On March 23, 2016, a wind and hail storm swept through Dallas County causing substantial damage to the roofs, HVAC, exteriors, and interiors of the condominiums. Immediately upon discovering the damage, the plaintiff filed an insurance claim under its policy with Peleus for damages caused by the storm. The plaintiff asked that the cost of repairs be covered pursuant to the policy. In response to the claim, Peleus assigned adjusters, consultants, and agents to the plaintiff’s file that were inadequate and improperly trained. More specifically, Peleus assigned Strata to adjust the claim and Strata assigned the claim to a claims manager. Peleus also assigned the plaintiff’s claim to Engle Martin, who in turn assigned it to an employee to adjust the damage.
Strata and Engle Martin failed to perform a thorough investigation of the claim. Strata, Engle Martin, and their representatives failed to prepare any estimates or scopes of damages to the property for the plaintiff. They also grossly undervalued the damages they did accept. Strata, Engle Martin, and their representatives made false representations to the plaintiff, including illegitimately representing that the entirety of damages occurred prior to the policy period and improperly ignoring facts confirming and supporting the hail and wind event and in turn extent of damages. Peleus had ultimate decision-making authority over the claim. Peleus falsely denied the claim, 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.
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As a result of Hurricane Harvey’s devastating winds, the building suffered damage to the interiors, exteriors, lighting, elevators, security cameras, and roofing systems, among other components. Immediately upon discovering the damage, the plaintiff filed an insurance claim with Texas Windstorm and asked that the cost of repairs be covered pursuant to the policy. In response to the claim, Texas Windstorm sent an adjuster to the property on September 29, 2017, who personally observed substantial wind damage resulting from Hurricane Harvey. However, Texas Windstorm relied upon an engineer from BSC Forensics who concluded the damage was not storm related, but instead resulted from long-term trapped moisture, installation deficiencies, and other excuses.
Despite clear evidence of covered damage, Texas Windstorm engaged in and ratified this improper claims conduct and ultimately approved a gross underpayment of the contractual damages. Texas Windstorm instead unreasonably blamed the loss on causes other than wind to avoid contractual responsibilities and to save in excess of $1,000,000. The plaintiff cooperated throughout the claim process and even had consultants meticulously point out the extent of the damages covered by the subject policy. Texas Windstorm chose to ignore obvious damages to the property. The plaintiff was forced to hire its own representative and demand re-inspections and re-evaluations of the obvious damages to the property that Texas Windstorm ignored.
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On September 9, 2018, a windstorm struck the plaintiff’s property which caused significant damage to the commercial structure, including damage to building components like the roof system, interior, exterior, and more. Upon discovering the damage, the plaintiff filed an insurance claim and asked that the cost of repairs be covered pursuant to the policy. The plaintiff’s own consultant further identified dramatic damage that ruined parts of the building’s roof.
The insurance carrier, through AmRisc, assigned adjusters, consultants, and agents to the plaintiff’s file that were inadequate and improperly trained. Specifically, the claim was delegated to AmRisc to assign the claims to CJW and Sedgwick as the third party adjusting firms to handle the claims. AmRisc and Underwriters’ preferred adjusting company, Sedgwick, engaged Rimkus Consulting Group, Inc. engineer Pablo Anguian who performed a cursory review of the damages aimed at denying the claim. After an unreasonable and inadequate investigation of the property, Mr. Anguian recommended a complete denial of the full scope of covered damages; and thus, the plaintiff’s claim for windstorm damage was wrongfully denied. Despite clear evidence of covered damage, Underwriters engaged in and ratified this improper claims conduct and ultimately approved a complete denial of the contractual damages. This underpayment omitted important facts, physical evidence, and meteorological data supporting the plaintiff’s claim.
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On April 12, 2016, a severe hailstorm swept through Bexar County causing significant damage to the roofs, interiors, and exteriors of condominiums contained in over 50 separate buildings managed by the policyholder homeowners association. Immediately upon discovering the damage, the homeowners association filed a hail damage insurance claim with Mid-Century to cover the cost of the repairs and other damages. In response to the claim, Mid-Century assigned adjusters, consultants, and agents to the plaintiff’s file that were inadequate and improperly trained. Specifically, the claim was assigned to two adjusters, both of whom were not properly trained to handle this type of claim and failed to perform an adequate evaluation of the damage.
After a haphazard investigation of the property, the adjuster prepared an estimate of damages to the structure that grossly undervalued and ignored obvious damages to the property. Mid-Century relied solely on the adjusters’ investigation to determine what amounts, if any, to pay on the plaintiff’s claim. Mid-Century and the adjusters represented to the plaintiff that certain damages were not covered under the policy when in fact they were. Mid-Century denied and grossly underpaid the plaintiff’s claim. In addition, Mid-Century continued to deny and delay timely payment of the damages it did accept. This caused the plaintiff to suffer significant economic impact, worry, distress, and continuing economic and physical damage.
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The property consists of 13 condominium buildings with approximately 140 units. On May 30, 2015, a wind and hailstorm swept through the area and pelted the property with hail one-inch in diameter. The wind and hail caused substantial damage to the property, including damage to the siding, roof structures, and HVAC units. Our client reported the hailstorm damage to Allstate and asked that the cost of repairs be covered pursuant to the policy. In response to the claim, Allstate assigned the claim to a claims representative located in Irving, Texas. In turn, the claims representative engaged the help of an engineering firm to evaluate the damage.
The investigation of the property only lasted approximately one hour and no investigation of the roof was conducted. The engineering firm was not hired to investigate the damages, but rather the exact date the damage occurred to determine whether or not the damage occurred during the coverage period. The engineering firm relied on “observation reports” from “storm spotters” throughout the United States, which are “not official records” but were “summarized and eventually reported by the National Climatic Data Center (NCDC).” However, the engineering firm did not provide any of those “observation reports,” records, or other NCDC data in support of its conclusions. Based solely on these observation reports, Allstate denied the insurance claim alleging the damage occurred outside of the coverage period. Allstate did not provide any supporting documentation for its conclusion.
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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.
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