Category: Insurance Claim Lawsuits

Insurance companies exist to provide an individual or entity financial protection or reimbursement from loses. These types of contracts can be full of confusing and sometimes conflicting information as well as fine print the average person may not be aware of. Although the companies are supposed to protect their clients, often they will deny, delay, or dispute claims to prevent having to provide compensation. The attorneys of Raizner Slania file lawsuits against these insurance companies acting in bad faith and fight for their client’s right to reimbursement.


Hurricane Harvey Damage Insurance Lawsuit

Houston Commercial Property Owner Files Hurricane Harvey Damage Insurance Lawsuit

Raizner Law has filed a Hurricane Harvey insurance lawsuit on behalf of a commercial property owner in Houston, Texas against Twin City Fire Insurance Company after its insurance company was wrongfully denied.

The property is a one-story commercial building with 12,214 square feet of interior space. Unfortunately, on August 26, 2017, Hurricane Harvey swept through Houston, Texas and caused significant damage to the property. Sizable portions of the building’s roof and exterior were compromised, causing damage to the interior of the property, including the ceilings and insulation. Immediately after the storm, the plaintiff alerted Twin City of the damage and asked that the cost of repairs be covered pursuant to its policy.

Twin City’s claims-handling process resulted in a wrongful denial that omitted a wealth of facts, physical evidence, obvious wind damage, and meteorological data from Hurricane Harvey supporting the plaintiff’s claim. Twin City unreasonably pinned the loss on anything but the wind, an action designed to save the insurer hundreds of thousands of dollars in claims payouts for Hurricane Harvey property damage and business interruption.

Specifically, just days after Harvey ravaged the property and the claim was submitted, on September 6, 2017, Twin City had already written off the plaintiff’s claim and issued a preliminary denial letter that offered no reasonable explanation of the facts underlying the denial and that failed to tie any relevant facts to the three pages of policy provisions cited by Twin City. Remarkably, after citing various exclusions and ignoring the relevant coverage, the letter claims no lost business income will be issued under the policy because the shutdown of the plaintiff’s business “was not due to direct physical damage by a covered cause of loss.”

Weeks after the plaintiff submitted the claim, on September 24, 2017, a “damage specialist”, inspected the property to determine the “cause of loss” that resulted from Harvey’s hurricane-force wind and water. Days later, on October 4, 2017, another denial letter was issued which was seemingly identical to the prior denial issued just days after the storm. Again, however, Twin City refused to acknowledge the damage caused by Hurricane Harvey in the midst of the catastrophe. Twin City did not prepare any scopes or estimates of damages and/or refused to provide them to the insured.

The plaintiff was forced to hire its own consultants to assess the damage properly and provide their own estimates of damages to Twin City in the face of the company’s refusal to do so. After Twin City ignored its obligations, forcing the plaintiff to demand the company reassess the damages, another inspection took place on June 19, 2018 by a preferred vendor. This inspection also ignored obvious and extensive damages Harvey caused to the property and was conducted with the intent to simply rubber stamp the prior denial of the plaintiff’s claim for a second time. The inspectors were not qualified to assess the type of damages to a commercial property like the one at issue and, as a result, the inspections were haphazard, rushed, and incomplete. Twin City ultimately denied the plaintiff’s claim.

Twin City Violated The Texas Insurance Code

Our client cites numerous violations of the Texas Insurance Code, including failure to effectuate a prompt, fair, and equitable settlement of a claim, failure to adopt and implement reasonable standards for prompt investigation of the claim, and refusal to pay the claim without conducting a reasonable investigation.

Filling Your Hurricane Harvey Damage Insurance Lawsuit

Insurance companies have been reluctant to pay out on valid claims in the wake of Hurricane Harvey. If your Hurricane Harvey claim is being denied or undervalued, contact Raizner Law today to see how we can help you obtain your rightful compensation under your policy.

hail damage insurance lawsuit

Raizner Law Files Hail Damage Insurance Lawsuit On Behalf of Dallas Motel Owner

Raizner Law has filed a hail damage insurance lawsuit on behalf of a Dallas, Texas motel owner against United Specialty Insurance Company, Strata Claims Management, LLC, and Engle Martin & Associates, LLC.

April 2017 Hail Storm

On April 25, 2017, a hail storm swept through Dallas, Texas. The hail storm caused severe damage to the property, including damage to the roof, HVAC system, exterior, and interior of the property. Immediately upon discovering the damage, the plaintiff filed an insurance claim with United Specialty alerting them to the damage. In response to the catastrophe claim, United Specialty assigned adjusters, consultants, and agents to the plaintiff’s file that were inadequate and improperly trained. More specifically, United assigned the plaintiff’s claim to Strata for adjustment, and Strata in turn assigned the claim to an employee to adjust the damages. Strata then assigned the plaintiff’s claim to Engle Martin as independent adjusters, who assigned an employee to handle adjusting the claims.

United Specialty, with ultimate decision-making authority and acting on its own accord and through its agents Strata, Engle Martin, and their employees, failed to conform to proper claim settlement practices in Texas, failed to properly supervise its designated representatives, and unreasonably denied and delayed full and fair claim payment. Specifically, Strata, Engle Martin, and their employees failed to perform a thorough investigation of the claim. Engle Martin’s employee inspected the property on June 26, 2017, and performed a cursory, substandard inspection. On July 5, 2017, this employee prepared an estimate of covered damages that grossly undervalued what should be covered and paid under the policy.

Upon reviewing the gross undervaluation of the damage, the plaintiff hired its own licensed public adjuster to evaluate the claim. It was only after learning the plaintiff had hired a public adjuster that the defendants decided to retain an engineering firm to inspect the property. The engineering firm performed a “Window Damage Evaluation Report,” dated August 21, 2017. This report found “none of the windows have sustained any wind or hail impact-related damage” and that condensation was due to “seal failure” consistent with “age-related deterioration of the windows.” In short, the engineering firm’s report was an unreasonable and pretextual rubber-stamp of the unreasonable investigation made and underpayment already found by Strata and Engle Martin.

Unfortunately, the defendants have delayed payment for the plaintiff’s necessary and covered property repairs under the insurance policy. Given the repeated delays of payment, the plaintiff has been subjected to significant economic impact, worry, distress, and continuing economic and physical damage. Because of the delays, denials, and underpayment, the plaintiff has been unable to make necessary repairs to the property, which has resulted in further damages, including additional interior and roof damage, among others.

United Specialty Acted In Bad Faith

Our client alleges United Specialty acted in bad faith and cites numerous violations of the Texas Insurance Code, including refusal to pay a claim without conducting a reasonable investigation, misrepresentation of an insurance policy under which it affords property coverage to the policyholder, and knowingly committing the foregoing acts with actual knowledge of the falsity, unfairness, or deception of the foregoing acts.

Get Help With Your Hail Damage Insurance Lawsuit

Policyholders deserve full protection under their policies. Many insurance companies prey upon uninformed policyholders who are unaware of their legal rights. If your insurance company is denying your claim or misrepresenting the terms of your policy, contact the hail damage insurance lawyers at Raizner Law today for a free consultation to get help with your hail damage insurance lawsuit.

Condominium Association Lawyers

Raizner Law Files Lawsuit On Behalf of Dallas Condominium Owner’s Association

Raizner Law has filed an insurance lawsuit on behalf of a condominium owner’s association against Maxum Indemnity Company after its wind damage claim was wrongfully denied.

March 2018 Windstorm

In March 2018, a windstorm swept through Dallas and caused significant damage to the subject condominium property. Large portions of the property’s roof were compromised, causing substantial interior damage. In total, the property suffered damage to the roof, HVAC systems, windows, and interiors. Immediately upon discovering the damage, the plaintiff filed an insurance claim with Maxum and asked that the cost of the repairs be covered pursuant to the policy.

Maxum utilized a preferred vendor to handle the adjustment of the claim. The vendor was disorganized, rife with delays, and left many of the insured’s questions unanswered. The plaintiff hired its own representative to assist with the claims process, but Maxum’s vendor continuously ignored the plaintiff’s representative in an effort to intentionally mislead the insured about the claims process and ultimately deny the claim. Maxum wrongly claimed the damage was caused by a “clogged roof drain” and therefore was not covered under the policy. To this day, the plaintiff has not been properly compensated for the cost of repairs to the property and has suffered extreme economic hardship as a result.

Maxum Acted In Bad Faith

Our client cites numerous violations of the Texas Insurance Code, including failure to effectuate a prompt, fair, and equitable settlement of a claim, failure to provide a reasonable explanation for the denial of a claim, misrepresentation of the policy under which it provides property coverage to the insured, and refusal to pay a claim without conducting a reasonable investigation. Our client also alleges Maxum violated the Texas Deceptive Trade Practices Act.

Condominium Association Lawyers

When your insurance company does not act quickly or fairly, your business may suffer. If the insurance company acts in bad faith, you may be able to recover not only the costs of repairs and replacements covered in your policy, but also other costs incurred due to their dishonest actions. Getting the compensation you are entitled to should not be an uphill battle. Contact a condominium association lawyer at Raizner Law today to protect your rights and see how we can help.

Hurricane Harvey insurance lawsuit

Padre Island, Texas Hotel Owner Files Hurricane Harvey Insurance Lawsuit

Raizner Law has filed a Hurricane Harvey insurance lawsuit on behalf of a Padre Island, Texas hotel owner against Greenhill Group LLC, First Specialty Insurance Corporation, Evanston Insurance Company, and Scottsdale Insurance Company. Our client alleges its Hurricane Harvey insurance claim was wrongfully denied under Texas law.

Our client owns a six-story hotel situated on 126,354 square feet of land with 79,810 square feet of interior space. The building is a well-known hotel and conference facility in the Corpus Christi area, and it contains guest rooms, meeting/reception areas, office space, a fitness area, laundry facilities, a restaurant and bar, and kitchen facilities.

On August 25, 2017, Hurricane Harvey, recognized as one of the most devastating natural disasters in United States history, made landfall on the Texas coast in San Patricio County and Aransas County as a Category 4 hurricane. Wind gusts of up to 132 miles per hour were reported in the same area as the property. As a result of Harvey’s extreme winds and rain when it hit Nueces County and specifically the property, the hotel suffered substantial damage. Sizeable portions of the property’s roof were compromised by wind, which in turn caused damage to the interior of the property, electrical components, ceilings, flooring, and HVAC.

Immediately upon discovering the damage, the plaintiff filed insurance claims with the carriers. As the primary insurer on the property, First Specialty took the lead during the claims handling process; however, its claims-handling process resulted in wrongful denials and gross underpayments that omitted a wealth of facts, physical evidence, obvious wind damages, and meteorological data from Hurricane Harvey supporting the plaintiff’s claim. First Specialty unreasonably pinned the loss on anything but the wind, an action designed to save the insurance company and the other carriers millions of dollars in damages to the property and the business.

Specifically, First Specialty assigned unqualified consultants and adjusters to handle the claim and ignored damages the adjusters initially accepted. First Specialty retained a preferred vendor to handle the initial adjustment. After an inspection on September 13, 2017, First Specialty’s adjuster verbally confirmed coverage and damages of millions of dollars to the building structure alone; however, those amounts were never paid. Rather, First Specialty sent additional consultants out in order to minimize the claim payout to the plaintiff. On September 20, 2017, additional adjusters were sent to the property and admitted they personally observed substantial Hurricane Harvey wind damage.

Acting with authority on behalf of the carriers, the adjusters conceded that millions of dollars were owed on the claim and verbally offered an undisputed amount to pay the insured’s claim. Despite this legally binding agreement, the carriers reneged on their promise, and continued to delay the claim until its partial denial in May 2018. To this day, the plaintiff has not been properly paid for property damage, and has suffered significant economic hardship not only in the cost of repairs but also in lost business income.

Violations of the Texas Insurance Code

Our client cites numerous violations of the Texas Insurance Code, including failure to promptly provide a reasonable explanation for the denial of a claim and misrepresenting the terms of the policy under which it affords property coverage to the plaintiff. Our client also claims the carriers violated the Texas Deceptive Trade Practice Act.

Fighting For Hurricane Harvey Victims

It’s a shame that Hurricane Harvey victims have to fight so hard for the compensation they are rightly entitled to under their insurance policies. Raizner Law is helping Hurricane Harvey victims with bad faith insurance claims. If your Hurricane Harvey insurance claim has been denied or underpaid, contact us today for a free consultation to discuss your case.

Bad Faith Insurance Denials

Raizner Law Files Bad Faith Insurance Lawsuit On Behalf of Harris County Commercial Property Owner

Raizner Law has filed a bad faith insurance lawsuit on behalf of a Harris County, Texas commercial property owner against Underwriters at Lloyd’s, London after its Hurricane Harvey damage insurance claim was wrongfully denied.

Our client owns a one-story building situated on 21,875 square feet of land with 13,261 square feet of interior space. The building houses several separate businesses. On August 25, 2017, Hurricane Harvey came ashore along the Texas coastline as a Category 4 hurricane. As a result of Hurricane Harvey’s extreme winds and rain, large portions of the property’s roof were damaged. Because the roof was compromised, there was also damage to the interiors, ceilings, walls, and flooring of the property.

Immediately after the storm, the plaintiff filed an insurance claim with Lloyd’s, asking that the cost of repairs be covered pursuant to the policy. Although Texas law provides an insurer has a “non-delegable duty” to responsibly handle claims, Lloyd’s does not have a single employee in Texas so they delegated the claim to a third party administrator.

The third party administrator’s adjustment was disorganized, rife with delays, and left many of the insured’s questions unanswered. The plaintiff hired its own representative to assist with the claims process, but adjusters continuously ignored the plaintiff’s representative in an effort to intentionally mislead the insured about the claims process and ultimately deny the claim.

The third party administrator, its adjusters, and Lloyd’s refused to provide any scopes of damage or answer any questions about the status of the claim, despite the plaintiff’s multiple requests. Additionally, they failed to complete an adequate inspection and refused to acknowledge all the damages to the property. In the denial letter, the third party administrator and Lloyd’s stated the “only portion” of the property damaged by Harvey was a small section of the porch, which fell below the policy’s deductible. While they did acknowledge “extensive water damage” at the property, the companies stated the water damage was a result of “improper roof drainage, age-related deterioration to the roof covering and metal decking and deferred maintenance,” which while boilerplate exclusions under the policy, were not supported by any relevant facts or data.

Lloyd’s Violated The Texas Insurance Code

Lloyd’s violated numerous sections of the Texas Insurance Code, including failure to effectuate a prompt, fair, and equitable settlement of a claim, refusal to pay a claim without conducting a reasonable investigation, and misrepresenting the policy under which it affords property coverage to the plaintiff.

Get Help With Bad Faith Insurance Denials

If you regularly pay your premium, you deserve complete protection under your insurance policy. Insurance companies have no right to issue bad faith insurance denials solely in an effort to help them save money. If your insurance company is acting in bad faith, contact Raizner Law today for a free consultation to discuss your case.

Aetna

Insurance Giant Aetna Slammed With $25.5 Million Bad Faith Jury Verdict

Insurance is a critically important financial safety net for most Americans. People pay into a system that will protect them financially in the event of a disaster or catastrophic medical treatment. However, this system only works if insurance companies honor their agreements. When insurers face large claim payouts, they sometimes resort to inappropriate tactics to minimize claims and wrongfully deny payouts. But policyholders were handed a powerful win recently when insurance giant Aetna was slammed with a $25.5 million jury verdict for wrongfully denying coverage for cancer treatment.

In 2014, Orrana Cunningham was denied coverage for treatment of her Stage 4 nasopharyngeal cancer located near her brainstem. Because of the cancer’s location, ordinary radiation therapy would cause blindness, memory loss, and other debilitating side effects. Her doctors instead recommended a targeted form of radiation called proton beam therapy.

Mrs. Cunningham was denied coverage for proton beam therapy because Aetna deemed the treatment “experimental” and therefore not covered under her policy. However, as expert witnesses explained during the recent jury trial, proton beam therapy has been used successfully for decades, hardly making the treatment experimental.

Radiation oncologist Dr. Andrew L. Chang explained it best when he told the jury, “Proton therapy is a well-established treatment for cancer and has been for decades. … Nobody in the oncology community considers proton therapy experimental for the treatment of cancer.” Dr. Chang also pointed out that Medicare covers proton beam therapy, as do most pediatric plans for patients up to 21 years old. If insurance companies covered the cost of this treatment for patients under 21 and over 65, what exactly makes it experimental for those between the ages of 22 and 64?

Nothing does, according to an Oklahoma jury. Mrs. Cunningham died in 2015, and an Oklahoma jury believed it was important to send Aetna a message, awarding $25.5 million in damages to Mrs. Cunningham’s spouse. One might think the verdict would give Aetna a sense of responsibility or remorse. But unfortunately, lesson about bad faith insurance denials, but this is unlikely. Mr. Cunningham reported that after the verdict was read aloud in the courtroom, Aetna’s lead congratulated him on the verdict before telling him he would lose on appeal.

Insurance Companies Prey On Policyholders

Insurance companies rely on uninformed policyholders. Most policyholders are completely unaware of their rights and the actions they can take against insurance companies operating in bad faith. Insurance companies are aware of this, so they often utilize bad faith tactics hoping they don’t get caught – because most of the time they don’t. This is wrong, and every policyholder has a right to stand up to insurance companies that wrongfully deny claims. Whether you own a commercial property insurance policy or health insurance policy, you deserve full coverage.

Fight Back With Raizner Law

At Raizner Law, our experienced insurance lawyers pursue claims against insurance companies that deny cancer treatment. If your insurance company is delaying, undervaluing, or outright denying your claim for medically necessary cancer treatment, contact us today to see how we can help. All of our consultations are free and we work on a contingency fee basis, meaning there is no upfront cost for working with us, and you won’t owe us anything unless we help you recover compensation.