Higginbotham v. Clark

432 S.E.2d 774, 189 W. Va. 504
CourtWest Virginia Supreme Court
DecidedJuly 20, 1993
Docket21417
StatusPublished
Cited by7 cases

This text of 432 S.E.2d 774 (Higginbotham v. Clark) is published on Counsel Stack Legal Research, covering West Virginia Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Higginbotham v. Clark, 432 S.E.2d 774, 189 W. Va. 504 (W. Va. 1993).

Opinions

BROTHERTON, Justice:

The appellant, Marshall Higginbotham, appeals from an April 22, 1992, ruling of the Circuit Court of Kanawha County which affirmed the Insurance Commissioner’s decision to dismiss the appellant’s claim of alleged mine subsidence damage to his home for lack of subject matter jurisdiction. The specific issue now before this Court is whether the Insurance Commissioner has subject matter jurisdiction to review either the West Virginia Board of Risk and Insurance Management’s denial of a claim filed under the appellant’s homeowner’s policy or the insurer’s subsequent cancellation of coverage.

Legislation enacted in West Virginia in 1982 provided that mine subsidence insurance coverage would be made available to all state residents through the office of the State Board of Risk and Insurance Management 1 (“Board of Risk”), which serves in an administrative capacity as the Manag[506]*506er and Trustee of the West Virginia Mine Subsidence Fund.2 In 1983, the appellant renewed his homeowner’s insurance policy with State Farm Fire and Casualty Company (“State Farm”), and, as required by W.Va.Code § 33-30-6, State Farm added mine subsidence coverage to the policy.3 The “coverage” portion of the policy explains that “the dwelling must have sustained the damage after the mine subsidence endorsement was added to the policy. The burden of proof is on the policyholder.”

There was no inspection of the home to determine if it had sustained any pre-exist-ing mine subsidence damage. At a hearing on January 26, 1989, the appellant’s State Farm agent, Joe Woodward, noted that the mine subsidence coverage was offered “across the board to all policyholders. It would have been physically quite difficult to look at homes to try to determine mine subsidence damage.” Thus, State Farm sent the appellant an endorsement which acknowledged his receipt of mine subsidence coverage, and he was charged for the coverage. He paid the premium and the coverage was effective for the period from September 28, 1983, to August 16, 1984.

On June 11, 1984, the appellant filed a claim for mine subsidence damage in which he listed an October 10, 1983, date of loss. Pursuant to regulations governing the adjustment of such claims, State Farm reported the claim to the Board of Risk, and the appellant’s claim was then assigned to the General Adjustment Bureau for investigation. This independent adjuster interviewed the appellant and inspected the property on July 24, 1984. In a February 6, 1985, letter to the General Adjustment Bureau, the Board of Risk advised that they did not feel that there was coverage. The Board of Risk met on February 19, 1985, and the minutes of that meeting reflect that with respect to the appellant’s claim, “[t]he Board denied reinsurance coverage because the subsidence began in 1981, long before the mine subsidence coverage was requested.”

In a letter dated March 18, 1985, Board of Risk Claim Manager T. K. Snyder told State Farm Claim Superintendent Joseph Rheney that “the Board [of Risk] met on March 12, 1985 and again decided that no reinsurance is available for homes where there is ongoing mine subsidence. The damage to [appellant Higginbotham’s] house began many years ago. We are instructing [General Adjustment Bureau Adjuster] John Roberts to close his file and you may proceed as your corporate policy dictates.”

State Farm subsequently requested an independent investigation, which took place in June, 1985. An investigator for Triad Engineering concluded that “we believe the distress cracking and movement in the house have been caused by soil movements on the uphill side of the house. We do not believe it is caused by subsidence, but the possibility of subsidence causing the movement will be investigated in a detailed study by the West Virginia DNR in the future.”

State Farm denied the appellant’s claim on July 15, 1985, but the reason given at that time was not prior mine subsidence. Instead, the appellant was informed that the “earth movement” damage to his home was not covered under his homeowner’s [507]*507policy.4 State Farm also told the appellant that the Abandoned Mine Lands Program would perform a detailed investigation of his house within the next two to three years: “When that report is completed, we will review its findings at that time. If that report does indicate that your damages are caused by mine subsidence, we will reconsider this matter.”

Several years later, the appellant submitted additional evidence and requested that his claim be reconsidered. In a letter to the appellant dated March 23, 1987, State Farm Claim Superintendent Joseph L. Rhe-ney again mentioned “earth movement” as a possible reason why State Farm might deny coverage for a loss:

... In any question of coverage relating to the mine subsidence portion of the policy, the State Board of Insurance [Board of Risk] has the authority for resolution of such question and not State Farm itself.
It is further not uncommon for the damage stated in the loss report completed by you to be as a result of some type of earth movement other than mine subsidence. This type of damage is excluded under your policy. If the investigation of your claim should determine that the damage to your residence was caused by perils such as earth movement as described in your policy, State Farm reserves its right to deny coverage to you for such loss.

In a March 31,1987, letter, Board of Risk Claims Manager James L. Boone informed State Farm Claim Superintendent Rheney that “[a] review of the [appellant’s] claim file reveals it was established, this insured does not qualify for Coal Mine Subsidence Insurance Coverage, because he had subsidence prior to the inception of the policy. Our position has not changed, and you should so advise Mr. Higginbotham.”

Although the insurer has no recourse in this situation and is bound by the Board of Risk’s determination, State Farm apparently felt that any subsidence damage that occurred after the insurance coverage was purchased should be covered.5 Nonetheless, State Farm had to deny coverage and offered the appellant the following explanation in a May 19, 1987, letter from Claim Superintendent Rheney:

As per your request, we reopened your mine subsidence claim and resubmitted it to the State Board of Risk and Insurance Management. As you will recall, as per the regulations governing the processing of mine subsidence claims, it is entirely up to the State Board to determine whether the mine subsidence coverage will apply to such claims. The State Board has responded to the request to reopen this claim and to determine whether mine subsidence coverage can be extended. The State Board has indicated that your loss does not qualify for Coal Mine Subsidence Insurance Coverage because the subsidence experienced at your dwelling occurred prior to the inception of your Mine Subsidence Endorsement.. A copy of the State Board’s letter is enclosed for your review.
The Board has consistently taken the position that if mine subsidence has occurred prior to the inception of the policy, then the Mine Subsidence Insurance Coverage will not be extended to cover the loss. The State Board has indicated that they have based their decision upon the determination that the mine subsidence damage at your dwelling occurred in 1979 while the Mine Subsidence Coverage was not in effect until August 1983.

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Higginbotham v. Clark
432 S.E.2d 774 (West Virginia Supreme Court, 1993)

Cite This Page — Counsel Stack

Bluebook (online)
432 S.E.2d 774, 189 W. Va. 504, Counsel Stack Legal Research, https://law.counselstack.com/opinion/higginbotham-v-clark-wva-1993.