Anderson v. State Farm Fire & Casualty Company

District Court, W.D. Oklahoma·Decided August 22, 2024·No. 5:22-cv-00991·Unknown

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF OKLAHOMA

MANUEL ANDERSON and CHERYL ) ANDERSON, ) ) Plaintiffs, ) ) v. ) Case No. CIV-22-991-D ) STATE FARM FIRE AND CASUALTY ) COMPANY, ) ) Defendant. )

ORDER

Before the Court is Defendant’s Motion for Summary Judgment and Brief in Support [Doc. No. 45]. Plaintiffs have filed a response [Doc. No. 49], to which Defendant replied [Doc. No. 62]. The matter is fully briefed and at issue. BACKGROUND Plaintiffs allege that their property suffered storm damage on or about October 14, 2021, during the term of Plaintiffs’ home insurance policy issued by Defendant. Plaintiffs submitted a property damage claim to Defendant, which was investigated and denied. According to Defendant, the estimate to repair the recent storm damage to Plaintiffs’ property did not exceed the policy deductible. Defendant inspected the property in November of 2021 and did not find any other evidence of recent damage. After hiring a third-party engineer to inspect the property, Defendant asserts that the alleged roof damage resulted from a storm in 2015 or earlier, well before the term of Plaintiffs’ insurance policy. Plaintiffs brought this breach-of-contract action against Defendant for failing to pay for losses that Plaintiffs allege are covered under their insurance policy. Defendant seeks summary judgment in its favor with respect to Plaintiffs’ breach-of-contract claim.

Defendant argues that the only evidence of loss for the damage claimed is outside the policy period stemming from 2015 or earlier, thereby negating Plaintiffs’ breach-of- contract claim as a matter of law [Doc. No. 45, at 1]. In response, Plaintiffs assert that because the Policy here is an “all-risks” or “all-perils” policy, State Farm bears the burden of proving coverage for an accidental or fortuitous loss is excluded [Doc. No. 56,

at 23]. Defendant responds that Plaintiffs incorrectly argue that because their Policy is “all risk,” it does not matter what was reported or when it occurred as any damage is covered unless excluded. Defendant further asserts that Plaintiffs improperly argue that State Farm has not proven any exclusion since State Farm did not deny the claim based on an exclusion or move for summary judgment on an exclusion [Doc. No. 62, at 2].

Thus, Defendant reiterates their main argument that Plaintiffs cannot prove, with any admissible evidence, the damage they claim to their house occurred after issuance of their Policy. Id. UNDISPUTED MATERIAL FACTS Defendant lists 26 undisputed material facts (“UMF”) [Doc. No. 45, at 3-10, ¶¶ 1-

26]. Plaintiff admits1 UMFs 1, 5-8, 10-12, 14-21, and 24; admits in part UMFs 2-4, 9, 13, and 25-26; denies UMFs 22-23; and finally asserts additional material facts (“AMF”) 1- 55 [Doc. No. 56, at 1-21].

1 Plaintiffs’ responses of “Admitted, but incomplete” the Court treats as admitted. I. Plaintiffs’ Property and Policy Plaintiffs’ house at 10428 Foxhorn Circle, Midwest City was built in 1996 and purchased by Plaintiffs in 2017 – they did not own the home in 2015 [Doc. No. 45, at 3, ¶ 1]. In 2017, Plaintiffs took out a homeowners’ policy with State Farm, Policy No. 36-B9-

F836-0 (“the Policy”), the relevant iteration of which was in effect from July 21, 2021 to July 22, 2022. Id., ¶ 2. II. The October 14, 2021 Storm Plaintiffs testified that while at home on October 14, 2021, a storm occurred where hail hit Plaintiffs’ house [Doc. No. 45, at 4, ¶ 5; Doc. No. 56, at 6]. After the storm, Plaintiffs became aware that there were two leaks in the interior of the house that they

had not noticed prior to the storm [Doc. No. 56, at 6]. As a result, Plaintiff Mr. Anderson contacted his State Farm agent to ask what the proper procedure was to report a claim, and the agent advised Mr. Anderson to call a roofer to inspect the roof for damage, and then to report a claim to State Farm if the damage exceeded his deductible. Id. During the next month, sometime in between November 6 and November 8, 2021

[Doc. No. 45-6, at 4], Plaintiffs asked Gerald “Neil” Cagle at All American Roofing for a roof inspection [Doc. No. 45, at 4, ¶ 8]. On November 8, 2021, Cagle performed the roof inspection and prepared an estimate of $36.821,01,2 after tax, to fully replace the roof of the house and the shed, and all guttering [Doc. No. 45, at 5].

2 During his deposition, Cagle changed his estimate to $51,452.28, citing a mistake [Doc. No. 45, at 5, n.1]. However, on November 20, 2023, Plaintiffs’ counsel produced a new estimate from All American Roofing which totals $55,159.22. Id. On November 8, 2021, Plaintiff Mr. Anderson made a claim to State Farm, which was assigned claim number 36-26Z2-12Q (“the Claim”) for hail damage to his roof and shed, with interior leaking [Doc. No. 45, at 5, ¶ 10]. For the Claim, State Farm and

Plaintiffs treated the date of loss as October 14, 2021, when the storm occurred. Id. III. State Farm’s Initial Claim Investigation by Johnny Gage On November 17, 2021, independent adjustor Johnny Gage inspected Plaintiffs’ property on behalf of State Farm for damage from wind, water and hail, took photographs, and prepared a report. Id. at 6, ¶ 11. During his inspection, in addition to finding “old and new hail” damage to one of Plaintiffs’ air conditioning (“AC”) units and

“interior leaking to [the] living and front sitting room,” Gage observed “very old hail damage” to the roof of the house, gutters, and other structures, specifically noting that “evidence of large hail that appears to be much older,” evidenced by the “lack of spatter to support large hail,” “expose[d] fiberglass,” and “hail strikes [that were] grayed out.” Id. Ultimately, Gage determined that the majority of damage observed was likely from a

much older date of loss. Id. Mr. Anderson told Gage on November 17, 2021 that the large hole in the shed roof was due to a branch that fell during the October 14, 2021 storm and that Anderson had cut up and removed the limb, then tarped the hole with plastic that had been covering exercise equipment he had outside [Doc. No. 56, at 6, AMF 7]. Gage told Mr. Anderson

that he did not believe the hole and the hail damage to the roof of the house and the shed were caused by the hailstorm on October 14, 2021, partly because of the age of the plastic tarp. Id. at 14, AMF 30. Also on November 17, 2021, Gage prepared an estimate for covered damages under the Policy from the reported date of loss (October 14, 2021, the date of the storm) [Doc. No. 56, at 9, AMF 13], which included the two stains on Plaintiffs’ ceiling and damage to the AC coils of Plaintiffs’ AC unit [Doc. No. 45, at 6, ¶

12]. The loss determination from Gage totaled $633.90, of which $406.73 was for repair to the interior damage (ceiling stains), $192.73 for the exterior damage (AC coils), and $34.44 for debris removal. Id. Finally on November 17, 2021, Gage communicated the claim decision to Plaintiffs [Doc. No. 45, at 7, ¶ 13] via two letters – one of which stated that State Farm’s

“inspection did not reveal any covered accidental physical loss to [the Plaintiffs’] roof” (emphasis added) and the other which stated that State Farm had “determined [the Plaintiffs’] loss [of $633.90 as noted above] does not exceed [their] $3,657.00 deductible.” [Doc. No. 56, at 15, ¶ 13 (citing [Doc. No. 45-14])]. Gage also entered a note in the claim file stating “Insured understood that he has older damage and why it could

not be covered without further questions.” [Doc. No. 56, at 15, ¶ 13 (citing [Doc. No. 45- 5])]. IV. Plaintiffs’ Retention of Coppermark Public Adjusters On January 26, 2022, Plaintiffs retained Coppermark Public Adjusters (“CPA”) to inspect their property [Doc. No. 45, at 7, ¶ 14; Doc. No. 56, at 16, ¶ 14 (citing [Doc. No. 56-1])]. On or about January 29, 2022, Greg Cannon from CPA performed the inspection

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