Mary Tagliaferri v. Palomar Specialty Insurance Company, et al.

CourtDistrict Court, N.D. California
DecidedApril 6, 2026
Docket4:25-cv-02148
StatusUnknown

This text of Mary Tagliaferri v. Palomar Specialty Insurance Company, et al. (Mary Tagliaferri v. Palomar Specialty Insurance Company, et al.) is published on Counsel Stack Legal Research, covering District Court, N.D. California primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Mary Tagliaferri v. Palomar Specialty Insurance Company, et al., (N.D. Cal. 2026).

Opinion

1 2 3 4 UNITED STATES DISTRICT COURT 5 NORTHERN DISTRICT OF CALIFORNIA 6 7 MARY TAGLIAFERRI, Case No. 25-cv-02148-KAW

8 Plaintiff, ORDER GRANTING IN PART AND 9 v. DENYING IN PART DEFENDANTS' MOTION TO DISMISS 10 PALOMAR SPECIALTY INSURANCE COMPANY, et al., Re: Dkt. No. 53 11 Defendants. 12 13 Plaintiff Mary Tagliaferri brings the instant action against Defendants Palomar Specialty 14 Insurance Co. (“Palomar”) and Sedgwick Claims Management Services (“Sedgwick”), alleging 15 that Defendants failed to pay the total amount due under an insurance policy. (Second Amend. 16 Compl. (“SAC”) ¶ 25, Dkt. No. 50.) Pending before the Court is Defendants’ motion to dismiss 17 the operative complaint. (Defs.’ Mot. to Dismiss, Dkt. No. 53.) 18 The Court previously deemed this matter suitable for disposition without a hearing 19 pursuant to Civil Local Rule 7-1(b). (Dkt. No. 57.) Having considered the parties’ filings and the 20 relevant legal authorities, the Court GRANTS IN PART and DENIES IN PART Defendants’ 21 motion to dismiss. 22 I. BACKGROUND 23 A. Factual Background 24 Plaintiff is the owner of a property located in San Anselmo, California (“Subject Property.” 25 (SAC ¶ 1.) The Subject Property is covered by a flood insurance policy (the “Policy”) issued by 26 Defendant Palomar, with claims administered by Defendant Sedgwick. (SAC ¶¶ 3-4.) The Policy 27 provides building property coverage at replacement cost without depreciation, and requires 1 Policy also includes Flood Coverage E -- Loss of Use, which provides up to $50,000 for loss of 2 use if the flood loss makes the property unfit for habitation. (SAC ¶ 65.) 3 In January 2023, a severe rainstorm caused flooding and water intrusion at the Subject 4 Property. (SAC ¶ 20.) Although Plaintiff submitted detailed estimates for remedial repairs in the 5 amount of $189,070.25 and demanded $50,000 for loss of use of the Subject Property, Defendants 6 denied payment of the full amount, claiming that the repairs included non-covered 7 “improvements,” “betterments,” and “upgrades.” (SAC ¶¶ 23-24.) 8 Plaintiff provides a timeline of her interactions with Defendants. On January 30, 2023, 9 Sedgwick’s field adjuster, John Weber, conducted an onsite inspection with Plaintiff and 10 Plaintiff’s contractor. (SAC ¶ 26.) During the inspection, Plaintiff’s contractor explained and 11 justified the corrective repairs, and Defendants did not dispute the need. (SAC ¶¶ 27-28.) 12 Instead, “Sedgwick claims personnel affirmatively acknowledged that the corrective repairs were 13 necessary to stop the water intrusion and implied that such corrective repairs would be paid as part 14 of the covered loss[.]” (SAC ¶ 45.) Additionally, “Sedgwick claims personnel” represented to 15 Plaintiff that the corrective repair scope would be reviewed line by line to determine which items 16 were covered. (SAC ¶ 43.) That personnel also represented that Plaintiff would be advised in 17 advance of any line items Defendants believed were not reimbursable, together with the policy 18 basis for each position. (SAC ¶ 44.) 19 On February 6, 2023, Plaintiff requested that Defendant Sedgwick provide a line-by-line 20 coverage determination of the scope of corrective repairs and identify any excluded items. (SAC ¶ 21 46.) On March 2, 2023, Plaintiff again requested that Defendants identify which corrective repairs 22 would not be paid and explain why. (SAC ¶ 47.) 23 On March 27, 2023, Mr. Weber conducted a second onsite inspection, during which 24 Plaintiff’s contractor again explained and justified the same corrective repairs. (SAC ¶¶ 29-30.) 25 Defendants again raised no objections. (SAC ¶ 31.) On April 12, 2023, Plaintiff requested that 26 Defendants “go through the scope and tell me what you will not pay for and the policy reason 27 why.” (SAC ¶ 48.) On April 25, 2023, Plaintiff’s contractor sent an e-mail to Mr. Weber, 1 On April 26, 2023, Plaintiff paid $6,737.94 to her contractor. (SAC ¶ 52.) On May 17, 2023, 2 Plaintiff had a telephone conversation with Mr. Weber, during which Mr. Weber expressed no 3 concerns with the scope of repair. (SAC ¶ 34.) 4 On November 10, 2023, Plaintiff paid $23,019.00 to her contractor. (SAC ¶ 52.) On 5 November 22, 2023, Mr. Weber conducted a third onsite inspection, and Plaintiff requested 6 prompt payment and proposed payment structures such as reimbursement per invoice. (SAC ¶ 7 38.) Defendants did not provide a clear written response. On November 28, 2023, Plaintiff wrote 8 Mr. Weber and others, requesting a prompt, written reimbursement plan. (SAC ¶ 39.) On 9 November 15, 2023, Plaintiff paid $31,467.02 to her contractor. (SAC ¶ 52.) On December 28, 10 2023, Plaintiff again wrote Mr. Weber and others, requesting a prompt, written reimbursement 11 plan. (SAC ¶ 39.) 12 At an unknown point, Plaintiff communicated with Defendant Palomar’s personnel, 13 complaining about the prolonged claim history. (SAC ¶ 41.) Plaintiff was “led to believe Palomar 14 could reach a swift resolution.” (SAC ¶ 41.) 15 In May 2023 and throughout 2024, Defendant Sedgwick through examiner/adjuster R. 16 Fachon Reed “and other claim personnel” made statements minimizing or obscuring prior claim 17 participants and communications, including a statement by Ms. Reed at an unknown time that, “In 18 regards to your 1st question, there were only 3 people on the call, your contractor, Mr. Weber, and 19 myself.” (SAC ¶¶ 60-61.) 20 On May 3, 2024, Ms. Reed reached out to Plaintiff, stating that she was the examiner 21 making recommendations for coverage and instructing Plaintiff to direct payment and coverage 22 inquiries to her. (SAC ¶ 54.) On July 5, 2024, Ms. Reed wrote Plaintiff, stating: “Your policy 23 affords coverage to return damaged property to its pre-damaged state; it does not allow for 24 improvements.” (SAC ¶ 55.) On July 30, 2024, Defendant Palomar’s claims relationship 25 specialist, Flo Harder, acknowledged the difference between the estimate by Plaintiff’s contractor 26 and Defendant Sedgwick’s determination, referencing discussion that allegedly included 27 “corrective repairs and betterment.” (SAC ¶ 56.) On August 6, 2024, Defendant Palomar’s Vice 1 improvements and betterments were not covered under the policy. (SAC ¶ 57.) 2 B. Procedural Background 3 On March 3, 2025, Plaintiff filed the instant action. (Dkt. No. 1.) On June 26, 2025, 4 Plaintiff filed a first amended complaint. (Dkt. No. 25.) On July 10, 2025, Defendants filed a 5 motion to dismiss and a motion to strike the punitive damages request; Defendants did not seek 6 dismissal of the breach of contract and breach of the covenant of good faith and fair dealing claims 7 against Defendant Palomar. (Dkt. Nos. 27, 28.) Plaintiff did not oppose the motion to strike the 8 punitive damages request, even after the Court issued an order to show cause. (See Dkt. No. 29.) 9 On December 1, 2025, the Court granted Defendants’ motion to dismiss, but gave 10 Plaintiff leave to amend the intentional misrepresentation claim. (Dismissal Order at 13, Dkt. No. 11 41.) The Court also struck Plaintiff’s request for punitive damages with prejudice. (Id.) The 12 Court gave Plaintiff 30 days to file an amended complaint. 13 On December 30, 2025, Plaintiff filed a Second Amended Complaint. (Dkt. No. 46.) The 14 parties then stipulated to the filing of the operative complaint, which Plaintiff then filed on 15 January 26, 2026 but confusingly again captioned as the Second Amended Complaint. (See Dkt. 16 Nos. 47, 50.) Therein, Plaintiff asserted claims for: (1) breach of contract as to Defendant Palomar 17 only, (2) breach of the implied covenant of good faith and fair dealing as to Defendant Palomar 18 only, (3) intentional misrepresentation and concealment as to both Defendants, and (4) unfair 19 competition under California Business & Professions Code § 17200 as to Defendant Palomar only. 20 Plaintiff also sought restitution, injunctive relief, and punitive damages.

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Bluebook (online)
Mary Tagliaferri v. Palomar Specialty Insurance Company, et al., Counsel Stack Legal Research, https://law.counselstack.com/opinion/mary-tagliaferri-v-palomar-specialty-insurance-company-et-al-cand-2026.