SIM LAKE, District Judge.
C.K. Lee brings this action against Catlin Specialty Insurance Company alleging that Catlin wrongfully handled an insurance claim that Lee submitted for hurricane damage to his commercial property.
C.K. Lee owns a commercial shopping center in northwest Houston.
On the same day that Catlin acknowledged receipt of Lee's insurance claim it authorized Engle Martin & Associates, Inc. ("Engle Martin") to represent Catlin's interests in the adjustment of the claim.
Mike Bass of Emergency Services 24, Inc. ("Emergency Services") contacted Engle Martin on November 13, 2008, and stated that he had been retained by Lee to meet with representatives of Engle Martin and to reach an agreement on the scope of the property's damages.
Engle Martin retained a roofing consultant and engineering firm, Project, Time & Cost ("PT & C"), to conduct an infrared inspection of the roof.
On December 11, 2008, PT & C inspected the roof and observed that (1) there was "no wind-related damage" to the roof covering, (2) "the roof membrane was brittle and deteriorated across the entire roof," (3) water infiltration, viewed through infrared photographs, existed in areas of previous repairs and in areas where normal wear and weathering had occurred, (4) there was "poorly installed roofing material along [the] parapet wall," and (5) "many areas of gravel ballast [were] missing prior to Hurricane Ike," confirmed by pre-hurricane aerial photographs.
Engle Martin submitted this information to Catlin in a report dated February 10, 2009, and noted that it still had not received the invoice from Emergency Services pertaining to the repairs it had made to Lee's roof.
On February 19, 2009, Van Fischer of PT & C reinspected the roof, again concluding that there was no wind-related damage.
Lee initiated this action in Texas state court on July 14, 2009, alleging breach of contract, breach of the duty of good faith and fair dealing, fraud, and violations of the Texas Insurance Code and the Texas Deceptive Trade Practices-Consumer Protection Act ("DTPA").
Summary judgment is authorized if the movant establishes that there is no genuine dispute about any material fact and the law entitles it to judgment. Fed.R.Civ.P. 56(a). Disputes about material facts are "genuine" if the evidence is such that a reasonable jury could return a verdict for the nonmoving party. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 106 S.Ct. 2505, 2511, 91 L.Ed.2d 202 (1986). The Supreme Court has interpreted the plain language of Rule 56(c) to mandate the entry of summary judgment "after adequate time for discovery and upon motion, against a party who fails to make a showing sufficient to establish the existence of an element essential to that party's case, and on which that party will bear the burden of proof at trial." Celotex Corp. v. Catrett, 477 U.S. 317, 106 S.Ct. 2548, 2552, 91 L.Ed.2d 265 (1986).
A party moving for summary judgment "must `demonstrate the absence of a genuine issue of material fact,' but need not negate the elements of the nonmovant's case." Little v. Liquid Air Corp., 37 F.3d 1069, 1075 (5th Cir.1994) (en banc) (quoting Celotex, 106 S.Ct. at 2553-54). If the moving party meets this burden, Rule 56(c) requires the nonmovant to show that specific facts exist over which there is a genuine issue for trial. Id. (citing Celotex, 106 S.Ct. at 2553-54). A party asserting that a fact cannot be or is genuinely disputed
When a party chooses not to respond to all or part of a summary-judgment movant's validly supported motion, the court will not merely enter a "default" summary judgment, but it may accept as undisputed the facts the movant provides in support of its motion. See Eversley v. MBank Dallas, 843 F.2d 172, 173-74 (5th Cir.1988) (finding that when the plaintiff failed to oppose the defendant's motion for summary judgment, the district court "did not err in granting the motion" because the motion established a prima facie showing of the defendant's entitlement to judgment).
Catlin argues that Lee's "common law and statutory bad faith claims are precluded" because a bona fide dispute exists as to whether the damages to Lee's property are covered by the insurance policy.
"Under Texas law, there is a duty on the part of the insurer to deal fairly and in good faith with an insured in the processing of claims." Higginbotham v. State Farm Mut. Automobile Ins. Co., 103 F.3d 456, 459 (5th Cir.1997) (citing Arnold v. Nat'l Cnty. Mut. Fire Ins. Co., 725 S.W.2d 165, 167 (Tex.1987)). To prove that an insurer acted in bad faith in violation of Texas common law, an insured must show that the insurer failed to settle the claim even though it "knew or should have known that it was reasonably clear that the claim was covered." Universe Life Ins. Co. v. Giles, 950 S.W.2d 48, 54-55 (Tex.1997). The statutory bad faith standard parallels the common law formulation. See Tex. Ins. Code § 541.060(a)(2)(A) (providing that an insurer engages in an unfair settlement practice by "failing to attempt in good faith to effectuate a prompt, fair, and equitable settlement of a claim with respect to which the insurer's liability has become reasonably clear").
"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." Transp. Ins. Co. v. Moriel, 879 S.W.2d 10, 17 (Tex.1994). On the other hand, denying a claim solely in reliance on an expert's report does not shield the insurer from bad faith liability "if there is evidence that the report was not objectively prepared or the insurer's reliance on the report was unreasonable." State Farm Lloyds v. Nicolau, 951 S.W.2d 444, 448 (Tex.1997). In determining the reasonableness of an insurer's decision a court reviews the facts that were available to the insurer at the time of denial. Viles v. Security Nat'l Ins. Co., 788 S.W.2d 566, 567 (Tex.1990).
The investigations conducted by Engle Martin and PT & C support Catlin's decision to deny Lee's claim. Engle Martin, the independent adjuster Catlin retained to investigate the claim, concluded that the damage to Lee's roof was not attributable to wind-related causes. Engle Martin's conclusion was based on both its own observations when it inspected the roof with Mike Bass from Emergency Services and on PTSC's two inspections.
The second inspection was conducted by Van Fischer of PT & C on December 11, 2008.
It was not reasonably clear to Catlin, based on this evidence, that the damages were covered by the insurance policy. The roof was inspected once by an independent adjuster and twice by a roof consultant, and none of the inspectors concluded that the damages were covered by the policy. Catlin was not privy to any information that concluded otherwise.
But Catlin's reliance on the reports from these inspections, standing alone, does not
In Nicolau, the Texas Supreme Court affirmed the jury's finding that an insurer acted in bad faith when it denied a claim that the insureds, loan and Liana Nicolau, brought under a homeowners insurance policy. Nicolau, 951 S.W.2d at 446, 450. The Nicolaus sought coverage for extensive foundation damage to their home, which they contended was caused by a covered condition, plumbing leakage, and which the insurer contended was caused by a an uncovered condition, either an "inherent vice" or a "settling" problem. Id. at 447. The Court concluded that there was "some evidence" that the insurer knew or should have known that it was reasonably clear that the insured's claim was covered. Id. at 448. This conclusion was based on evidence in the record that the expert's reports were "not objectively prepared," that the insurer "was aware of [the expert's] lack of objectivity," and that the insurer's "reliance on the reports was merely pretextual." Id.
Similarly, the appellate court in Johns affirmed the jury's finding that the insurer acted in bad faith when it denied an insured's claim for foundation damage. Johns, 1998 WL 548887, at *7.
The facts of Nicolau and Johns, however, are distinguishable from those in this action. First, in Nicolau and Johns the insurers were faced with competing conclusions as to the cause of the foundation damage. Nicolau, 951 S.W.2d at 449-50; Johns, 1998 WL 548887, at *5-6. In Nicolau the insureds hired a foundation—repair contractor, a structural engineer, and a licensed civil engineer, all of whom concluded that the foundation damage was attributable to a "significant leak in the plumbing system." Nicolau, 951 S.W.2d at 446-47. The Nicolaus' insurer referred the claim to an adjuster, who twice reported to the insurer that it was doubtful that the damage was attributable to plumbing leakage. Id. at 447. The Nicolaus then forwarded to their insurer the report from the engineering firm that reached the opposite conclusion. Id. After receiving the plaintiff's competing report the insurer authorized
Likewise, the insurer in Johns was in possession of competing conclusions as to the cause of the insured's foundation damage. The insurer's adjuster retained a professional engineer to investigate the home, and the engineer concluded that the problems were caused by "normal foundation movement." Johns, 1998 WL 548887, at *4. In response, the insured hired a geotechnical engineer specializing in soil conditions to investigate the home, and the engineer concluded that the foundation distress was caused by plumbing leaks. Id. at *5. The insurer's engineer reviewed this competing report but concluded it was "not thorough" and "too general." Id. The insurer's engineer never inspected the home for plumbing leaks and did not reinspect the property after reviewing the competing report. Id. The insurer nevertheless decided to "go with the report that [its engineer] had supplied" and denied the claim. Id.
Here, Catlin's decision to deny the claim was based on Engle Martin's and PTSC's conclusions that the damages to Lee's roof were caused by natural deterioration and low-quality prior repairs instead of wind.
The record does not contain a report with conclusions that conflict with those formulated by Engle Martin and PT & C. The only document in the record that was prepared by Emergency Services is an estimate of the cost of repairing the exterior and interior of the shopping center and of repairing the roof.
Instead of presenting a report that contradicts Catlin's findings, Lee bases its argument exclusively on an answer that Rick Lathrum, one of Catlin's senior
Nevertheless, even if it can be gleaned from Lathrum's deposition that he believed there were competing experts' reports, there is nothing in the record showing that Catlin's decision to believe its own experts, rather than other experts, was unreasonable. In contrast to Nicolau and Johns, there is nothing in the record that indicates what Emergency Services concluded, if it came to a conclusion, or what observations supported its conclusion. Furthermore, there is nothing in the record indicating that any of the companies used to investigate the roof, whether retained by Lee or Catlin, were unqualified.
Lee argues that there is a genuine issue as to the reasonableness of Catlin's reliance on Engle Martin's and PT & C's reports because Catlin was aware that they were not objectively prepared. The evidence shows that Catlin and Engle Martin entered into an informal agreement that Engle Martin would be the independent adjusting firm with respect to all of the Hurricane Ike claims, and Catlin assigned approximately 200 such claims to Engle Martin.
In Nicolau the evidence showed that the engineering company selected by the insurer did a "substantial amount" of work for insurance companies. An expert also testified that out of the eighty or ninety reports he had reviewed that were produced by the company, only two had concluded that foundation damage was caused by plumbing leaks, and that to his knowledge the engineers who made those conclusions never again worked on a slab-foundation case. Nicolau, 951 S.W.2d at 448-49. Similarly, in Johns "[m]ost of"
As evidence that Engle Martin did not act objectively, Lee points to an email between an employee of Engle Martin, Justin Carroll, and an employee of PT & C, in which Carroll states: "What we will need to support our argument is [sic] photographs of the temporary repair, as well as photos of repairs present on other areas of the roof for comparison purposes."
The Texas Supreme Court's conclusion in Nicolau that there was "some evidence" supporting a finding of bad faith was based on the engineers' bias in tandem with evidence that the insurer knew that it received biased reports. See Nicolau, 951 S.W.2d at 448-50. Here, even if it were determined that Engle Martin and PT & C worked primarily with insurers, there is no evidence that the investigations were outcome-oriented or that Catlin expected to receive reports concluding that the claim should be denied. In Nicolau there was evidence that the insurer selected the particular engineering company to investigate the property because of the company's "general view" that plumbing leaks rarely cause foundation damage. Id. at 448-49. There is nothing in the record here that suggests that Engle Martin or PT & C held predetermined general views concerning the cause of roof damage. The evidence in Nicolau also showed that the engineering firm used by the insurer never examined the leaking pipe and failed to take samples of the soil for testing, and that the insurer knew that its engineers had not reinspected the property after they received the Nicolaus' conflicting report. Id. at 449-50. The record here shows that Engle Martin and Emergency Services first inspected the property together, and that PT & C subsequently conducted an initial inspection of the roof and then a reinspection of the roof at Engle Martin's request.
The evidence shows no more than a bona fide dispute between Catlin and Lee as to whether the damages to the roof were covered by Lee's policy. See Avila v. State Farm Fire & Cas. Co., 147 F.Supp.2d 570, 577-79 (W.D.Tex.1999) (granting summary judgment to the insurer on the insured's bad faith claims based on evidence that the insurer hired two experts who concluded that the damages fell outside the policy and evidence that the report submitted by the insured did not conflict with the insurer's conclusion at the time the claim was denied).
The summary-judgment evidence is insufficient to persuade a reasonable juror that Catlin knew or should have known that it was reasonably clear that Lee's claim was covered. Giles, 950 S.W.2d at
Lee alleges that Catlin violated the Texas Insurance Code by engaging in the following unfair settlement practices:
Tex. Ins. Code § 541.060(a)(1), (3), (4).
Lee's claim that Catlin made material misrepresentations about the policy or the coverage lacks merit because there is no evidence of any such misrepresentations in the record. Lee testified at his deposition that he has never had any discussions with Catlin about the terms of the policy.
Lee's claims that Catlin failed to deny coverage within a reasonable time and failed to promptly provide Lee with a reasonable explanation of its basis for denying the claim also fail as a matter of law. Lee testified at his deposition that he was aware that Catlin denied his claim because the amount of covered damages was less than the $36,000 deductible on the policy.
Engle Martin attempted to contact Lee several times by telephone between September 26, the day after it received notice of Lee's claim, and October 2, 2008, but Lee was out of the country.
This evidence viewed collectively does not show that Catlin unreasonably delayed investigating the claim, notifying Lee that it was reserving its rights, or explaining to Lee that it needed more information to make a determination on his claim. Lee offers no summary-judgment evidence that would lead a reasonable juror to conclude that Catlin failed to promptly provide Lee with a reasonable explanation for denying his claim or failed to deny coverage within a reasonable time.
Lee alleges that Catlin violated the prompt payment of claims provisions of the Texas Insurance Code by:
Section 542.055 provides that an insurer shall (1) "acknowledge receipt of the claim," (2) "commence any investigation of the claim," and (3) "request from the claimant all items, statements, and forms that the insurer reasonably believes, at that time, will be required from the claimant" within fifteen days of receiving
Catlin received notice of Lee's claim on September 24, 2008,
Section 542.056 provides that an insurer generally must notify a claimant in writing of the acceptance or rejection of a claim, and the underlying reasons for a rejection, within fifteen business days of receiving all items, statements, and forms that are required for the insurer to secure final proof of loss. Tex. Ins. Code § 542.056(a), (c). The insurer may notify the claimant within the same time frame that it needs additional time, but the insurer must accept or reject the claim within 45 days of the date of the additional-time notification. Id. § 542.056(d).
Catlin argues that it did not notify Lee of its rejection of the claim because Catlin never received the invoice and leases it requested, items that are necessary to its final determination concerning coverage.
Section 542.058 provides that an insurer is liable for statutory damages if, after receiving all items, statements, and forms reasonably requested and required, it delays payment of the claim for a period exceeding the period specified by other applicable statutes or, if other statutes do not specify a period, for more than sixty days. Tex. Ins. Code § 542.058(a). As stated previously, there is a genuine issue of material fact as to whether Catlin has received all of the necessary items to make its final determination. Furthermore, because Catlin does not seek summary judgment on Lee's claim for breach of contract, summary judgment on this claim would be premature. A determination as to whether
The court will therefore deny Catlin's motion with respect to Lee's prompt-payment claims under Section 542.056 and 542.068.
Lee alleges that Catlin violated the DTPA by engaging in false, misleading, or deceptive acts and practices, Tex. Bus. & Com.Code § 17.46(a), by:
Lee states that when he purchased the insurance policy there were no misrepresentations in the policy and that he has never had any conversations with anyone at Catlin about the terms of his insurance policy.
Catlin is also entitled to summary judgment with respect to Lee's DTPA claims relating to unconscionable conduct and violations of the Texas Insurance Code. Under the DTPA an "unconscionable action" is defined as "an act or practice which, to a consumer's detriment, takes advantage of the lack of knowledge, ability, experience, or capacity of the consumer to a grossly unfair degree." Tex. Bus. & Com.Code § 17.45(5). As discussed above the evidence does not give rise to a claim for bad faith or otherwise show that Catlin intended to deceive Lee in issuing the policy or investigating the claim. Although Lee's allegations of unfair settlement practices are actionable under the DTPA, see id. § 17.50(a)(4), Catlin is entitled to summary judgment on those claims because, as discussed above, a reasonable juror could not
Lee alleges that Catlin "knowingly or recklessly made false representations as to material facts and/or knowingly concealed all or part of material information from Plaintiff with the intent of inducing Plaintiff to accept a denial and/or underpayment of insurance benefits."
Catlin has demonstrated that there are no genuine issues of material fact with respect to Lee's extra-contractual claims. The court therefore concludes that Catlin has established that it is entitled to judgment as a matter of law with respect to Lee's allegations of (1) common law and statutory bad faith, (2) unfair settlement practices under the Texas Insurance Code, (3) prompt payment of his claim under Section 542.055 of the Texas Insurance Code, (4) DTPA violations, and (5) fraud. Because there is a genuine issue of fact as to whether Catlin complied with the time frames set out in Sections 542.056 and 542.058 of the Texas Insurance Code, the court concludes that Catlin is not entitled to summary judgment with respect to those claims.
For the reasons explained above, Catlin Specialty Insurance Company's Motion for Partial Summary Judgment (Docket Entry No. 28) is