a result of the hurricane.”  Mr. Saucier did not determine if the damage was a direct result of the hurricane, or separately, if the damage was a result of maintenance issues as Defendant’s evidence shows.  Instead, Mr. Saucier guesses “if they had a maintenance problem prior to the hurricane, it would have caused leaks.”  Without any evidence connecting the damage of the roof to the hurricane, the opinions of Mr. Saucier are speculative.  Plaintiffs objections are overruled and the Magistrate’s analysis on this issue is correct.

Plaintiffs’ objections regarding their breach of contract claims are relatedly overruled based on the lack of a genuine issue of material fact on the causation of damages to their property.  Plaintiffs do not specifically object to the Magistrate Judge’s recommendation on their claims under the Texas Deceptive Trade Practices and Insurance Code. The Court accordingly agrees with the magistrate judge’s findings on these causes of action.

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