North River Insurance Company v. Pomerantz

492 S.W.2d 312, 65 A.L.R. 3d 816, 1973 Tex. App. LEXIS 2273
CourtCourt of Appeals of Texas
DecidedMarch 7, 1973
Docket714
StatusPublished
Cited by8 cases

This text of 492 S.W.2d 312 (North River Insurance Company v. Pomerantz) 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
North River Insurance Company v. Pomerantz, 492 S.W.2d 312, 65 A.L.R. 3d 816, 1973 Tex. App. LEXIS 2273 (Tex. Ct. App. 1973).

Opinion

COULSON, Justice.

This is a suit by Donald Pomerantz and Melvin Pomerantz, appellees here and *313 plaintiffs in the trial court, on an insurance policy issued by the North River Insurance Company, appellant here and defendant in the trial court, to recover for property damage, occurring on July 26, 1969, to appellees’ apartment units located in Houston, Texas. The claim arose from an incident in which a backhoe tractor was being used to dig a ditch to lay a replacement sewer line on appellees’ property. While engaged in this digging operation, the bucket of the backhoe allegedly came in contact .with an underground conduit containing electrical cables furnishing electrical power to appellees’ property. A short circuit resulted and damaged the wiring system of appellees’ property. Appel-lees notified the insurance agent that this mishap had occurred and sought payment under a provision of the policy insuring against direct loss resulting from “land vehicles”. Appellant, the North River Insurance Company, denied appellees’ claim on the basis that the backhoe involved was not operating as a “land vehicle” at the time of this occurrence and that there was no “direct” loss within the meaning of the policy. The latter contention was based on the insurer’s contention that the backhoe did not actually touch the underground conduit or the electrical lines therein. Although ap-pellee Donald Pomerantz discussed this claim with agents of appellant on two occasions within 91 days after the loss occurred, no sworn proof of loss was submitted to appellant within the 91 day period as required by the policy.

After appellant’s failure to pay appellees’ claim, appellees, on December 26, 1969, brought suit on the insurance contract. Trial was to a jury which found (1) that appellant, The North River Insurance Company, had through its duly authorized agents unconditionally denied appellees’ claim within 91 days of the loss; (2) that the damages incurred were caused by the operation of a land vehicle; and (3) that the cost of repairing the damage to the insured premises was $3,778.25. Judgment for plaintiff was entered based on the jury’s verdict and the defendant insurance company has duly perfected its appeal.

In its first two points of error appellant complains of the submission of and answer to Special Issue No. 1 which inquired whether appellant’s authorized agents had denied appellees’ claim under the policy. These points of error encompass no evidence, insufficient evidence and great weight grounds. An affirmative finding on this issue was vital to appellees’ right to bring suit on the policy since, as previously noted, no sworn proof of loss was ever given to the insurer. A denial of liability by the insurance company within the period allowed for filing proof of loss, on grounds other than the failure to submit proof of loss, constitutes a waiver of this requirement. Sun Mut. Ins. Co. v. Mattingly, 77 Tex. 162, 13 S.W. 1016 (1890); Sanders v. Aetna Life Ins. Co., 146 Tex. 169, 205 S.W.2d 43 (1947). We have carefully examined the Statement of Facts and exhibits in this case' and have concluded that although the evidence is somewhat conflicting, there is sufficient evidence to support the jury’s finding that appellees’ claim was denied within 91 days after the occurrence of the loss. Such finding is not against the overwhelming weight and preponderance of the evidence.

The testimony of appellee Donald Pom-erantz indicates that one month after the loss occurred he met with a line adjuster from the San Antonio office of Floyd West & Company. It was stipulated that this company is the general agent of appellant, The North River Insurance Company. The line adjuster informed Mr. Pomerantz that the claim was being denied on the ground that it was not within the coverage of the policy. Other testimony indicates that the line adjuster had authority to convey such information to claimants. The insurance agent corroborated appellees’ testimony that liability was denied by the line adjuster. Testimony of three persons, first, appellee, second, the insurance agent and, third, the claims manager for Floyd West & Company in Houston, establishes *314 that the denial of liability was reaffirmed by the Houston claims manager within the 91 day period after loss. There was, however, some inconsistency in the evidence as to the exact date on which this took place.

Evidence was admitted which tended to show that counsel for the insurance company may have been still considering the validity of appellees’ claim after the termination of the 91 day period for filing the proof of loss. Appellant contends that whatever denial of liability was made before the lapse of the 91 days was therefore not “unconditional” and thus not a waiver of the policy provision. First, we hold that this evidence does not amount to such an overwhelming preponderance of the evidence as to make the jury’s finding clearly wrong. Secondly, from an examination of the cases, we can not say that an unconditional denial of liability is necessary to constitute a waiver. The important characteristic of the denial is shown by the language of the Supreme Court of Texas in Scottish Union & Nat. Ins. Co. v. Clancey, 83 Tex. 113, 18 S.W. 439, 440-441 (1892):

“It is a well-known principle in this class of cases that the acts relied on as constituting a waiver should be such as are reasonably calculated to make the assured believe that a compliance on his part with the stipulations providing the mode of proof of loss, and regulating the appraisement of the damage done, is not desired, and that it would be of no effect if observed by him.”

We think the evidence of denial in the instant case is sufficient to meet that standard. The claims manager from Floyd West & Company indicated that he had received all the information he needed for proof of loss. Only the formality of a sworn statement was missing. Under these circumstances we do not find it of any consequence whether the insurance company informs the insured that the claim absolutely will not be paid or simply indicates that it is not planning to pay the claim unless some new development arises. It is enough that the actions of the insurance company are such as would reasonably lead the insured to believe that the company is not going to pay the claim because of some reason other than failure to file the required proof of loss. Appellant’s first two points of error are overruled.

In its third and fourth points of error, appellant attacks the submission of and answer to Special Issue No. 2 which inquired if the damage to the insured property was caused by the operation of a “land vehicle”. Again the grounds of attack are no evidence, insufficient evidence and that the jury’s answer is against the weight of the evidence. Grouped with these points in appellant’s brief is its fifth point of error which complains of the trial court’s failure to give appellant’s requested instruction defining the term “land vehicle”. The requested instruction reads as follows:

“You are instructed that a ‘land vehicle’ is a vehicle which during its use moves over the land and is not stationery (sic) machinery or equipment.”

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Bluebook (online)
492 S.W.2d 312, 65 A.L.R. 3d 816, 1973 Tex. App. LEXIS 2273, Counsel Stack Legal Research, https://law.counselstack.com/opinion/north-river-insurance-company-v-pomerantz-texapp-1973.