Tag: Bad Faith

Wind Driven Rain and Storm Created Openings: How Insurance Companies Are Using Policy Exclusions and Limitations to Deny Harvey Claims

Much of Texas is struggling to rebuild in the aftermath of Hurricane Harvey. Progress has been slow for many property owners because insurance companies are dragging their feet in paying out on claims. Many Texans are discovering their insurance companies are using certain exclusions and limitations in their policies to wrongfully deny legitimate claims. This approach has become common throughout the Coastal Bend area of Texas, as real estate owners and businesses are beginning to receive denial letters from their insurance companies.

Is your insurance company refusing to pay your claim on the grounds that the damage resulted from wear and tear and not wind from Hurricane Harvey? Are they admitting that there is damage to the interior of the building that resulted from wind driven rain, but refusing to pay because there was “no storm created opening”? Let’s take a look at the applicable clauses, and what you can do about it.

All Risks Policies and Wind Driven Rain 

Most policies issued in Texas consider any direct physical loss to be covered unless the loss is either excluded or limited by a specific policy provision. Wind damage from a hurricane and wind driven rain are both considered a covered cause of loss under most insurance policies. Because of that basic rule, insurance companies will have to identify and prove that a specific “Exclusion” or “Limitation” contained in the policy applies before they can avoid coverage.

In Texas, a policyholder bears the responsibility to demonstrate a covered cause of loss, but if an insurance company wants to avoid payment based on an exclusion or limitation, they have to prove that it applies.

Ensuing Loss and Policy Exclusions For Wear and Tear, Faulty Maintenance, Manufacturing Defects and Other Pre-Existing Conditions

Most policies contain a series of exclusions that are crafted to avoid coverage. One of the most commonly used exclusions pertains to “wear and tear.” If an insurer can demonstrate that roof damage was the result of wear and tear and not hurricane winds, there is no coverage under the policy.

Often, however, these condition-based exclusions are written back in coverage for an “ensuing loss.” An ensuing loss is a new loss that follows an earlier loss. In the case of an ensuing loss, the earlier loss is often uncovered under the policy, while the new loss is, meaning policyholders will only receive compensation for damage caused by the new loss and are left paying out of pocket for damage caused by the original loss.

For Hurricane Harvey claims, this is most commonly playing out like this: insurance companies will claim the roof, siding or other component of the building envelope were not damaged by wind, but rather deteriorated due to wear and tear over time. Then wind driven rain, a covered cause of loss, enters the building through the existing defects and causes interior water damage. The alleged original loss – the deteriorated roof – is not covered under the policy, so insurance companies do not have to pay for the water and wind damage caused by the storm. The interior water damage is covered under the policy, so insurance companies will compensate policyholder only for this damage.

When an insurance company denies damage to a roof, but pays for interior damage due to water or wind driven rain, it is typically a result of an ensuing loss type of provision.

Even in a circumstance where an insurer pays for interior damage due to ensuing loss, they will try to minimize those payments. The interior of a building includes anything beneath the roof covering, such as insulation and decking. When an insurer has a responsibility to pay for interior damage under a policy, they are obligated to pay for all interior damage, and not just limited payments for sheetrock. This includes substantial repairs for the parts of the building just below the roof, such as wet insulation or corroded decking.

Storm Created Opening Limitations

In addition to outright exclusions, an all risks policy may also contain certain “Limitations.” One common limitation provides that the insurer will not pay for damage to the interior of a building unless “the building or structure first sustains damage from a Covered Cause of Loss to its roof or walls through which the rain . . . enters.” In other words, with this type of limitation, there is no coverage for interior damage unless it resulted from a storm created opening. Many policies do not contain this type of limitation, and in those cases, interior damage is covered even without evidence of wind damage to the roof, siding or windows.

How Insurance Companies Are Abusing Wind Driven Rain Clauses

In the aftermath of Hurricane Harvey, insurance companies are facing the financial liability for billions of dollars in claims. Insurance companies are run first and foremost as businesses. This means insurance companies may not always have a policyholder’s best interests at heart. In order to avoid paying out on claims, many insurance companies are wrongfully claiming damages were caused by wear and tear, and not a covered loss such as wind driven rain.

While this might seem like a small detail, the reality is that this can determine if a claim is paid or not. Many policyholders in places like Fort Bend County, Rockport, and all along the Texas coast are shocked to find out insurance companies wrongfully classify their wind damage.

Hurricane Harvey was a Category 4 hurricane with maximum sustained winds at 130 miles per hour. Wind damage from Hurricane Harvey was obvious. Roofs were destroyed, trees were downed, and properties were decimated. So why do insurance companies fraudulently deny these claims?

Very few policyholders understand the nuances and complexities of commercial insurance and are unaware of their rights. By giving policyholders the runaround, companies are saving themselves millions of dollars in payouts. This is wrong and insurance companies must be held responsible.

Raizner Slania LLP Helps Policyholders With Hurricane Harvey Wind Claims

If you regularly pay your premiums, you are entitled to full coverage under your insurance company. If your insurance company has wrongfully denied, delayed, or underpaid your claim, call the experienced Hurricane Harvey wind claim lawyers at Raizner Slania LLP today. We have a successful track record of taking on some of the largest insurers in the country. Don’t wait to get help on your Hurricane Harvey claim.

Wind and Hail Damage Lawsuit

Local Funeral Home Files Wind and Hail Damage Lawsuit

Raizner Slania has filed a wind and hail damage lawsuit on behalf of a local funeral home against Ohio Security Insurance Company after its commercial property hail damage claim was wrongfully denied under Texas law.

April 2014 Tarrant and Dallas County Wind and Hail Storm

On April 4, 2014, a wind and hail storm swept through Tarrant County and Dallas County and caused severe damage to the roof, HVAC, exterior, and interior of the property. Immediately upon discovering the damage, the plaintiff filed an insurance claim with Ohio Security Insurance and asked that the cost of repairs be covered pursuant to the policy.

In response to the claim, Ohio Security Insurance assigned adjusters, consultants, and agents to the plaintiff’s file that were inadequately trained to handle this type of claim. Specifically, the claim was assigned to an adjuster who failed to perform a thorough investigation of the claim. The adjuster performed a substandard inspection of the property and did not prepare any estimates or scopes of damages for the properties and/or failed to provide those items to the plaintiff.

The adjuster failed to hire qualified experts to assess the damage and continually delayed the claims process. Ohio Security Insurance relied solely on the adjuster’s inadequate, incomplete, and unreasonable investigation to determine what amounts, if any, to pay on the claim. As a result, the plaintiff’s claim was grossly underpaid and the plaintiff has been unable to make the necessary repairs to the property. This has caused additional damage to the exterior and interior of the property.

Ohio Security Insurance Acted In Bad Faith

Our client alleges numerous violations of the Texas Insurance Code, including the failure to effectuate a prompt, fair, and equitable settlement of a claim and the failure to provide a reasonable explanation for the denial of a claim. Additionally, Ohio Security Insurance misrepresented the insurance policies under which it affords property coverage to plaintiff.

Misrepresentations of Policies

Many insurance companies purposefully misrepresent policies during claims investigations to avoid costly payouts. For policyholders who regularly pay their premiums, this isn’t just dishonest – it’s illegal. If your insurance carrier delayed, denied, or undervalued your claim, the experienced bad faith insurance lawyer at Raizner Slania can help. Contact us today to schedule a free consultation to discuss your case.

Houston Fire Insurance Claim Attorneys

Houston Builder Files Fire Damage Insurance Claim Lawsuit

Raizner Slania has filed a bad faith insurance lawsuit against American Zurich Insurance Company and Vericlaim, Inc. on behalf of a local Houston builder whose fire damage insurance claim was wrongfully denied.

May 2016 Fire

On May 13, 2016, a fire broke out at the plaintiff’s property, which consisted of structures under construction at the time of the fire. The fire damaged the structure, plumbing, windows, walls, floors, frame, roof, exterior, and interior of the property. The plaintiff filed an insurance claim under its policy with Zurich for damages to the property caused by the fire.

The plaintiff and its representatives presented the full scope of damages consistent with the current state of construction to Zurich. However, Zurich improperly applied a co-insurance penalty to the loss and falsely represented that the plaintiff was underinsured on its builder’s risk insurance policy. Zurich and Vericlaim also misinterpreted policy provisions concerning the reporting of construction status and property values.

In response to the claim, Zurich assigned the claim to Vericlaim, which in turn assigned the claim to an employee. Vericlaim and the employee failed to perform a thorough investigation of the property and improperly ignored clear damages covered by the policy. Additionally, the employee failed to hire qualified experts to appropriately assess the full extent of damages.

Vericlaim and its employee sought to deny the plaintiff’s claim and conducted an outcome-oriented investigation geared toward concluding the plaintiff was underinsured for the loss, which would result in a large financial benefit to Zurich.

Zurich relied solely on Vericlaim and its employee’s investigation of the claim to determine what amounts, if any, to pay on the claim. As a result of the haphazard investigation, the plaintiff has been grossly underpaid for property damages. Zurich and Vericlaim engaged in illegal insurance claim settlement practices by refusing to accept responsibility for the loss.

Violations of the Texas Insurance Code

The plaintiff cites numerous violations of the Texas Insurance Code, including failure to implement reasonable standards for prompt investigation of claims, failure to promptly provide a reasonable explanation for the denial of a claim, and misrepresentation of the insurance policy under which it affords property coverage to plaintiff.

Houston Fire Insurance Claim Attorneys

 If your commercial insurance carrier has denied, delayed, or underpaid your fire damage insurance claim, the experienced Houston fire insurance claim attorneys at Raizner Slania can help. Contact us today for a free consultation to discuss your case.

Oklahoma Bad Faith Insurance Lawyers

Oklahoma Industrial Building Owner Files Bad Faith Insurance Lawsuit

Raizner Slania has filed a bad faith insurance lawsuit on behalf of an industrial building owner against Acadia Insurance and Union Standard Insurance Group after its wind and hail insurance claim was wrongfully denied.

April 2016 Wind and Hailstorm

On April 19, 2016, a severe wind and hailstorm swept through Durant, Oklahoma. The wind and hailstorm caused severe damage to the roof, HVAC, exteriors, and interiors of the property. Immediately upon discovering the damage, the plaintiff filed an insurance claim for the cost of repairs.

In response to the claim, Acadia assigned representatives, adjusters, consultants, and agents to plaintiff’s file that were inadequate and improperly trained. Specifically, Union Standard and an employee out of Dallas, Texas mishandled the plaintiff’s claim. The employee conducted an unreasonable investigation of the cause and extent of damages, was improperly trained, and was not equipped to handle this type of claim.

In May 2016, an adjuster visited the property but failed to complete an adequate inspection and refused to acknowledge all the damages to the property. The employee did not prepare any estimates or scopes of damages, so the plaintiff was forced to prepare its own estimate of damages and point the issues out to the employee.

However, the employee ignored the facts supporting coverage, failed to give the plaintiff’s presentation proper consideration, and denied the true extent of damages covered by the policy. Instead, the employee retained consultants from a preferred vendor and was unnecessarily hostile to the insured in claim communications and investigation methods. The employee then utilized the preferred vendor’s report to make recommendations to Acadia on what portions of the claim to deny under the policy.

Acadia and Union Standard Operated 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 promptly provide a reasonable explanation for the denial of a claim, and failure to pay a claim without conducting a reasonable investigation.

Oklahoma Bad Faith Insurance Lawyers

If your insurance company wrongfully denied, delayed, or underpaid your commercial insurance claim, the experienced Oklahoma bad faith insurance lawyers at Raizner Slania can help. Contact us today to schedule a free consultation to discuss your case.

Bexar County Commercial Hail Damage

Bexar County Commercial Hail Damage Lawsuit

Our client, a commercial building owner, was forced to file a lawsuit against American National Property and Casualty Company (“American National”) after its hail damage insurance claim was wrongfully denied under Texas law.

April 2016 San Antonio Hail Storm

On April 12, 2016, a severe hail storm swept through Bexar County. As a result, the plaintiff’s business sustained significant damage to the roof, exteriors, and interiors of the property. Immediately upon discovering the damage, the plaintiff filed an insurance claim with American National for damages caused by the storm. The plaintiff asked for the cost of the repairs to be covered pursuant to the policy.

In response to the claim, American National assigned representatives, adjusters, consultants, and agents to the plaintiff’s file that were inadequately and improperly trained to handle this type of claim. Specifically, American National assigned the claim to an internal representative charged with assessing the damage.

The internal representative performed a substandard inspection of the property and did not prepare any estimates or scopes of damages. Instead, the internal representative retained a preferred vendor who was not qualified to evaluate this type of loss to inspect the damage. The internal representative refused to retain appropriate consultants to evaluate the claim.

American National relied solely on the internal representative’s substandard investigation to determine what amounts, if any, to pay on the plaintiff’s claim. As a result of the haphazard investigation, American National wrongfully denied the plaintiff’s insurance claim.

Because of American National’s refusal to pay the claim, the plaintiff has not been able to make necessary repairs and the property has suffered further damage to the interior, roof, and other areas.

American National 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 implement reasonable standards for the investigation of a claim, and refusal to pay a claim without conducting a reasonable investigation.

Raizner Slania: Hail Damage Claim Attorneys

If your insurance carrier denied, delayed, underpaid, or disputed a Texas hail damage claim, you need an experienced team of insurance lawyers to help you get the compensation you deserve. The attorneys at Raizner Slania are extremely successful in obtaining fair compensation for victims of bad faith insurance practices. Contact us today for a free consultation to discuss your case.

Damage Claim

Raizner Slania Files Commercial Hail Damage Lawsuit On Behalf of Nonprofit

Our client, a veteran’s group and non-profit organization, was forced to file a lawsuit against Covington Insurance Company and Engle Martin & Associates after its commercial property damage insurance claim was wrongfully denied.

April 2016 Wind and Hail Storm

On April 26, 2016, a severe wind and hail storm struck Tarrant County, causing damage to the roof, exterior, and interior of the plaintiff’s property. Immediately upon discovering the damage, the plaintiff filed an insurance claim with Covington for the damages caused by the storm. In response to the claim, Covington assigned adjusters, consultants, and agents to the plaintiff’s file that were inadequately and improperly trained to assess this type of damage. Specifically, Covington assigned the claim to Engle Martin, who in turn, assigned the claim to an employee.

The Engle Martin employee inspected the property on May 4, 2016, but he performed a substandard inspection. Engle Martin and Covington failed to hire qualified experts to properly inspect the damage and did not prepare any estimates or scope of damages for the plaintiff.

Engle Martin and Covington performed an inadequate, incomplete, and unreasonable investigation of the claim, and Covington relied exclusively on this inadequate investigation to determine what amounts should be paid. As a result, our client’s claim was grossly underpaid.

Because of Covington’s delays, denials, and underpayment, the plaintiff remains unable to make the necessary repairs to its property, which has resulted in further interior and roof damage. The plaintiff suffered significant economic impact, worry, distress, and continuing economic and physical damage.

Covington Operated 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 implement reasonable standards for investigation of a claim, and refusal to pay a claim without conducting a reasonable investigation.

Texas Wind and Hail Damage Attorneys

If your insurance carrier wrongfully denied or grossly underpaid your Texas wind and hail damage insurance claim, the experienced attorneys at Raizner Slania can help. Our consultations are free and you won’t owe us anything unless we help you recover compensation. Call us today to schedule your consultation.