In Re Slavonic Mutual Fire Insurance Ass'n

308 S.W.3d 556, 2010 Tex. App. LEXIS 2365, 2010 WL 1236333
CourtCourt of Appeals of Texas
DecidedApril 1, 2010
Docket14-09-01057-CV
StatusPublished
Cited by49 cases

This text of 308 S.W.3d 556 (In Re Slavonic Mutual Fire Insurance Ass'n) is published on Counsel Stack Legal Research, covering Court of Appeals of Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
In Re Slavonic Mutual Fire Insurance Ass'n, 308 S.W.3d 556, 2010 Tex. App. LEXIS 2365, 2010 WL 1236333 (Tex. Ct. App. 2010).

Opinion

OPINION

ADELE HEDGES, Chief Justice.

In this original proceeding, relator, Slavonic Mutual Fire Insurance Association, seeks a writ of mandamus ordering the respondent, the Honorable Mike Miller, presiding judge of the 11th District Court in Harris County, to abate the underlying case filed under cause number 2009-26523, and enforce the appraisal clause in the insurance contract between Slavonic and its insureds, the real parties in interest, Miguel Requena and Leanna Landin-Re-quena. See Tex. Gov’t Code Ann. § 22.221 (Vernon 2004); see also Tex.R.App. P. 52. We conditionally grant the writ.

The Insurance Policy

Slavonic issued a fire and extended coverage insurance policy to the Requenas covering their home, which was damaged by Hurricane Ike on September 12-13, 2008. The policy provides coverage for losses caused by windstorm, hurricane, and hail, among other specified risks. The policy limit on the dwelling is $135,000, and claims are subject to a $500 deductible.

The policy provides that when a loss occurs, the insured must give notice to Slavonic by providing a sworn proof of loss and any reasonably necessary supporting documentation. The parties must then ascertain the amount of the loss. If the parties disagree about the amount of the loss, either party may demand an appraisal. The policy’s appraisal clause provides as follows:

Appraisal. In case the insured and this Company shall fail to agree as to the actual cash value or the amount of loss, then, on the written demand of either, each shall select a competent and disinterested appraiser and notify the other of the appraiser selected within twenty days of such demand. The appraisers shall first select a competent and disinterested umpire; and failing for fifteen days to agree upon such umpire, then, on request of the insured or this Company, such umpire shall be selected by a judge of a district court of a judicial district where the loss occurred. The appraisers shall then appraise the loss, stating separately actual cash value and loss to each item; and, failing to agree, shall submit their differences only to the umpire. An award in writing, so itemized, of any two when filed with this Company, shall determine the amount of actual cash value and loss. Each appraiser shall be paid by the party selecting him and the expenses of appraisal and umpire shall be paid by the parties equally.

The insurance policy does not specify a deadline by which either side must request appraisal.

*559 The policy further provides that the loss is not payable until sixty days after the parties have ascertained the amount of the loss, either by agreement or through the appraisal process. The policy specifically provides that “[n]o suit or action on this policy for the recovery of any claim shall be sustainable in any court of law or equity unless all the requirements of this policy shall have been complied with.”

Appraisal Process

Almost all insurance policies contain provisions specifying appraisal as a means of resolving disputes regarding the “amount of loss” for a covered claim. See State Farm Lloyds v. Johnson, 290 S.W.3d 886, 888 (Tex.2009).' As in this case, appraisal provisions generally provide that either the insui’ed or the insurer may demand an appraisal pursuant to the terms of the policy. See In re Allstate Cty. Mut. Ins. Co., 85 S.W.3d 193, 195 (Tex.2002).

In 1888, the Texas Supreme Court first enforced an appraisal clause similar to the one at issue here. See Scottish Union & Nat’l Ins. Co. v. Clancy, 71 Tex. 5, 8 S.W. 630, 631 (1888) (holding that appraisal was condition precedent to suit); see also Scottish Union & Nat’l Ins. Co. v. Clancy, 83 Tex. 113, 18 S.W. 439, 441 (1892) (holding that insurer’s attempt to adjust and settle claim did not waive its right to appraisal). Where an insurance contract mandates appraisal to resolve the parties’ dispute regarding the value of a loss, and the appraisal provision has not been waived, a trial court abuses its discretion and misapplies the law by refusing to enforce the appraisal provision. Scottish Union, 18 S.W. at 440. More recently, the supreme court has expressed a strong policy in favor of enforcing appraisal clauses in insurance contracts. See State Farm Lloyds, 290 S.W.3d at 891-93 (holding that insurer is bound by appraisal clause to have amount of loss determined, even when dispute also involves questions of causation); Allstate, 85 S.W.3d at 195 (granting mandamus relief to enforce appraisal provision).

The Insurance Code

The Texas Insurance Code mandates prompt payment of claims. See Tex. Ins. Code Ann. §§ 542.051-.061 (Vernon 2009). The act is to be liberally construed to promote its purpose of obtaining prompt payment of insurance claims. Id. § 542.054. An insurer is required to acknowledge receipt of a claim, begin an investigation, and request documentation from its insured within fifteen days of notification of the claim. Tex. Ins.Code Ann. § 542.055(a) (Vernon 2009). The insurer is to notify the claimant in writing of the acceptance or rejection of the claim within fifteen days after it receives the required documentation for proof of loss. Id. § 542.056(a). If the insurer notifies the claimant it requires more time, the acceptance or rejection must be made within forty-five days of the notice. Id. § 542.056(d). Section 542.057 provides that a claim must be paid within five business days after notice that the claim, or a part of the claim, will be paid. Tex. Ins. Code Ann. § 542.057(a) (Vernon 2009). An insurer’s failure to comply with the statutorily prescribed timeframes will subject the insurer to damages, including interest on the amount of the claim and attorney’s fees. See Tex. Ins.Code. Ann. §§ 542.058(a), 542.060 (Vernon 2009).

The Claim

The Requenas reported the loss on September 14, 2008, immediately after the hurricane struck the Houston area. 1 Sla *560 vonic assigned the claim to an adjuster, Charlie Vaughn with All-Tex Claims Service, and he inspected the house on September 23, 2008. On September 25, 2008, Vaughn mailed the Requenas a “reservation of rights” letter, stating that “no rights of the company are waived either by taking of a Sworn Proof of Loss or further investigation as to the cause of this loss, or ascertaining the amount of loss and damage that occurred.” On October 10, 2008, Vaughn sent his report to the Requenas. Vaughn determined that the total amount of the loss, after subtracting depreciation and the policy’s deductable, was $13,165.35, which included $1,530.70 for roof repairs. Slavonic then sent the Re-quenas a check in that amount.

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Bluebook (online)
308 S.W.3d 556, 2010 Tex. App. LEXIS 2365, 2010 WL 1236333, Counsel Stack Legal Research, https://law.counselstack.com/opinion/in-re-slavonic-mutual-fire-insurance-assn-texapp-2010.