Raizner Law LLP has filed an insurance lawsuit on behalf of a Harris County apartment complex against AmRisc LLC, Certain Underwriters at Lloyd’s London, QBE Specialty Insurance Company, Lexington Insurance Company, International Insurance Company of Hannover SE, Indian Harbor Insurance Company, Steadfast Insurance Company, United Specialty Insurance Company, Safety Specialty Insurance Company, and Old Republic Union Insurance Company (hereinafter referred to as the “Carriers”). The lawsuit was necessary due to an unreasonable underpayment of the plaintiff’s commercial property windstorm damage claim.
April 2019 Windstorm
On or about April 18, 2019, the plaintiff’s property was damaged following a windstorm, including damage to complex’s structure and building elements like the roof system, interior, exterior, and more. Upon discovering the damage, the plaintiff filed an insurance claim with the Carriers and asked that the cost of repairs be covered pursuant to the policy. The complex’s own consultant further identified dramatic damage that ruined parts of the building’s roof.
The Carriers insure the property, and through AmRisc assigned adjusters, consultants, and agents to the plaintiff’s file that were inadequately and improperly trained. Specifically, the carriers delegated to AmRisc the job of assigning the claims to CJW and Sedgwick as third-party adjusting firms. AmRisc’s preferred adjusting company, Sedgwick, engaged Stephens Engineering Consultants, Inc. engineer Shafaeen “Rickey” Sohaib as an internal adjuster. After an unreasonable and pretextual investigation of the property, Mr. Sohaib recommended an underpayment of the full scope of covered damages; thus, the plaintiff’s claim for windstorm damage was wrongfully delayed and underpaid.
Despite clear evidence of covered damage, the Carriers approved a gross underpayment of the property damage, omitting important facts, physical evidence, and meteorological data supporting our client’s claim.
The Carriers Acted In Bad Faith
Our client cites multiple violations of the Texas Insurance Code, including:
- Failure to effectuate a prompt, fair, and equitable settlement of a claim with respect to which liability has become reasonably clear
- Failure to adopt and implement reasonable standards for prompt investigation of claims arising under its policies
- Failure to provide promptly a reasonable explanation, in relation to the facts or applicable law, for the denial of a claim
- Failure to within a reasonable time to affirm or deny coverage of a claim to a policyholder; or submit a proper reservation of rights to a policyholder
- Refusal to pay a claim without conducting a reasonable investigation with respect to the claim
- Misrepresentation of the insurance policy under which it affords Property coverage, by making an untrue statement of material fact
- Misrepresentation of the insurance policy under which it affords Property coverage by failing to state a material fact that is necessary to make other statements made not misleading
- Misrepresentation of the insurance policy by failing to state a material fact that is necessary to make other statements made not misleading
- Misrepresentation of the insurance policy under which it affords Property coverage by making a statement in such manner as to mislead a reasonably prudent person to a false conclusion of material fact, and failing to disclose a matter required by law to be disclosed
- Misrepresentation of the insurance policy by making a statement in such manner as to mislead a reasonably prudent person to a false conclusion of material fact, and failing to disclose a matter required by law to be disclosed
- Knowingly committing the foregoing acts, with actual knowledge of the falsity, unfairness, or deception of the foregoing acts and practices
- Failure to acknowledge receipt of the claim
- Failure to timely commence investigation of the claim or to request from our client any additional items, statements or forms that the Carriers, Sedgwick, and Mr. Sohaib reasonably believe to be required from the plaintiff
- Failure to notify the claimant in writing of the acceptance or rejection of the claim not later than the 15th business day after receipt of all items, statements and forms required by the Carriers
- Delayed payment of claim in violation of Texas Insurance Code
The plaintiff additionally alleged the carriers breached their contract, breached their non-delegable duty to deal fairly and in good faith, acted fraudulently and with malice, and violated The Deceptive Trade Practices-Consumer Protection Act (DTPA).
Texas Insurance Coverage Attorneys
If you are the owner of a Houston apartment complex and your insurance claim was wrongfully denied or grossly underpaid, the Texas insurance coverage attorneys at Raizner Law LLP can help. Contact us today for a free consultation to review your case.