Luna v. Nationwide Property & Casualty Insurance

798 F. Supp. 2d 821, 2011 U.S. Dist. LEXIS 69372
CourtDistrict Court, S.D. Texas
DecidedJune 27, 2011
DocketCivil Action H-10-2918
StatusPublished
Cited by8 cases

This text of 798 F. Supp. 2d 821 (Luna v. Nationwide Property & Casualty Insurance) is published on Counsel Stack Legal Research, covering District Court, S.D. Texas primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Luna v. Nationwide Property & Casualty Insurance, 798 F. Supp. 2d 821, 2011 U.S. Dist. LEXIS 69372 (S.D. Tex. 2011).

Opinion

OPINION AND ORDER OF PARTIAL DISMISSAL

MELINDA HARMON, District Judge.

Pursuant to the Court’s opinion and order of December 17, 1210, 2010 WL 5387569 (instrument #21), Plaintiff Guillermo A. Luna has filed a First Amended Complaint (# 22) in an attempt to satisfy Federal Rules of Civil Procedure 8, 9(b), and 12(b)(6) in his action to recover full payment of insurance policy benefits for alleged damage to his home property caused by Hurricane Ike on September 12-13, 2008. Pending before the Court is Defendant Nationwide Property and Casualty Insurance Company’s (“Nationwide’ s”) renewed motion for partial dismissal (# 23) under Federal Rules of Civil Procedure 8, 9(b), and 12(b)(6).

Allegations of Plaintiffs First Amended Complaint (# 22)

The amended pleading alleges that Plaintiff owns a Texas Homeowners’ Insurance Policy (“policy”) issued by Nationwide, insuring his property at 17010 David Glen, Friendswood, Texas 77546, which was extensively damaged by Hurricane Ike on September 12-13, 2008. He claims that his roof was damaged, resulting in extensive damage throughout the entire house, including ceilings, walls, insulation, windows, screens, and flooring, as well as structural and exterior damage. Plaintiffs patio, fence, and shed were also damaged. He filed a claim with Nationwide for the damages to his home, food and contents loss, structural damage, roof damage, wa *824 ter damage and wind damage, caused by Hurricane Ike to the insured property.

Nationwide assigned Joe B. Rehders (“Rehders”) as the individual adjuster on the claim, but Plaintiff contends that Rehders was improperly trained and unable to adequately perform a thorough inspection of Plaintiffs damages. Rehders spent only thirty minutes on or around October 6, 2008 inspecting the property, did not inspect the interior of Plaintiffs home, nor get on the roof of his house or shed. Rehders’ inspection report was devoid of pictures, did not include payment for interior damage to the residence (unspecified by Plaintiff), and covered only one roof vent turbine and 0.5 of a square of Plaintiffs shed roof.

The complaint asserts that Rehders also severely underestimated the damages, exemplified by Nationwide’s payment of only $140.52 for Plaintiffs roof and $140.89 for a minimum service charge; he claims that these amounts would not allow Plaintiff to make necessary roof repairs. The estimate also included only $57.21 for repair of the shed and $77.75 for the minimum service charge, again insufficient to cover repairs. 1 Plaintiff further insists that Nationwide’s prices in adjusting Hurricane Ike claims do not reflect the local market prices where the claim was made, but does not indicate what any local rates were compared with the prices attributed for repairs by Nationwide. Plaintiff also asserts that Rehders’ estimate did not include any amount for overhead or profit on the building or other structure items. 2

The complaint states that Nationwide had special knowledge of the insurance industry, superior to that available to Plaintiff, and was therefore aware that the estimated payment would not allow Plaintiff to adequately repair his damages. Plaintiff maintains that such special knowledge of specific facts underlying a false opinion can support a claim of affirmative misrepresentation here.

Plaintiff insists that Nationwide was responsible for the training and guidance of Rehders for the investigation and that it had full oversight and review of Rehders’ resulting estimate of damage, as well as of any payment of Plaintiffs claim. Nevertheless, Nationwide let Rehders’ inadequate investigation go forward and constitute the sole basis for the insufficient payment of Plaintiffs claims. Nationwide continues to delay full payment for the damages to Plaintiffs property and has yet to give Plaintiff a reasonable explanation for the lack of coverage for the reported damages or for Nationwide’s failure to pay Plaintiffs claim in full.

Plaintiff asserts that given its special knowledge of the insurance business and local market prices, neither specified in the complaint, Nationwide is liable for fraud in the intentional undervaluing of damages as its regular business practice, though he fails to present a single example. He points to a letter he received from Nationwide in which Nationwide allegedly knowingly and falsely stated that the estimate given to Plaintiff “represents the amount to restore your damaged property to its pre-loss condition. This estimate contains our valuation of the damages for the *825 reported loss and was prepared using reasonable and customary practices for your geographic area.” 3 He states that he relied on this statement in not repairing the damages to his property for lack of funds and/or making temporary repairs using his own funds, thus prolonging his hardship in living in a damaged house. He also asserts that Nationwide initially represented that his -insurance policy would cover his losses; Plaintiff therefore purchased the policy in exchange for this promised benefit that Nationwide knew he would not receive.

In sum, the complaint asserts the following causes of action' against Nationwide: (1) engaging in unfair and deceptive acts or practices in violating Sections 541.060(a), 4 541.060(a)(1), 5 541.060(a)(2)(A), 6 541.060(a)(3), 7 541.060(a)(4), 8 and 541.060(a)(7) 9 of the Texas Insurance Code (unfair settlement practices); (2) noncompliance with Sections 542.055, 542.056, and 542.058 of the Texas Insurance Code (failure to investigate and promptly pay claims); (3) common law fraud; (4) breach of insurance contract between Nationwide and Plaintiff in Nationwide’s failure to adequately compensate Plaintiffs with the full proceeds owed under the policy; and (5) breach of the common law duty of good faith and fair dealing owed by insurers to insureds in insurance contracts because of their unequal bargaining power, here because of the inadequate investigation and unreasonable denial or partial payment of Plaintiffs claims.

Standards of Review

Federal Rule of Civil Procedure 8(a)(2) provides, “A pleading that states a claim for relief must contain ... a short and *826 plain statement of the claim showing that the pleader is entitled to relief.” All well pleaded facts must be viewed as true, “in the light most favorable to the plaintiff.” Lindquist v. City of Pasadena, Texas, 525 F.3d 383, 386 (5th Cir.2008).

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Bluebook (online)
798 F. Supp. 2d 821, 2011 U.S. Dist. LEXIS 69372, Counsel Stack Legal Research, https://law.counselstack.com/opinion/luna-v-nationwide-property-casualty-insurance-txsd-2011.