Tag: Bad Faith

Hurricane Harvey Wind Damage Lawsuit

Raizner Law Files Hurricane Harvey Wind Damage Lawsuit One Year After The Storm

Posted by Jeff Raizner on

One year after the devastation wrought by Hurricane Harvey, Raizner Law has filed a Harvey wind damage lawsuit on behalf of a Houston condominium complex owner against AmRisc LLC, Certain Underwriters at Lloyd’s London, Indian Harbor Insurance Company, QBE Specialty Insurance Company, Steadfast Insurance Company, General Security Indemnity Company of Arizona, United Specialty Insurance Company, Lexington Insurance Company, and the International Insurance Company of Hannover SE.

The insurance carriers, through the program design and management of AmRisc, sold a commercial property policy the plaintiff whereby the carriers would provide insurance coverage for the property. On August 26, 2018, Hurricane Harvey reached Houston and caused devastating damage. Hurricane Harvey damaged the roofing system, drywall, flooring, and other parts of the property. Immediately upon discovering the damage, the plaintiff filed a claim with the carriers and asked the cost of repairs be covered pursuant to the policy.

The insurance carriers, through AmRisc, assigned adjusters, consultants, and agents to the plaintiff’s file that were inadequate and improperly trained. Specifically, AmRisc, on behalf of all carriers, assigned the claims to a third party adjusting firm. In turn, the third party adjusting firm assigned the claim to its internal adjuster. The internal adjuster conducted an unreasonable and inadequate investigation. The claim process, inspections, and results were continuously delayed starting the day the claim was made. The carriers, Amrisc, and their agents reassigned the claim to different adjusters, refused to provide the insured with answers, ignored obvious damages at the property, and misrepresented policy benefits, all while the property sat in disrepair and they refused to issue any payments whatsoever.

Nearly two months after Hurricane Harvey hit, the internal adjuster performed a haphazard inspection of the property. Without relying on any qualified consultants whatsoever, the third party adjusting firm and its internal adjuster valued the hotel’s damages at $8,897.93, a number well below the policy deductible. The carriers relied on these findings and willfully refused to do their own investigation to verify the obvious damages. The carriers, AmRisc, and the third party adjusting firm all failed to pay or adjust the claim appropriately after liability was reasonably clear. Over the next several months, the claim was delayed under the guise of “additional investigation,” aimed at ultimately denying the plaintiff’s claim despite obvious evidence to the contrary. The carriers and AmRisc continued to bounce the claim around internally while refusing to provide answers to the plaintiff regarding covered damages. The carriers eventually wrongly denied the Hurricane Harvey commercial property damage insurance claim.

Violating the Texas Insurance Code

Our client cites numerous violations of the Texas Insurance Code, including failure to effectuate the prompt, fair, and equitable settlement of a claim, refusal to pay a claim without conducting a reasonable investigation, and failure to affirm or deny coverage of a claim to a policyholder within a reasonable time.

Get Help With Your Hurricane Harvey Wind Damage Lawsuit

It’s been just over a year since Hurricane Harvey devastated much of Texas, but many property owners are still struggling to rebuild because insurance companies aren’t paying out on valid claims. Get help with your Hurricane Harvey wind damage lawsuit today. Call Raizner Law for a free consultation to see how we can help.

Hurricane Harvey Insurance Lawyers

Victoria, Texas Hotel Owner Files Hurricane Harvey Insurance Lawsuit

Posted by Jeff Raizner on

Raizner Law has filed a Hurricane Harvey Insurance Lawsuit on behalf of a Victoria, Texas hotel owner against Palomar Specialty Insurance Company after its insurance claim was wrongfully denied under Texas Law.

Hurricane Harvey Causes Catastrophic Damage

On August 25, 2017, Hurricane Harvey made landfall in Texas and caused widespread damage. Our client’s Texas hotel is a two-story structure that contains a main lobby, offices, a restaurant, conference rooms, and 126 hotel rooms. When Hurricane Harvey swept through Victoria, Texas, the storm caused significant damage to the property. Sizeable portions of the property’s roof were compromised by wind. As a result, there was also interior damage to HVAC, ceiling, insulation, flooring, and drywall. Immediately upon discovering the damages, the plaintiff filed an insurance claim with Palomar.

Palomar’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. Palomar unreasonably pinned the loss on anything but the wind, an action designed to save Palomar hundreds of thousands of dollars in damages to the property and the business.

Palomar assigned an internal adjuster to handle the claim who was located in Indiana. The internal adjuster was unqualified, incapable of adequately assessing the damages to the property, and was the source of many delays throughout the claims process. After utilizing a preferred vendor to inspect the property in December, four months after Harvey hit, Palomar and the internal adjuster continued to delay claim resolution and ignored the insured’s requests for updates. The plaintiff and its representative continued to press Palomar for updates and/or an estimate of damages after their inspection, but they declined and ignored the requests. Two months after the inspection, three months after the initial inspection, and after the plaintiff’s representative continuously pressed Palomar and the internal adjuster for updates, the internal adjuster simply said Palomar was “still reviewing” the claim. Palomar eventually denied the claim in February 2018.

Violating the Texas Insurance Code

Palomar made 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 the investigation of a claim, and refusal to pay a claim without conducting a reasonable investigation.

Hurricane Harvey Insurance Lawyers

Policyholders that regularly pay their premiums deserve full coverage under their policies in the event of a natural disaster. If your business was damage by Hurricane Harvey and the insurance company has delayed, underpaid, or outright denied your claim, contact Raizner Law today for a free consultation.

Menchaca Ruling

Menchaca: Clarification of the Law Regarding Recovery On Insurance Claims

Posted by Andrew Slania on

Menchaca Clarified Decades of Conflicting Case Law

USAA Lloyds v. Menchaca, a case recently decided by the Texas Supreme Court, sought to eliminate confusion regarding conflicting decisions about insureds’ claims against their insurance companies. The decision announced five rules about the relationship between insurance contract claims, which are claims against the insurance company for damages under the policy, and statutory claims under the Texas Insurance Code, which can give insureds additional damages.

Background: Gail Menchaca, Hurricane Ike, And USAA

Gail Menchaca’s home was damaged during Hurricane Ike in 2008. However, when she contacted her insurer, USAA, to report the claim they sent an adjuster who found minimal damages that did not exceed the policy’s deductible. Doubting this, Gail requested a second inspection, which rendered similar results, and USAA refused to pay Gail anything on her claim. Gail sued USAA to recover her policy benefits, costs, and attorney’s fees. She sued for breach of the policy and for unfair settlement practices and violations of the Texas Insurance Code. The jury found that USAA had fulfilled its obligations under the policy but that it still owed Gail $11,350 in damages plus $130,000 in attorney’s fees. This presented an interesting conflict in case law, which held both that Gail could recover at least her policy benefits under the Insurance Code, and that Gail could not recover under the code without a finding of a breach of the policy. The Court declared five rules in an attempt to reconcile its previous decisions.

The General Rule

The Court confirmed the general rule that an insured cannot recover policy benefits for an insurer’s statutory violation if the insured doesn’t have a right to those benefits in the first place. The insured must have actual damages caused by the statutory violation, and without coverage under the policy for the claimed damages there are no actual damages. If the policy does not cover the loss, there are no benefits to recover. However, there does not have to be an actual finding of breach of the policy to show the policy covered the loss and the insurer didn’t pay.

The Entitled-To-Benefits Rule

One of the most important clarifications in Menchaca was that an insured who establishes a right to receive benefits under an insurance policy can recover those benefits as “actual damages” for a statutory violation. The benefit to recovery under the statute is that an insured may recover additional penalties such as interest on their claim and attorney’s fees. We are currently handling a case before the Texas Supreme Court, Barbara Technologies Corp. v. State Farm Lloyds, which will further clarify whether statutory penalties survive payment of an appraisal.

The Benefits-Lost Rule

The third rule recognizes an insured’s right to recover benefits under the policy for a statutory violation, even if there is no coverage for the claimed damage, if the insurer’s conduct caused the insured to not have that coverage. For example, if an insurer misrepresents that a policy covers wind damage, and the insured relies on that representation to buy the policy, but the policy does not actually cover wind damage—under the benefits-lost rule, the insurer’s misrepresentation caused the insured to not have benefits it reasonably thought it had. Therefore, the insured can still recover benefits for wind damage as actual damages for a statutory violation under the benefits-lost rule.

The Independent-Injury Rule

Menchaca clarified the two aspects of the independent injury rule. First, if an insurer’s statutory violation causes an injury independent of the insured’s right to recover policy benefits, the insured may recover damages for the injury even if the policy does not entitle the insured to receive benefits. However, when an insured seeks to recover damages that flow from denial of the policy benefits, the general rule applies and precludes recovery unless the insured is entitled to policy benefits. Second, an insurer’s statutory violations don’t permit the insured to recover actual damages beyond the policy benefits unless the violation causes an injury that is independent from the loss of benefits.

The No-Recovery Rule

Under this rule, a corollary to the other four, an insured cannot recover any damages based on an insurer’s statutory violation unless the insured establishes a right to receive benefits under the policy or an injury independent of the right to receive benefits.

Barbara Technologies And The Unanswered Question in Appraisal Cases

A question still to be answered—perhaps in our Barbara Technologies case, which is currently pending before the Court—is whether in a case where a valid claim is rejected and then appraisal is invoked and paid, can the insured still recover statutory prompt payment penalties under Section 542 of the Texas Insurance Code. The holding in Menchaca— particularly the entitled to benefits rule— seems to suggest an affirmative answer, but another line of appraisal cases hold that nothing further can be recovered when an appraisal provided for in the contract is conducted and the award is paid in full. However, without the statutory penalties in the Insurance Code an insurer has no incentive to promptly settle or pay claims; the insurer can just wait months or years to invoke the appraisal provision and then be exonerated from paying interest and attorney’s fees on the claim. Hopefully, the Court will continue to recognize the rights of insured Texans who are being wrongfully abused by their insurance companies, and provide the statutory benefits the Legislature enacted to help prevent wrongful treatment of insureds in all cases where the insurer violated the statute.

Insured’s Who Are Not Timely Paid In Full Can Recover Statutory Penalties

If you have been mistreated by your insurance company during the claims process, or your payment has been wrongfully delayed, contact the experienced lawyers at Raizner Slania LLP, who can help get you the benefits you deserve.

fire damage insurance attorneys

Industrial Building Owner Files Bad Faith Insurance Lawsuit After Fire

Posted by Jeff Raizner on

Raizner Slania LLP has filed a bad faith insurance lawsuit on behalf of an industrial building owner against Certain Underwriters at Lloyd’s London – Brit Syndicate 2987 and Hibbs-Hallmark & Company after its insurance claim was wrongfully denied.

Catastrophic Fire Devastates Commercial Property

The plaintiff owns a scrap metal dealing business that processes metal and then sells it to mills for profit. The property encompasses nearly four acres of land and includes multiple buildings, including a large scrap metal yard, a main office building, and several covered areas throughout the property. The business also utilizes numerous machines and large pieces of equipment, such as excavators, shredders, and separators, among others.

On May 5, 2017, a catastrophic fire broke out at the property. As a result, the business equipment on the property was severely damaged. In addition to damaged business equipment, the plaintiff lost extensive business income as a result of the fire damage to the property. Two pieces of industrial machinery were completely destroyed and two others sustained significant damage.

The damaged machinery prevented the plaintiff from processing and preparing its scrap metal. Because of this, the plaintiff lost business on significant materials that could have been purchased and sold to mills for a profit in the course of ordinary business operations. The damaged machines meant the plaintiff was unable to process the metal, so the plaintiff was forced to resell bulk material after the fire. Unfortunately, the post-fire material had to be processed manually, which caused the materials to incur higher labor costs.

Soon after the fire, the plaintiff filed an insurance claim for substantial property damages and lost business income. The plaintiff asked that the cost of the damages be covered pursuant to the policy, but Lloyd’s has refused to make a full payment on the plaintiff’s claim.

Lloyd’s conducted an unreasonable and inadequate investigation of the damages to the equipment and looked to find policy exclusions in order to deny the claim. Lloyd’s wrongfully denied, underpaid, and delayed plaintiff’s claim for actual damages to the property and lost business income. Specifically, Lloyd’s has chosen to continue to deny and delay timely payment of the damages.

Violations of the Texas Insurance Code

Our clients cites numerous violations of the Texas Insurance Code, including the failure to effectuate a prompt, fair, and equitable settlement of a claim and misrepresentation of the insurance policy under which it affords property coverage to the plaintiff. Our client also alleges numerous violations of the Texas Deceptive Trade Practices-Consumer Protection Act.

Get Help With Your Insurance Claim

If your commercial insurance claim includes damage to specialty equipment, you will need the help of an experienced insurance attorney. Insurance companies often try to use dishonest tactics and misrepresentation to deny coverage for specialty equipment. At Raizner Slania LLP, our fire damage insurance attorneys have helped scores of clients with insurance claims and we know how to evaluate specialty equipment insurance claims. Contact us today to schedule a free consultation to discuss your case.

Reinsurance Issues In Puerto Rico After Hurricane Maria

Posted by Amy Hargis on

Practically every insurance company utilizes reinsurance to pass on the risk of claims to other insurance companies, or reinsurers. Reinsurance is basically insurance for insurance companies. In principle, the practice of reinsuring risk should help policyholders get their rightful payments without fear that the insurance company will become insolvent. However, in practice, reinsurers are typically foreign based companies that have no incentive to expediently investigate or pay claims. Most primary insurance companies in Puerto Rico cede the vast majority of the liability from their insurance policies to reinsurers. Since Hurricane Maria, insurers have been so slow to act that Puerto Rico’s Commissioner of Insurance has levied over $2 million in fines to insurers who are delaying the processing and closing of claims.

The Power of Maria

Hurricane Maria was the most powerful storm to hit Puerto Rico in almost 100 years, and it came right on the tail of Hurricane Irma, which had already knocked out power on parts of the island. The island faces billions of dollars of damage and is still, eight months later, not fully recovered. Sadly, with the trend over the last 35 years of increased natural disasters more storms like Maria are to be expected. The problem of reinsurer recalcitrance after natural disasters is not going away.

The Reinsurance Traffic Jam After Hurricane Maria

Many business and commercial buildings were damaged by Maria, and thousands of business policyholders filed claims with the insurer they received their policy from, only to find their insurer had ceded the vast majority of their coverage to a reinsurer. While there is nothing unique about that process, the way the insurance market is structured in Puerto Rico has created a traffic jam preventing insurance capital from flowing back into the economy. Here’s why: the insurance market in Puerto Rico is dominated by thinly capitalized domestic insurers who ceded almost all of their risk to European reinsurance companies. But the primary obligation to inspect properties and handle claims falls to these marginally capitalized primary insurers, some of which are nothing more than fronting entities. Given the vast numbers of claims filed after Maria, these domestic insurers lack the resources and expertise to handle the volume of claims they are being presented with, and many continue to do absolutely nothing with those claims.

Meanwhile, in the United Kingdom, German, Switzerland and elsewhere, the reinsurers who bear the vast majority of the risk on Maria claims are simply watching, waiting, and investing money they should be paying out to rebuild Puerto Rico. The reinsurer generally doesn’t have an obligation to pay until the primary insurer completes its investigation and requests payment; and the primary insurers don’t have the resources to accomplish these basic tasks.

The policy holder now has two companies either unmotivated or incapable of paying out on claims. Recalcitrant, slow paying insurance companies are causing policyholders additional economic hardship in a time when it matters the most. Without prompt payouts some businesses are unable to make the repairs necessary to rebuild and reopen.

Know Your Rights

Recalcitrant reinsurers have been a huge issue in Puerto Rico in the aftermath of Hurricane Maria. There are many ways recalcitrant insurers can slow down the claims process. They have every motivation to do so: most profits for an insurance or a reinsurance company come from the “float,” meaning the cash difference between premiums and claim payouts. Insurers invest the float, and make money on their investments. Even though the insurers are being fined for their wrongful conduct, it is still cheaper for them to pay the fines than to pay the claims. This is a gross violation of the legal rights of the insured. Under Puerto Rico’s insurance laws, policyholders have the right to have their claims handled in a timely manner. Policyholders in Puerto Rico can report abuses by their insurance company to the Commissioner of Insurance. Once reported, the Commissioner of Insurance will investigate these claims and levy fines if the insurance company is found to be acting in bad faith.

Commercial Insurance Attorneys

What Is Reinsurance?

Posted by Andrew Slania on

Natural disasters have the potential to cause millions of dollars in claims payouts from insurance companies. Most insurance companies would be unable to make such large payouts if it weren’t for reinsurance. Reinsurance is like insurance for insurance companies. It allows insurance companies to pass on the risk of large payouts to other insurers in exchange for part of the premium they receive from policyholders. Commercial insurance attorneys frequently witness firsthand the effect reinsurance has on insurance claims.

Why Do Insurance Companies Need Reinsurance?

By law, insurance companies are required to have enough capital in their reserves to pay all potential claims. This protects policyholders from not receiving payouts if an insurance company becomes insolvent. For example, if an insurance company receives $50 million in premiums from policyholders in a year, but a natural disaster comes and causes $100 million in covered damages, the insurance company may not have enough money to pay out on all the claims. To prevent this, insurance companies will mitigate their risks through reinsurance. When insurance companies utilize reinsurance to mitigate their risks, they are also lowering the amount of capital they are required to have in their reserves.

What Is A Reinsurance Treaty?

A reinsurance treaty is like an insurance policy between insurance companies. The original insurance company contracts under a treaty with the reinsuring company for it to cover a particular type of risk in a group of policies. The original insurance company cedes the risk to a reinsurer and will share the premiums it receives from its own policyholders with them. In turn, the reinsurer will pay out on claims against the original insurer that involve that particular type of risk.

What Is A Reinsurance Bordereau?

An initial reinsurance bordereau is a detailed report to the reinsurer on the premiums ceded from each of the underlying policies. Typically, it includes basic details about each policy including the gross premium and ceded premium. This is how the reinsurer initially finds out the details of the policies they are reinsuring. Bordereaux are usually required periodically under a reinsurance treaty. In this case, they are frequently monthly or quarterly reports of premiums and losses. A loss bordereau will contain details of claims on reinsured policies and any paid-out losses or expenses.

Limitations Placed On Reinsurance

Insurance companies are regulated by the state (or commonwealth in the case of Puerto Rico) governments where they do business. Each state can put limits on how much risk an insurer can cede, but it often is a very high percentage. The Office of the Insurance Commissioner (OIC) of each state can require extra approval for insurance companies to reinsure more than a certain amount of risk. For example, in Puerto Rico an insurer can cede the total or partof their risk, but a domestic insurer needs written authorization from the OIC to cede more than 75%. Various states have similar rules on whether an insurer can cede all or part of its risk to other insurers. Similarly, states and territories may place restrictions on whether an insurer may reflect proceeds due from a reinsurer as an asset on the insurer’s balance sheet, and these limitations are important when insurers calculate their compliance with capitalization rules.

Commercial Insurance Attorneys

The use of reinsurance can complicate the insurance process. Regardless of whether an insurance company has a reinsurance policy, policyholders are entitled to complete protection under their policies. If your insurance company has delayed, underpaid, or denied your insurance claim, contact the commercial insurance attorneys at Raizner Slania LLP today for a free consultation to discuss your case. We have experience dealing with the largest insurance companies in the world and our commercial insurance attorneys can make sure you get what you are rightfully entitled to under your policy.