Winston v. State Farm Lloyds

District Court, W.D. Texas·Decided August 11, 2022·No. 5:20-cv-00515·Unknown

Opinion

UNITED STATES DISTRICT COURT WESTERN DISTRICT OF TEXAS SAN ANTONIO DIVISION

JOHN H. WINSTON III,

Plaintiff,

v. Case No. SA-20-CV-00515-JKP

STATE FARM LLOYDS,

Defendant.

MEMORANDUM OPINION AND ORDER Before the Court is Plaintiff Dr. John H. Winston, III’s Motion for Attorneys’ Fees, Defendant State Farm’s Response, Dr. Winston’s Reply, and State Farm’s Sur-Reply. ECF Nos. 107, 109, 110, 111. The parties also briefed the Court on Dr. Winston’s breach of contract and Texas Prompt Payment of Claims Act awards. Dr. Winston’s Motion is GRANTED IN PART. The Court awards Dr. Winston $91,138.71 for his breach of contract claim, $43,379.50 under the Texas Prompt Payment of Claims Act, $14,126.50 in pre-judgment interest, such sums as may be appropriate in post-judgment interest, and $112,338.60 in attorneys’ fees.

FACTUAL BACKGROUND This case arises from a dispute between Dr. Winston and his homeowner’s insurance carrier, State Farm. In April 2019, Dr. Winston filed a claim with State Farm for hailstorm damage to his home. State Farm paid Dr. Winston based on its inspector’s assessment of the damage. Dr. Winston was dissatisfied with the payment because the parties disagree about the extent of the damage—specifically, Dr. Winston contends that his roof needs to be replaced, while State Farm believes it could be repaired. When the parties reached an impasse, Dr. Winston invoked an appraisal clause in the parties’ contract to determine the actual amount of loss. The appraisal was conducted in October 2019, finding that $91,138.71 was necessary to replace the roof. State Farm continued to maintain that the roof did not need to be replaced. As

such, State Farm reduced the appraisal award by $91,138.71 and paid Dr. Winston the amount it estimated was necessary to repair the roof, plus some additional funds for other damages to the home. All told, State Farm paid Dr. Winston $28,193.74 for hail damage. At issue in the case was whether State Farm breached the parties’ contract by refusing to pay $91,138.71 to replace Dr. Winston’s roof. The case went to trial and a jury found that State Farm had breached the contract. The jury awarded Dr. Winston $77,896.71, which is the $91,138.71 appraised amount to replace the roof minus Dr. Winston’s $13,242.00 deductible. The question now before the Court is whether the jury awarded the appropriate amount for Dr. Winston’s breach of contract claim. Both parties contend that it did not, for different

reasons. The Court also considers the parties’ briefings on the amount State Farm owes Dr. Winston under the Texas Prompt Payment of Claims Act and for attorneys’ fees.

DISCUSSION I. Breach of Contract The parties disagree about whether the jury awarded Dr. Winston the correct amount for his breach of contract claim. Dr. Winston maintains the jury should not have applied the deductible because State Farm stipulated before trial that $91,138.71 was the amount recoverable for the breach of contract claim. State Farm maintains it stipulated only that $91,138.71 was the “maximum” amount recoverable, subject to appropriate offsets. As such, State Farm argues the jury properly applied the deductible and the Court should further reduce the jury award for depreciation and prior payments. Prior to trial, the parties agreed, as the Final Pretrial Order reflects, that $91,138.71 was the “maximum recovery available” for Dr. Winston’s breach of contract claim. ECF No. 87, p. 3.

State Farm, however, reserved the right to seek offsets to Dr. Winston’s recovery for applicable policy deductibles, prior payments, and policy limitations. ECF No. 22, p. 4; ECF No. 87, p. 5. The right of offset is an affirmative defense. Brown v. Am. Transfer & Storage Co., 601 S.W.2d 931, 936 (Tex.1980). The party asserting offset has the burden of pleading this affirmative defense and proving the facts necessary to support it. Id. Therefore, State Farm, as the party asserting offset, had the burden of pleading and providing adequate evidence at trial to support its affirmative defense. State Farm sufficiently pled offset in its Amended Answer and reserved it in the Final Pretrial Order. ECF No. 22, p. 4; ECF No. 87, p. 5. State Farm then had the burden to proffer adequate evidence at trial to support its affirmative defense. To the extent any offsets

are omitted from the jury award, the jury’s verdict is an implicit rejection of State Farm’s affirmative defense. The Court therefore declines to apply State Farm’s requested offsets for depreciation and prior payments post-verdict. The jury’s application of the $13,242.00 policy deductible, however, was improper. The Court’s review of the record reveals that State Farm already applied the deductible in prior payments it made to Dr. Winston. Specifically, a summary of the payment State Farm issued after its initial April 2019 inspection indicates the $13,242.00 deductible was subtracted from the total award issued. ECF No. 37-4, p. 2. In addition, an October 17, 2019 letter State Farm sent Dr. Winston summarizing its post-appraisal payment reflects the $13,242.00 deductible was again applied. ECF No. 37-11, p. 2. For these reasons, the Court finds the jury improperly applied the policy deductible to its award. Dr. Winston has already paid the deductible. The Court therefore adjusts Dr. Winston’s award on his breach of contract claim to $91,138.71. II. Texas Prompt Payment of Claims Act Chapter 542 of the Texas Insurance Code requires an insurer to follow certain procedures

and meet certain deadlines when it receives, accepts, rejects, or pays an insurance claim. The statute’s purpose is to require insurers to promptly pay claims made by their insureds. See Tex. Ins. Code §542.054. Courts are required to construe the statute liberally to promote this purpose. Id. The elements of a cause of action for a violation of chapter 542 are the following: (1) the plaintiff had a claim under an insurance policy; (2) the plaintiff gave proper notice of its claim to the insurer; (3) the insurer is liable for the claim; and (4) the insurer violated chapter 542 by not timely: (a) acknowledging, investigating, or requesting information about the claim, (b) accepting rejecting, or extending the deadline for deciding the claim, or (c) paying the claim. Tex. Ins. Code §§ 542.051, 542.055, 542.056, 542.057, 542.060. The parties do not dispute that

Dr. Winston had a claim under the insurance policy and gave proper notice of his claim to State Farm, satisfying elements (1) and (2). The jury’s finding that State Farm breached the parties’ contract by failing to pay to replace Dr. Winston’s roof satisfies elements (3) and (4)(c), because the jury found State Farm is liable for a claim it did not pay. Therefore, State Farm is liable for violating chapter 542. In an action for violation of chapter 542, the insurer is liable to pay simple interest on the amount of the claim as damages. Tex. Ins. Code § 542.060(c). Simple interest is calculated by applying the formula P x R x T = I, in which P is the principal (or the amount of the claim), R is the rate of interest, T is the time period, and I is the interest awarded. Texas Farmers Ins. v. Cameron, 24 S.W.3d 386, 400 n.5 (Tex.App.—Dallas 2000, pet. denied). Each of these values is calculated as follows: • The P value, or principal value, is the value of Dr. Winston’s breach of contract claim, or $91,138.71.

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