More good news on the hailstorm litigation front from Jay Old & Associates PLLC:

In an unanimous opinion, the Houston 1st Court of Appeals the first appellate opinion addressing the 2011 reforms to Ch. 2210 of the Texas Insurance Code, otherwise known as “House Bill 3.”

This case involved a claim for damage to the Joneses home which TWIA accepted in full.  The claim was identified by the independent adjuster as pertaining to a portion of the Jones’ roof.  TWIA gave notice of claim acceptance to the Joneses, and informed them of their right to seek appraisal of any dispute arising from the claim determination.  They did not seek appraisal.  Instead, almost immediately after the deadline to seek appraisal expired, the Joneses filed suit against TWIA claiming that their claim had been wrongfully denied.  TWIA filed a motion to dismiss the case because the claim had not been denied, and the sole remedy for the insured was to have sought appraisal within the statutorily proscribed period of time, which had already passed.  The Joneses responded to that motion by attaching an estimate which recommended that the entire roof be replaced.  The Joneses argued that since this estimate exceeded the scope of TWIA’s adjuster’s estimate, the claim had been “denied” by TWIA by virtue of TWIA’s non-payment for the entire roof.

The Court of Appeals wrote a concise opinion which quoted liberally from TWIA’s briefs.  The Court recognized and further clarified the definition of a “claim” for insurance coverage and distinguished that term from the issue of “coverage” for a claim.  The Court also explicitly found that TWIA fulfilled its obligations under the new statute, over-ruling the Joneses’ argument that the documentation sent by TWIA suggested that a partial denial of the claim had been made.

The decision has broader implications as well, given that it involves the definition of the term “claim” and directly impacts claims raised for the first time during litigation.

Pin It on Pinterest

Share This