Properly Pleading The Wrongs Of The Adjuster

For an insurance attorney to know the insurance adjuster did something wrong when it comes to a lawsuit is not good enough.  When filing a lawsuit, the allegations of wrongdoing by the adjuster must be properly alleged in the lawsuit papers.  This is illustrated in the Southern District, Corpus Christi Division, opinion styled, Esteban Cruz v. State Farm Lloyds.

This case was filed against State Farm in State Court and State Farm caused the case to be removed to Federal Court based on diversity jurisdiction.

State Farm seeks dismissal of the extra-contractual claims for “failure to state a claim upon which relief can be granted” pursuant to Rule 12(b)(6)Rule 8(a)(2) requires a short and plain statement of the claim showing that the pleader is entitled to relief.  This includes sufficient factual allegations to indicate that the claim is plausible.

Cruz alleges that when the adjuster inspected the damage to Cruz’s house that he would be “fully covered” and “had nothing to worry about.”  The adjuster spent less than one hour assessing the damage and prepared an estimate of the damage.  Explaining that the damage did not exceed Cruz’s deductible under the policy, State Farm denied payment on the claim.

Missing from Cruz’s allegations are facts as to why more time was needed to assess the damage, what damage was overlooked, whether that damage was covered, what unnecessary delay transpired between making the claim and receiving the denial of payment, or how the damage actually exceeded his deductible.  With respect to the statements made, Cruz has identified the speaker, place, and content of State Farm’s statements, but he had not alleged why or how the statements are false or misleading.  The statements appear to be nothing more than general representations in the course of evaluating the claim.  Therefore, the allegations are merely conclusory.

Reviewing Cruz’s allegations in the light most favorable to him, the Court finds that his factual allegations are insufficient to support a finding that his extra-contractual claims are plausible under the law.

This Court then gave Cruz gave Cruz a deadline to amend his pleadings.

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