Church Mutual Insurance v. Alliance Adjustment Group

102 F. Supp. 3d 719, 2015 U.S. Dist. LEXIS 121852, 2015 WL 5334358
CourtDistrict Court, E.D. Pennsylvania
DecidedSeptember 14, 2015
DocketCIVIL ACTION No. 15-461
StatusPublished
Cited by14 cases

This text of 102 F. Supp. 3d 719 (Church Mutual Insurance v. Alliance Adjustment Group) is published on Counsel Stack Legal Research, covering District Court, E.D. Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Church Mutual Insurance v. Alliance Adjustment Group, 102 F. Supp. 3d 719, 2015 U.S. Dist. LEXIS 121852, 2015 WL 5334358 (E.D. Pa. 2015).

Opinion

MEMORANDUM

Juan R. Sánchez, District Judge

Plaintiff Church Mutual Insurance Company (Church Mutual) brings this insurance fraud action against a licensed public adjuster and his public adjustment group, a law firm and two of its lawyers, and two companies contracted to examine and perform repairs to a property insured under a policy issued by Church Mutual to non-party African Episcopal Church of St. Thomas (AEC). Church Mutual alleges Defendants Alliance Adjustment Group (Alliance) and James Wagner (together, the adjusters) filed two fraudulent insurance claims on behalf of AEC with the assistance of DeLong Service Co., Inc. (DeLong),1 an HVAC/chiller contractor, and JLD Emergency Services (JLD), an emergency remediation contractor. When Church Mutual denied one claim in part and the other entirely, the adjusters hired Defendants Claims Worldwide, LLC, Joseph A. Zenstein, Esq., and Joseph Thiroway, Esq. (together, the lawyers) to pursue the coverage claims in court. Ultimately, AEC dismissed that litigation with prejudice after hiring alternative counsel. Church Mutual subsequently filed this action against the adjusters, the lawyers, DeLong, and JLD, asserting claims for negligent misrepresentation in violation of the Restatement (Second) of Torts § 552 (Count I), fraud in violation of the Pennsylvania Insurance Fraud Statute, 18 Pa. Cons.Stat. § 4117 (Count II), and civil conspiracy (Count III).

Three sets of Defendants have moved separately to dismiss the Complaint: (1) the adjusters, Alliance and Wagner; (2) the lawyers, Claims Worldwide, Thiroway, and Zenstein; and (3) DeLong. All three sets move to dismiss the three-count Complaint for failure to state a claim. In the alternative, the lawyers assert the judicial privilege • immunizes their actions as to Counts I and II, and the Insurance Fraud Statute is unconstitutional under the Pennsylvania Constitution as applied to them. For the reasons set forth below, the Court will deny the adjusters’ motion and grant DeLong’s motion. Because the Court agrees the judicial privilege bars Church Mutual’s negligent misrepresentation and statutory fraud claims against the lawyers, the Court will dismiss Counts I and II as to them. Because, however, Church Mutual has stated a claim against the lawyers for civil conspiracy, the Court will not dismiss Count III.

BACKGROUND2

Church Mutual has long insured AEC, a church in West Philadelphia, against property damage. Over the course of this relationship, Church Mutual has processed several claims on AEC’s behalf. For instance, in 1996, AEC’s property suffered extensive damage as a result of water infiltration, and Church Mutual paid AEC $514,000, of which $140,000 was used to repair the roof. No other- repairs were made. '

In June 2011, DeLong, a company specializing in heating and air-conditioning service and repair, inspected the chiller system at the AEC property. DeLong noted there was moisture and leaks around the system, some controls were set in the [724]*724wrong direction, valves were missing, and insulation around the pipes was defectively installed. DeLong later .recommended AEC install new pipe insulation.

On December 19, 2011; AEC entered into a contract with Alliance, which is owned by Wagner, a licensed public adjuster. The contract authorized Alliance or its representative to assist in the adjustment of an insurance claim allegedly arising from “loss by water” on August 30, 2011. The contract provided AEC would pay the adjusters 25% of any amount paid by the insurance company in settlement of the loss. Two days later, the adjusters filed a claim reporting that AEC’s property had sustained damage due to frozen copper pipes in the property’s HVAC/chiller system, causing water to leak on August 30, 2011 (hereinafter the. chiller claim). The adjusters also submitted an undated estimate for $133,385.66 in repairs, which listed costs to repair a number of rooms in the property without explaining what work needed to be done or how the work related to water damage. Church Mutual hired .two experts to investigate the chiller claim. Colin Seybold, a forensic mechanical engineer, reported the water damage claimed resulted from defectively installed or missing insulation, which is not covered by the insurance policy. The other expert, Dewpoint Mechanical, an HVAC contractor, indicated it was highly improbable the damage was caused by frozen pipes. As result, Church Mutual denied coverage on the chiller claim on July 24, 2012.

On January 30, 2012, while the chiller claim was pending, AEC entered into 'a second contract with Alliance, retaining Alliance to assist in adjusting a claim arising from “loss by storm” on August 27, 2011. Again, the contract authorized the adjusters to collect 25% of the amount paid by the insurance company in settling the loss. Several days after AEC signed the contract, the adjusters filed an insurance claim alleging AEC sustained severe damage on August 27, 2011, as result of Hurricane Irene (hereinafter the hurricane claim). The adjusters also attached an undated estimate for $1,147,451.40 in repairs and again listed repair costs for a number of rooms in the property without explaining what work needed to be done or how the hurricane caused the damage. In support of the claim, Alliance submitted photographs purporting to show damage sustained during the hurricane such as broken slate shingles. These photographs were taken by JLD, an emergency remediation company owned by non-party Jennifer L. Dezutter, the wife of non-party Daniel Baruto, an Alliance employee. While investigating the claim, however, Church Mutual’s structural engineer, Russ Daniels, determined the damage allegedly caused by the hurricane was already present during a July 2011 Risk Control Inspection of the property and opined the majority of the damage resulted from wear and tear, not the hurricane. Daniels also noted aerial photographs of AEC’s roof taken six weeks after the hurricane and later in 2013 showed no damage. Church Mutual’s adjuster, Lew Gohean, who handled the 1996 claims for water infiltration, concluded the interior water damage allegedly caused by the hurricane was identical to the damage presented in AEC’s 1996 claim. Ultimately, Church Mutual’s roofer, Pro-Craft Roofing, determined any hurricane damage to the roof totaled only $2,500.00. As a result of these findings, Church Mutual determined no more than $7,563.33 in damage was caused by the hurricane, paid that amount, and denied coverage for the balance of the claims on September 27, 2012.3

[725]*725After Church Mutual denied both the chiller claim and the hurricane claim, Alliance retained Claims Worldwide, Zenstein, and Thiroway, to pursue the two claims via litigation. The lawyers filed two separate coverage actions in the Court of Common Pleas of Philadelphia County. Church Mutual removed both actions to federal court in the Eastern District of Pennsylvania on July 31, 2013, and then moved to consolidate the actions.4 During discovery, the lawyers deposed three individuals affiliated with AEC: Richard Jones, Randall Blakehey, and LeDon Elliotte. Jones, the rector’s warden, denied seeing the estimates Alliance submitted to Church Mutual and testified the areas set forth in the estimates had not sustained damage. Blakeney, the Church’s property chair, testified that other than a leak in the sanctuary of the church, the hurricane did not damage the property.

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Cite This Page — Counsel Stack

Bluebook (online)
102 F. Supp. 3d 719, 2015 U.S. Dist. LEXIS 121852, 2015 WL 5334358, Counsel Stack Legal Research, https://law.counselstack.com/opinion/church-mutual-insurance-v-alliance-adjustment-group-paed-2015.