Opinion by: Sandee Bryan Marion, Chief Justice.
In the underlying lawsuit, Candelaria Garcia alleged State Farm Lloyds and Sylvia Garza (collectively, "appellees") failed to properly investigate and adjust an insurance claim made under Garcia's State Farm homeowner's policy. After the lawsuit was filed, the parties agreed to an appraisal for the purpose of determining the amount of the loss. After completion of the appraisal, State Farm paid the appraisal award and appellees moved for summary judgment on all of Garcia's claims. Garcia then amended her petition to ask that the appraisal award be set aside. The trial court rendered summary judgment in favor of appellees and signed a final judgment disposing of all of Garcia's claims. Garcia now appeals the trial court's summary judgment.
In 2014, State Farm issued a homeowner's policy to Garcia providing coverage for her home. Following storm damage to her house, Garcia retained a private adjustor to "examine, investigate, estimate, collect documentation, and communicate" with State Farm with regard to any and all claims for damages. One day later, on January 22, 2015, Garcia submitted a claim to State Farm for hail-related and possibly wind-related damage to her house. State Farm assigned the claim to its own adjustor, Sylvia Garza. On February 26, 2015, Garza inspected Garcia's house and prepared an estimate of damage, which concluded the $902.37 loss did not exceed Garcia's $1,760.00 deductible. On March 2, 2015, State Farm advised Garcia that no payment would be made to her.
On April 8, 2015, Garcia sued appellees, alleging breach of contract, breach of duty of good faith and fair dealing, as well as violations of the Texas Prompt Payment of Claims Act, the Insurance Code, and the DTPA. Thereafter, State Farm demanded the appraisal process provided in the insurance policy and appointed Lee Moynahan as its appraiser. Garcia responded and appointed Jamie Wesselski as her appraiser. Litigation was stayed pending the appraisal. On September 23, 2015, the appraisers signed an agreement estimating an actual cash value of $6,142.92 and a replacement cost value of $7,835.70 for hail
On December 11, 2015, State Farm notified Garcia the litigation stay was lifted. Appellees then moved for summary judgment, alleging State Farm's payment of the appraisal award estopped Garcia from maintaining a breach of contract claim and, without a contract claim, she could not maintain her extra-contractual claims.
On January 27, 2016, Garcia's attorney notified State Farm's attorney that Garcia was rejecting State Farm's offer to pay $4,382.92. On February 25, 2016, Garcia filed an amended petition, in which she added a request that the appraisal award be set aside and disregarded. Garcia also filed a response to appellees' motion for summary judgment. Appellees filed a reply in support of their motion for summary judgment responding to Garcia's claim that the appraisal award should be set aside and disregarded. On March 10, 2016, the trial court rendered summary judgment in favor of appellees.
In their answer to Garcia's petition, appellees pled the affirmative defense of estoppel, asserting Garcia's breach of contract claim, extra-contractual claims, and any claims under the Prompt Payment of Claims Act were all barred by State Farm's payment of the appraisal award. In the motion for summary judgment, appellees asserted that payment of the appraisal award resolved and disposed of all claims in the lawsuit.
In her first issue on appeal, Garcia asserts the trial court erred when it rendered summary judgment on her claim to set aside and disregard the appraisal award because appellees' motion for summary judgment did not address that claim and appellees did not file an amended or supplemental motion for summary judgment after she filed her amended petition raising that claim. Garcia also asserts the trial court could not consider appellees' reply in support of their motion for summary judgment in ruling on the motion. Appellees counter that their motion for summary judgment was broad enough to encompass Garcia's amended petition because the validity of the appraisal award was central to their motion for summary judgment; therefore, the trial court did not err in rendering summary judgment on all of Garcia's claims.
A trial court may grant a party summary judgment only on a ground raised in that party's motion. See Lehmann v. Har-Con Corp., 39 S.W.3d 191, 200 (Tex. 2001). Although a trial court generally commits reversible error by granting summary judgment on a ground or claim not addressed in the motion, such error is rendered harmless if "the omitted cause of action is precluded as a matter of law by other grounds raised in the case." G & H Towing Co. v. Magee, 347 S.W.3d 293, 297-98 (Tex. 2011). Similarly, when a summary judgment movant fails to amend its motion after an amended or supplemental petition, we may affirm the summary judgment if (1) the amended or supplemental petition essentially reiterates previously pleaded causes of action, (2) a ground asserted in the motion for summary judgment conclusively negates a common element of the newly and previously pleaded claims, or (3) the original motion is broad enough to encompass the newly asserted claims. Callahan v. Vitesse
"We review a trial court's grant of summary judgment de novo." Frost Nat'l Bank v. Fernandez, 315 S.W.3d 494, 508 (Tex. 2010). Estoppel is an affirmative defense. TEX. R. CIV. P. 94. A defendant moving for summary judgment on an affirmative defense has the burden to conclusively establish that defense. Diversicare Gen. Partner, Inc. v. Rubio, 185 S.W.3d 842, 846 (Tex. 2005). A defendant who conclusively establishes an affirmative defense is entitled to summary judgment. Fernandez, 315 S.W.3d at 508. "When reviewing a summary judgment, we take as true all competent evidence favorable to the nonmovant, and we indulge every reasonable inference and resolve any doubts in the nonmovant's favor." Diversicare Gen. Partner, 185 S.W.3d at 846. Once the movant has established a right to summary judgment, the nonmovant must expressly present any reasons seeking to avoid the movant's entitlement and must support the reasons with summary judgment proof to establish a fact issue. City of Houston v. Clear Creek Basin Auth., 589 S.W.2d 671, 678 (Tex. 1979). If the nonmovant does not raise a fact issue as to every element of the estoppel defense, summary judgment is proper. See Toonen v. United Serv. Auto. Ass'n, 935 S.W.2d 937, 940 (Tex. App.-San Antonio 1996, no writ) ("As a general rule, a party seeking to avoid a summary judgment by virtue of an affirmative defense bears the burden of raising a material issue of fact on that defense.").
In this case, appellees bore the initial summary judgment burden on their estoppel defense to conclusively establish that all of Garcia's claims were barred by the payment of the appraisal award. If they satisfied that burden, the burden shifted to Garcia to raise a fact issue on whether the appraisal award should be set aside. See Barnes v. Western Alliance Ins. Co., 844 S.W.2d 264, 267 (Tex. App.-Fort Worth 1992, writ dism'd by agr.) (burden of proof on party seeking to avoid award). In her response to appellees' motion for summary judgment, Garcia argued genuine issues of material fact existed as to whether the appraisal award should be set aside. Therefore, whether she raised this argument in her amended petition or in her response to appellees' motion for summary judgment, the issue of whether the appraisal award should be set aside was encompassed within appellees' motion for summary judgment.
Appraisal awards made pursuant to the provisions of an insurance contract are binding and enforceable. Providence Lloyds Ins. Co. v. Crystal City Indep. Sch. Dist., 877 S.W.2d 872, 875 (Tex. App.-San Antonio 1994, no writ). The effect of an appraisal provision is to estop one party from contesting the issue of damages in a suit on the insurance contract, leaving only the question of liability for the court. Franco v. Slavonic Mut. Fire Ins. Ass'n, 154 S.W.3d 777, 786 (Tex. App.-Houston [14th Dist.] 2004, no pet.). An appraisal award made pursuant to an insurance policy is binding
Here, the parties do not dispute the contractual validity of the appraisal clause contained in the insurance policy as a manner of resolving a dispute as to the amount of Garcia's loss. There also is no dispute (1) Garcia's claim was appraised pursuant to the appraisal clause, (2) the two appraisers agreed on the amount of the loss and they both signed the "Insurance Appraisal Award Agreement," and (3) State Farm tendered the award amount to Garcia. Accordingly, appellees were entitled to summary judgment in their favor on their estoppel defense to Garcia's breach of contract claim unless Garcia raised an issue of fact as to a ground for setting aside the appraisal award or that appellees' estoppel defense fails because she rejected payment of the award. See id. (holding, USAA's motion and supporting proof were legally sufficient to establish (1) insured's claim had been appraised pursuant to the policy, and (2) USAA had tendered the amount awarded by the appraisers; accordingly, USAA was entitled to summary judgment in its favor on insured's breach of contract claim unless insured raised a fact issue on ground for setting aside the appraisal award); see also Cantu v. S. Ins. Co., 03-14-00533-CV, 2015 WL 5096858, at *4 (Tex. App.-Austin Aug. 25, 2015, no pet.) ("Southern offered as summary judgment evidence the appraisal award signed by the umpire and one appraiser. Thus, Southern met its summary judgment burden to establish that the appraisal was valid and binding, and the burden shifted to [the insured] to create a fact issue as to one of the three grounds for setting aside an appraisal award.").
Because every reasonable presumption will be indulged to sustain an appraisal award, the burden of proof is on the party seeking to avoid the award. Barnes, 844 S.W.2d at 267. However, although every reasonable presumption will typically be made in favor of an appraisal award, when reviewing a summary judgment, that rule must yield to the degree its application conflicts with the presumptions required to be made in favor of a summary judgment non-movant. Wells v. Am. States Preferred Ins. Co., 919 S.W.2d 679, 683 (Tex. App.-Dallas 1996, writ denied); Hennessey v. Vanguard Ins. Co., 895 S.W.2d 794, 798 (Tex. App.-Amarillo 1995, writ denied). Therefore, although Garcia had the burden to raise a fact issue on setting aside the appraisal award, we are required to view the summary judgment proof in the light most favorable to Garcia, as the non-movant, and to resolve against appellees any doubt as to the existence of a genuine issue of material fact on their estoppel defense. Mays v. Foremost Ins. Co., 627 S.W.2d 230, 233-34 (Tex. App.-San Antonio 1981, no writ).
Texas courts recognize three grounds on which the results of an otherwise binding appraisal may be set aside: (1) when the award was made without authority; (2) when the award was made as a result of fraud, accident, or mistake; or (3) when the award was not in compliance with the requirements of the policy. Wells, 919 S.W.2d at 683; Providence Lloyds Ins. Co., 877 S.W.2d at 875-76. Garcia argues the award should be set aside based only on the first and second grounds.
Garcia's public adjuster estimated costs to repair, among other items, one turtle-type roof vent, the interior kitchen ceiling, and the dining room ceiling. State Farm and its adjustor (Garza) estimated
An appraisal "binds the parties to have the extent or amount of the loss determined in a particular way." Scottish Union & Nat'l Ins. Co. v. Clancy, 71 Tex. 5, 8 S.W. 630, 631 (1888). Appraisers have no authority to determine questions of causation, coverage, or liability. Wells, 919 S.W.2d at 684. "[T]he function of the appraisers is to determine the amount of damage resulting to the property submitted for their consideration. It is certainly not their function to resolve questions of coverage and interpret provisions of the policy." Id. at 685. "The principle in Wells was that the appraisers have certain powers and that, acting within those powers, their determination `can estop one party... from contesting the issue of damages in a suit on the insurance contract, leaving only the question of liability for the court.'" Johnson v. State Farm Lloyds, 204 S.W.3d 897, 902 (Tex. App.-Dallas 2006) (quoting Wells), aff'd, 290 S.W.3d 886 (Tex. 2009). "Actions beyond those powers are not given estoppel effect." Id.
However, whether causation is a liability question or a damages question depends on the circumstances. For example, "when different causes are alleged for a single injury to property, causation is a liability question for the courts." State Farm v. Johnson, 290 S.W.3d 886, 892 (Tex. 2009). "Appraisers can decide the cost of repairs in this context, but if they can also decide causation there would be no liability questions left for the courts." Id. "By contrast, when different types of damage occur to different items of property, appraisers may have to decide the damage caused by each before the courts can decide liability." Id. In this context, courts can decide whether a particular type of damage is covered, "but if [the courts] can also decide the amount of damage caused by each, there would be no damage questions left for the appraisers." Id.
Id. at 892-93 (footnotes omitted).
Distinguishing between causation as a damages question and causation as a liability question is complicated by the practical reality that
Id. at 893. Ultimately, "whether the appraisers have gone beyond the damage questions entrusted to them will depend on the nature of the damage, the possible causes, the parties' dispute, and the structure of the appraisal award." Id.
The appraisal clause in this case allowed Garcia and State Farm to each "select a competent, disinterested appraiser." The clause further provided as follows:
Garcia and State Farm each selected an appraiser. The two appraisers agreed on the amount of the loss; therefore, an umpire was not necessary. Both appraisers signed the "Insurance Appraisal Award Agreement." Nothing in the appraisal clause specifies the manner in which the appraisers were to determine the amount of the loss, nor were they required to rely on — or even refer to — any prior damage estimates. Instead, the appraisers were required only to be "disinterested" and "set the amount of the loss." The appraisal award states:
In an unpublished opinion cited by State Farm, a federal district court addressed whether an appraisal panel was required to consider earlier damage estimates. In Gronik v. Chubb Indemnity Insurance Co., Nos. 10-cv-0954, 11-cv-697, 2015 WL 7430026, at *2 (E.D. Wis. Nov. 20, 2015), a dispute over which line items of the appraisal award were still in dispute and should be presented at trial arose because, before the appraisal process was completed, the insurance company made a series of payments to the insureds, which they accepted, for structural damage to the property. The insurance company made these payments based on estimates from Belfor, a property restoration company, and the process Belfor used in assessing damage was different from the process the appraisers used. Thus, when the appraisal was complete and confirmed, it proved impossible for the parties to line up the pre-payments with specific line items listed in the appraisal. Subsequently, the insurance company went through the appraisal line items and concluded that a total of $661,383.61 of the line item damages from Part 1 of the award was covered under the policy. Because the insurance company had
The insured argued the line items the insurance company agreed were covered were still at issue in the case because the insurance company could not prove the pre-payments it issued before the appraisal were issued for specific line items of damage listed in the appraisal. The district court disagreed, stating:
Id.
The holding in Gronik is consistent with the holding in Providence Lloyds Insurance Co., wherein a panel of this court considered the appellee's argument that the appraisal award was not made in substantial compliance with the appraisal provisions because the umpire exercised independent judgment with regard to five items, instead of simply agreeing with one appraiser or the other as to those items. 877 S.W.2d at 876. This court stated
Id. at 877-78.
We hold that, under Gronik and Providence Lloyds Insurance Co., the damage estimates prepared by Garcia's adjuster and by State Farm's adjuster no longer mattered once the appraisal process was complete. The only obligation imposed on the appraisers in this case was to be "disinterested," and the only obligation imposed on an umpire was to be "impartial." Also, there is no summary judgment evidence establishing the appraisers determined the omitted items were not damaged by hail. Instead, they simply omitted certain items from the appraisal award, and Garcia provided no summary judgment evidence regarding why both appraisers decided to omit the items. See Johnson, 290 S.W.3d at 892-94 (appraisers
In her response to appellees' motion for summary judgment and on appeal, Garcia does not distinguish between fraud, accident, or mistake. Instead, she broadly alleges the evidence regarding the appraisers' omission of damage items that were part of the prior damage estimates may be construed to show such omissions were due to fraud, accident, or mistake. Because Garcia did not specifically argue fraud and submitted no evidence in support of any claim that the appraisers' actions were fraudulent, we conclude she did not carry her burden to raise a fact issue on that ground. Regarding accident or mistake, in her brief on appeal, Garcia complains about the "omission" of various items
"A court may set aside an award on the ground of mistake [or accident] only `upon a showing that the award does not speak the intention of the appraisers.'" MLCSV10 v. Stateside Enter., Inc., 866 F.Supp.2d 691, 702 (S.D. Tex. 2012) (quoting Providence Washington Ins. Co. v. Farmers Elevator Co., 141 S.W.2d 1024, 1026 (Tex. Civ. App.-Amarillo 1940, no writ)). "Mistake" in this context has a narrowly defined meaning: an actionable "mistake" is one that caused an award to operate in a way the appraisers did not intend. Providence Washington Ins., 141 S.W.2d at 1026-27 (trial court's judgment setting aside an award by two appraisers and an umpire reversed and rendered because there was no mistake — the award was the intended result); see also Continental Ins. Co. of N.Y. v. Guerson, 93 S.W.2d 591, 594 (Tex. Civ. App.-San Antonio 1936, writ dism'd) ("Any errors of judgment, honestly and fairly exercised, on the part of the [appraisers] in making the award, are matters with which the courts cannot concern themselves; but if the award returned does not embody their real judgment on the matters as submitted for their determination and award, the courts, under proper pleading and proof, can and should grant relief."). The Fort Worth Court of Appeals has defined "mistake" as:
Barnes, 844 S.W.2d at 268 (quoting district court's jury instruction).
In MLCSV10, the court considered whether the appraisal award was the result of fraud, mistake, or accident. The insured's appraiser (Haden) refused to sign the appraisal award, in part, because he disagreed with the appraised amounts for repairing various items. 866 F.Supp.2d at 697. Haden testified he disputed the umpire's incorporation of the insurance company's appraiser's (Lochridge) estimates rather than Haden's to arrive at the appraisal amounts for these categories of damage. One reason for Haden's disagreement was that he had submitted various contractors' reports to support his numbers and Lochridge had not. Id.
On appeal, the court determined the insured provided no evidence that the appraisal award did not reflect the umpire's intent. Id. at 702. "To the contrary, the record is clear that, for certain damages, [the umpire] decided to use Lochridge's estimates over Haden's. An umpire must often choose between two competing values. [The umpire's] decision to use Lochridge's estimates rather than Haden's does not mean that the appraisal award resulted from accident or mistake." Id. The court also concluded there was no evidence anyone lied to the appraisers or to the umpire during the appraisal process, or that the appraisal panel was confused as to what damage the property sustained as a result of the hurricane and vandalism. Id.
Here, Garcia's summary judgment evidence includes the original damage estimates provided by the parties' adjusters, both of which included estimated costs to repair certain items, albeit for different amounts. However, the appraisers did not include some of these items in their appraisal award. Other than the prior damage estimates, Garcia provided no other summary judgment evidence; for example, an affidavit from either appraiser.
On appeal, Garcia argues appellees failed to conclusively establish their estoppel defense, in part, because they cannot show she accepted payment of the appraisal award because her attorney sent a letter to State Farm formally rejecting its offer to pay $4,382.92 as the proper appraisal award amount. Garcia's letter stated, in pertinent part, as follows:
Garcia contends that, in viewing the evidence in the light most favorable to her as the non-movant, this court may infer she did not voluntarily accept the tendered amount with full knowledge of all material facts and as a full and final release.
Appellees rely on several cases for their argument that their estoppel defense is not defeated by Garcia's rejection of the appraisal award on the ground that if an appraisal award has been reached in accordance with the terms of the insurance policy and the insurer has timely tendered the full amount awarded by the appraisers, that conduct is legally sufficient to entitle the insurer to summary judgment on the breach-of-contract claim against it. See, e.g., United Neurology, P.A. v. Hartford Lloyd's Ins. Co., 101 F.Supp.3d 584, 619-20 (S.D. Tex. 2015) (finding that United Neurology and Hartford were in substantial compliance with the appraisal award clause in the policy, that the award was binding and enforceable, and despite United Neurology's refusal to accept the payment tendered, it failed to show that Hartford breached the contract), aff'd, 624 Fed. Appx. 225 (5th Cir. 2015); Brownlow v. United Serv. Auto. Ass'n, No. 13-03-758-CV, 2005 WL 608252, at *2 (Tex. App.-Corpus Christi Mar. 17, 2005, pet. denied) (insured claimed breach of contract because USAA did not pay the full value of a plumbing re-route job; court held, "USAA participated in the appraisal process and tendered the amount awarded by the umpire. Because USAA complied with the requirements of the contract it cannot be found in breach."); Caso v. Allstate Texas Lloyds, Civ. A. No. 7:12-CV-478, 2014 WL 528192, at *5 (S.D. Tex. Feb. 7, 2014) (insured returned tendered award; court held, "the award remains both binding and enforceable until it is set aside, notwithstanding Plaintiffs' rejection of Allstate's tender, an apparently-baseless rejection for which Plaintiffs have not offered an explanation."); Devonshire Real Estate & Asset Mgmt., LP v. American Ins. Co., 3:12-CV-2199-B, 2014 WL 4796967, *18 (N.D. Tex. Sept. 26, 2014) ("[S]o long as there is a binding and enforceable appraisal award and the insurer timely and full[ly] pays the resulting award, estoppel should apply regardless of whether the insured actually accepts payment.").
Garcia, on the other hand, relies on other cases for her argument that an insured is not estopped from pursuing a breach of contract claim unless she accepts payment of the appraisal award as a full and final release. See, e.g., Blum's Furniture Co. v. Certain Underwriters at Lloyds London, CIV.A. H-09-3479, 2011 WL 819491, at *3 (S.D. Tex. Mar. 2, 2011) ("A plaintiff, however, is estopped from pursuing a breach of contract claim not by the issuance of the appraisal award. Instead, the plaintiff is estopped only where, as here, the plaintiff
But the cases on which Garcia relies are distinguishable on their facts. In Blum's
There is a strong public policy favoring enforcement of appraisal clauses and every reasonable presumption is indulged to sustain an award. United Neurology, 101 F.Supp.3d at 595; see also Johnson, 290 S.W.3d at 895 ("But in every property damage claim, someone must determine the `amount of loss,' as that is what the insurer must pay. An appraisal clause `binds the parties to have the extent or amount of the loss determined in a particular way.' Like any other contractual provision, appraisal clauses should be enforced."). The purpose of an appraisal clause is to provide a binding, extra-judicial remedy for any disagreement regarding the amount of the loss. Amine v. Liberty Lloyds of Texas Ins. Co., No. 01-06-00396-CV, 2007 WL 2264477, at *3 (Tex. App.-Houston [1st Dist.] Aug. 9, 2007, no pet.).
Here, the insurance policy clearly specified an appraisal process was the remedy for any disagreement regarding the amount of loss, and that the decision reached by the appraisers and umpire "will set the amount of the loss" and "shall be the amount of the loss." Garcia chose to take advantage of the insurance policy's contractual, extra-judicial means of resolving the amount of loss; State Farm and Garcia participated in the appraisal process; and State Farm fully paid the amount of loss set by the appraisers. On this record, we conclude Garcia cannot defeat an otherwise valid and binding appraisal award simply by rejecting State Farm's payment of the award.
Garcia argues that, even if the appraisal award is binding and enforceable, summary judgment in favor of appellees should still be reversed because there are genuine issues of material fact on whether State Farm breached the insurance contract. Garcia attempts to create a
"Texas law clearly holds the discrepancy between the initial estimate and the appraisal award cannot be used as evidence of breach of contract." Gabriel v. Allstate Texas Lloyds, No. 7:13-CV-181, 2013 WL 7885700, at *3 (S.D. Tex. Nov. 1, 2013). In Breshears v. State Farm Lloyds, 155 S.W.3d 340, 343 (Tex. App.-Corpus Christi-Edinburg 2004, pet. denied), the insureds argued that because the appraisal award was greater than the initial payment made by State Farm, State Farm was in breach of the contract as a matter of law. The court held:
Id. (citation omitted).
The reason for this defense is to prevent the insured from taking advantage of the binding appraisal process to determine the value of its claim and then, after the insurer fully pays the appraisal award, suing the insurer for its initial failure to pay. See id. The defense applies with special force where, as here, "the contract [the insured] claim[s] is being breached provides for resolution of disputes through appraisal." Id.
Here, the language of the appraisal clause, as in Breshears and Gabriel, describes disagreement as to the amount of loss as a condition precedent to the appraisal process,
We hold Garcia failed to raise a fact issue on her breach of contract claim because
Garcia asserted a claim under Texas Insurance Code Chapter 542, the Prompt Payment of Claims Act. The Act provides that an insurer shall pay damages, with interest, and attorney's fees if an insurer delays payment of a claim for longer than sixty days. TEX. INS. CODE ANN. § 542.058(a) (West Supp. 2016).
In this case, Garcia reported her claim to State Farm on January 22, 2015. On January 24, 2015, Garcia's adjuster sent a notice of representation to State Farm. By letter dated February 17, 2015, Garza wrote to Garcia's adjuster requesting the adjuster's estimates and photographs. Garcia contends State Farm received the requested items on February 18, 2015. State Farm inspected the house on either February 26 or 28, 2015.
On appeal, Garcia argues that, notwithstanding a valid appraisal award, case law does not support a conclusion that the award precludes statutory interest damages for violations of the Act that occurred before the appraisal was invoked. Garcia asserts that, at best, an appraisal only tolls the accrual of statutory interest damages from the date of the alleged wrongful denial (March 2, 2015) to the date appraisal was invoked (July 21, 2015). State Farm argues it is entitled to judgment as a matter of law on Garcia's prompt payment claim because it is undisputed that it timely paid the appraisal award.
Garcia relies on the opinion in Graber, in which the insured alleged State Farm violated the Act by delaying full payment of his claim until twenty-eight months after he submitted the claim. State Farm did not dispute that it did not pay the insured's claim in full until twenty-eight months after the claim was submitted, but argued its full and timely payment of the
But, neither Higginbotham nor Mex-Tex were appraisal cases. And, in Higginbotham, the insurer was found liable on the breach of contract claim. After noting "there may be no liability for statutory damages if it is subsequently determined, by litigation, that the claim in question is invalid and not payable" the court held that "State Farm took a risk when it chose to reject Higginbotham's claim. State Farm lost when it was found liable for breach of contract. Therefore, it must pay this 18 percent per annum interest and reasonable attorneys' fees." Higginbotham, 103 F.3d at 461.
Contrary to the authorities on which Garcia's relies, a long line of cases has held that full and timely payment of an appraisal award under the policy precludes an insured from recovering penalties under the Act as a matter of law. In re Slavonic Mut. Fire Ins. Ass'n, 308 S.W.3d 556, 563-64 (Tex. App.-Houston [14th Dist.] 2010, orig. proceeding) (citing Texas cases) (noting Insurance Code does not expressly provide deadline for completion of appraisal process and that "Texas courts considering the issue have concluded that full and timely payment of an appraisal award under the policy precludes an award of penalties under the Insurance Code's prompt payment provisions as a matter of law."); see also Waterhill Cos. Ltd. v. Great Am. Assur. Co., No. Civ. A. H-05-4080, 2006 WL 696577, at *3 (S.D. Tex. Mar.16, 2006); Breshears, 155 S.W.3d 345; Anderson, 2016 WL 3438243, at *5; Bernstien v. Safeco Ins. Co. of Illinois, 05-13-01533-CV, 2015 WL 3958282, at *1 (Tex. App.-Dallas June 30, 2015, no pet.); Amine, 2007 WL 2264477, at *4-5. In Scalise, the court
2013 WL 6835248, at *6.
We hold that because it is undisputed State Farm paid the appraisal award, Garcia cannot sustain her late payment claim.
Garcia also asserted claims for violations of the DTPA, unfair insurance practices, and common law breach of duty of good faith and fair dealing. Garcia asserted appellees violated the DTPA by (1) their unreasonable delays in the investigation, adjustment, and resolution of her claim; failing to give her "the benefit of the doubt" and failing to pay for the proper repair to her house; (2) misrepresenting the insurance policy and its benefits; (3) breaching an express warranty that the damage caused by the hail storm would be covered; and (4) taking advantage of her lack of knowledge, ability, and experience. As unfair insurance practices, Garcia alleged the same actions, as well as a laundry-list of other violations. Under her breach of duty of good faith and fair dealing, Garcia again alleged the same actions, as well as that State Farm unreasonably delayed payment or settlement of her entire claim. In their motion for summary judgment, appellees argued they were entitled to summary judgment as a matter of law on Garcia's extra-contractual claims because (1) State Farm promptly investigated Garcia's claim after she reported it, participated in the appraisal process, and timely tendered payment of the appraisal award; and (2) Garcia did not allege any facts giving rise to an independent injury claim.
In her final issue on appeal, Garcia asserts a fact issue remains on her extra-contractual claims because appellees failed to show that State Farm's payment of the appraisal award precluded liability on these claims. Garcia argues that even without an independent injury or even if the insurer complied with the policy, an insurer is liable to pay the full amount owed for a covered loss as damages on an extra-contractual claim.
Under Texas law, "[a]n insurer has a duty to deal fairly and in good faith with its insured in the processing and payment of claims." Republic Ins. Co. v. Stoker, 903 S.W.2d 338, 340 (Tex. 1995). An insurer breaches this duty of good faith and fair dealing "if the insurer knew or should have known that it was reasonably clear that the claim was covered," but denies or unreasonably delays payment of the claim. Universe Life Ins. Co. v. Giles, 950 S.W.2d 48, 55-56 (Tex.1997).
However, insurance coverage claims and bad faith claims are by their nature independent. Liberty Nat'l Fire Ins. Co. v. Akin, 927 S.W.2d 627, 629 (Tex. 1996). In most circumstances, an insured may not prevail on a bad faith claim without first showing that the insurer breached the contract. Id.; Stoker, 903 S.W.2d at 341; Toonen, 935 S.W.2d at 941-42; Lundstrom v. United Services Auto. Ass'n-CIC, 192 S.W.3d at 78, 96 (Tex.App. — Houston [14 Dist.] 2006) (holding there can be no claim for bad faith when insurer denies claim that is not covered and has not otherwise breached contract). The threshold of bad faith is reached when a breach of contract is accompanied by an independent tort. Transp. Ins. Co. v. Moriel, 879 S.W.2d 10, 17 (Tex. 1994), superseded by statute on other grounds, Act of June 2, 2003, 78th Leg., R.S., ch. 204, § 13.02, 2003 Tex. Gen. Laws 847, 887). Evidence that merely shows a bona fide dispute about the insurer's liability on the contract does not rise to the level of bad faith. Id.; State Farm Fire & Cas. Co. v. Simmons, 963 S.W.2d 42, 44 (Tex. 1998); Laird v. CMI Lloyds, 261 S.W.3d 322, 328 (Tex. App.-Texarkana 2008, pet. dism'd w.o.j.). Nor is bad faith established if the evidence shows the insurer was merely incorrect about the factual basis for its denial of the claim, or about the proper
Here, State Farm agreed there was covered damage caused by hail, but in an amount that was less than Garcia's deductible. Therefore, State Farm did not pay her. State Farm also stated its adjuster observed additional damage not caused by wind and hail and denied "coverage for damage to shingles and other exterior roofing components, except those damages identified in [its] estimate ...." About one month after receiving this notice from State Farm, Garcia filed suit. State Farm then invoked the appraisal clause in the insurance policy. State Farm argues its payment of all covered damages pursuant to the appraisal award extinguished any breach of contract claim arising from the dispute; therefore, it is entitled to summary judgment on Garcia's extra-contractual claims in the absence of an independent injury. But, payment of an appraisal award does not necessarily bar Garcia's extra-contractual claims for pre-appraisal conduct. The Texas Supreme Court has "left open the possibility that an insurer's denial of a claim it was not obliged to pay might nevertheless be in bad faith if its conduct was extreme and produced damages unrelated to and independent of the policy claim." Progressive Cty Mut. Ins. Co. v. Boyd, 177 S.W.3d 919, 922 (Tex. 2005) (per curiam); see also Stoker, 903 S.W.2d at 341 ("We do not exclude, however, the possibility that in denying the claim, the insurer may commit some act, so extreme, that would cause injury independent of the policy claim."). Thus, in order to avoid summary judgment on her common law bad faith claim, Garcia had the burden to raise a genuine issue of material fact that appellees "commit[ed] some act, so extreme, that would cause injury independent of the policy claim" or failed to timely investigate her claim. See Stoker, 903 S.W.2d at 341.
In her response to appellees' motion for summary judgment and on appeal, Garcia does not point to an independent tort. Instead, she relies on two cases for her argument that an independent injury is not required in her case. The first case on which Garcia relies is United National Insurance Co. v. AMJ Investments, LLC, in which the court held that an insurer's "unfair refusal to pay the insured's claim causes damages as a matter of law in at least the amount of the policy benefits wrongfully withheld." 447 S.W.3d 1, 11 (Tex. App.-Houston [14th Dist.] 2014, pet. dism'd) (quoting Vail v. Tex. Farm Bur. Mut. Ins. Co., 754 S.W.2d 129, 136 (Tex. 1988)). "If a property insurer fails to pay the full amount of the claim as a result of an unfair claim-settlement practice under the Insurance Code, the insured may elect to recover its damages under either a breach-of-contract or a statutory-violation theory." Id.
The second case on which Garcia relies is USAA Texas Lloyd's Co. v. Menchaca in which USAA argued that because the jury found no breach of contract, the insured's extra-contractual claims failed as a matter of law. The court noted the general rule that, in most circumstances, an insured may not prevail on a bad faith claim without first showing that the insurer breached the contract. 13-13-00046-CV, 2014 WL 3804602, at *8 (Tex. App.-Corpus Christi-Edinburg July 31, 2014, pet. granted). But the court then noted
Id. at *9.
AMJ Investments can be distinguished in that it did not involve an appraisal and the insured pled and proved the insurer breached the insurance contract. Menchaca can be distinguished in that it is not an appraisal case. Therefore, we do not find the holdings in these cases helpful.
Although Garcia referred to her bad faith claims in her response to appellees' motion for summary judgment, she produced no summary judgment evidence related to bad faith claims, much less any evidence of "extreme" behavior. Garcia only alleged that coverage and liability on her breach of contract claim remained issues of material fact for the jury to decide; and material issues of fact remained on whether the appraisal award should be set aside.
We conclude Garcia did not present evidence of an act so extreme that it caused injury independent of the policy claim. See Scalise, 2013 WL 6835248, at *7 (finding no independent injury where insured "made only those fairly routine allegations of a substandard (albeit timely) investigation and initial undervaluation of his covered claim, the entirety of which was timely paid upon issuance of the appraisal award"); see also Mid-Continent Cas. Ins. Co. v. Eland Energy, Inc., 709 F.3d 515, 521-22 (5th Cir. 2013) (noting that "in seventeen years since [Stoker] appeared, no Texas court has yet held that recovery is available for an insurer's extreme act ...."). Rather, the summary judgment evidence demonstrates only a bona fide dispute about the amount necessary to compensate Garcia for covered damage to her home. See Simmons, 963 S.W.2d at 44 ("Evidence establishing only a bona fide coverage dispute does not demonstrate bad faith."). This bona fide dispute was submitted to the appraisal process for resolution.
Under Texas law, an individual damaged by "unfair method[s] of competition or unfair or deceptive act[s] or practice[s] in the business of insurance" may bring a cause of action under the Texas Insurance Code. TEX. INS. CODE ANN. § 541.151(1) (West 2009). A violation of Chapter 541 of the Texas Insurance Code is also a violation of the DTPA. TEX. BUS. & COM. CODE ANN. § 17.50(a)(4) (West 2011) ("A consumer may maintain an action where [the use or employment by any person of an act or practice in violation of Chapter 541, Insurance Code] constitute[s] a producing cause of economic damages or damages for mental anguish."). An insurer's liability under the Insurance Code and the DTPA incorporate the common-law bad faith standard developed as part of the elements of a claim for breach of the duty of good faith and fair dealing. See Boyd, 177 S.W.3d at 922; Texas Mut. Ins. Co. v. Sara Care Child Care Ctr., Inc., 324 S.W.3d 305, 317 (Tex. App.-El Paso 2010, pet. denied); Spicewood Summit Office Condo. Ass'n, Inc. v. Am. First Lloyd's Ins. Co., 287 S.W.3d 461, 468 (Tex. App.-Austin 2009, pet. denied) ("Absent legally sufficient evidence of bad faith, however,
Because Garcia's unfair insurance practice claims and her DTPA section 17.50(a)(4) claim arise from the same underlying theory as her common law bad faith claim, we hold that because she failed to present evidence on her breach of common law bad faith claim or of an independent injury, and because State Farm timely paid all covered damages determined by the appraisal award, Garcia's statutory bad faith claims are foreclosed.
For the reasons stated above, we overrule Garcia's issues on appeal and affirm the trial court's judgment.