v.
State Farm Lloyds
04-17-00251-CV
FOURTH COURT OF APPEALS
SAN ANTONIO, TEXAS
9/27/2017 2:37 PM
FILED INA. Lorber
Melissa
4th COURT(512)
OF APPEALS
615-1205
SAN ANTONIO, TEXAS
[email protected]
09/27/2017 2:37:51 PM
September 27, 2017 KEITH E. HOTTLE
CLERK
Keith E. Hottle, Clerk of the Court
Fourth Court of Appeals
Cadena-Reeves Justice Center
300 Dolorosa, Suite 3200
San Antonio, Texas 78205-3037
Re: No. 04-17-00251-CV, Juan Alvarez v. State Farm Lloyds, In the Court of Appeals, Fourth District of Texas – San Antonio
Dear Mr. Hottle:
State Farm writes to inform the Court about two new Texas court decisions, issued since State Farm filed its appellee’s brief, that address the same issues as this case. Please forward this letter to the justices on the panel for this case.
Both of these new opinions support State Farm’s position in this case:
• On September 21, 2017, the United States Court of Appeals for the Fifth Circuit issued an opinion in Mainali Corp. v. Covington Specialty Insurance Co. (attached as Appendix A). The Fifth Circuit affirmed a take-nothing summary judgment on the insurer’s breach of contract and Insurance Code, Chapter 542 claims that had been granted after the insurer paid an appraisal award. Id. at 3-6.
• On September 22, 2017, the Texas Supreme Court denied the insurer’s petition for review in Richardson East Baptist Church v. Philadelphia Indemnity Insurance Co., No. 16-0347. The petition had challenged the Dallas court of appeals’ decision affirming a take-nothing judgment on breach of contract and Insurance Code, Chapter 541 claims after the insurer’s payment of an appraisal award. See No. 05–14–01491– CV, 2016 WL 1242480, *6-11 (Tex. App.—Dallas Mar. 30, 2016, pet. denied) (attached as Appendix B).
Sincerely,
/s/ Melissa A. Lorber
Melissa A. Lorber
Bridgepoint Plaza
p: 512.615.1200
ENOCH KEVER PLLC 5918 W. Courtyard Drive, Suite 500 enochkever.com f: 512.615-1198 Austin, Texas 78730
Keith E. Hottle, Clerk of the Court
September 27, 2017
Page 2
CERTIFICATE OF SERVICE
I hereby certify that, on September 27, 2017, a true and correct copy of the above and foregoing has been served via electronic service on the following:
Joshua P. Davis
[email protected]
Katherine Ray
[email protected]
Davis Law Group
1010 Lamar, Suite 200
Houston, Texas 77002
/s/ Melissa A. Lorber
Melissa A. Lorber
APPENDIX A
IN THE UNITED STATES COURT OF APPEALS
FOR THE FIFTH CIRCUIT
United States Court of Appeals
Fifth Circuit
No. 17-10350 FILED
Summary Calendar September 21, 2017
Lyle W. Cayce
Clerk
MAINALI CORPORATION,
Plaintiff - Appellant
v.
COVINGTON SPECIALTY INSURANCE COMPANY; ENGLE MARTIN;
ASSOCIATES, INCORPORATED; LYNN SUMMERS,
Defendants - Appellees
Appeal from the United States District Court
for the Northern District of Texas
Before DAVIS, CLEMENT, and COSTA, Circuit Judges.
GREGG COSTA, Circuit Judge:
A fire damaged a gas station and convenience store owned by Mainali Corporation. Mainali filed a claim with its property insurer, Covington Specialty Insurance Company, which paid the claims based on an independent adjuster’s estimates. Mainali thought it was owed more, so it sued Covington for breach of contract, breach of the duty of good faith and fair dealing, fraud, and violations of the Texas Insurance Code and Texas Deceptive Trade Practices Act. After a full appraisal process, a panel’s appraisal award was less than Covington had already paid to Mainali under the insurance policy. But Covington did pay a relatively small additional sum to ensure its payments were consistent with the way the appraisal panel allocated the losses. The district court granted summary judgment for Covington on all of Mainali’s claims. The key issue we decide involves the application of the Prompt Payment of Claims Act to payments of an award pursuant to an appraisal process. For the reasons that follow, we AFFIRM.
I.
Mainali owned a gas station and convenience store (the Property) in Decatur, Texas. Covington insured Mainali’s Property. The commercial package insurance policy included coverage for the building, associated business personal property, the gas and fuel pumps, the gas station’s canopy and awnings, and lost business income. It also provided for payment of loss on an actual cash value basis—that is, with deduction for depreciation—and required payment of the depreciation holdback or full replacement cost value only if the insured repaired or replaced the property.
In April 2014, a fire damaged Mainali’s Property. The following day, Mainali notified Covington of the fire. Three days after the fire, Covington sent Lynn Summers, an independent adjuster, to investigate Mainali’s claim. Over the course of several payments made from May 2014 through January 2015, Covington paid Mainali $389,255.59 using an actual cash value basis.
Mainali disputed this calculation. And in March 2015, about two months after Covington’s last payment, Mainali filed suit against Covington and Summers in state court. Covington removed the lawsuit to federal court and then exercised its right of appraisal under the policy. As a result, Covington and Mainali each designated an appraiser, and the two appraisers agreed on an umpire. The appraisal panel issued an appraisal award of $387,925.49 as actual cash value and a replacement cost value of $449,349.61. The latter was the relevant figure as Mainali did not repair or replace the Property. The appraisal award provided that it was “inclusive of all FIRE damages sustained to the insured property” and was the sum of three types of losses: Building, Contents, and Business Interruption. Although Covington had already paid more than the total amount the appraisal panel said it owed, it paid an additional $15,175.82 for the building allocation after the panel announced its award.
Covington and Summers subsequently moved for summary judgment on Mainali’s claims. They argued that under Texas law, the timely payment of the appraisal award precluded liability on Mainali’s breach of contract and extracontractual claims. Mainali responded that the appraisal award was incomplete because it did not expressly include any amounts for fuel and gas pumps, the gas station’s canopy and awnings, or code upgrades. As for its extracontractual claims, Mainali pressed only its claim under the Prompt Payment of Claims Act in Chapter 542 of the Texas Insurance Code. It argued the postappraisal payment was subject to that Act’s interest penalties for payments made more than 60 days after the insurer receives necessary documentation from the insured. The district court granted Covington’s motion.
II.
Mainali first challenges the district court’s grant of summary judgment on the breach of contract claim. Under Texas law, “appraisal awards made pursuant to the provisions of an insurance contract are binding and enforceable, and every reasonable presumption will be indulged to sustain an appraisal award.” Franco v. Slavonic Mut. Fire Ins. Ass’n-CIC, 154 S.W.3d 777, 786 (Tex. App.—Houston [14th Dist.] 2004, no pet.). “The effect of an appraisal provision is to estop one party from contesting the issue of damages in a suit on the insurance contract, leaving only the question of liability for the court.” TMM Invs., Ltd. v. Ohio Cas. Ins. Co., 730 F.3d 466, 472 (5th Cir. 2013) (quoting Lundstrom v. United Servs. Auto. Ass’n, 192 S.W.3d 78, 87 (Tex.
App.—Houston [14th Dist.] 2006, pet. denied)). Courts have thus repeatedly rejected breach of contract claims when an insurer timely paid an appraisal award. See, e.g., Quibodeaux v. Nautilus Ins. Co., 655 Fed. App’x 984, 986−87 (5th Cir. July 7, 2016); Blum’s Furniture Co. v. Certain Underwriters at Lloyds London, 459 Fed. App’x 366, 368−69 (5th Cir. Jan. 24, 2012); Nat’l Sec. Fire & Cas. Co. v. Hurst, 2017 WL 2258243, at *3–4 (Tex. App.—Houston [14th Dist.] May 23, 2017, no pet. h.); Garcia v. State Farm Lloyds, 514 S.W.3d 257, 273−74 (Tex. App.—San Antonio 2016, pet. denied). Indeed, Texas law recognizes only three situations that allow a court to set aside an appraisal award: “(1) when the award was made without authority; (2) when the award was made as a result of fraud, accident, or mistake; or (3) when the award was not in compliance with the requirements of the policy.” Franco, 154 S.W.3d at 786.
Apparently relying on the third exception to breathe life into his breach of contract claim, Mainali contends that the appraisal award was incomplete because it “excludes” damage to items covered by the policy: fuel and gas pumps, the gas station’s canopy and awnings, and code upgrade costs. But Mainali cites nothing in the record showing these items were not included. It is Mainali’s burden to identify such evidence in order to overcome summary judgment given that the appraisal award states that it “is inclusive of all FIRE damages sustained to the insured property” (and shows code upgrade costs were included in the building loss calculation). Its failure to do so means there is no disputed issue of material fact, and the appraisal award will not be set aside.
III.
We next address Mainali’s prompt payment claim under Chapter 542 of the Texas Insurance Code. TEX. INS. CODE §§ 542.051 et seq. Section 542.058 of the statute requires the insurer to pay the policyholder’s claim within 60 days of receiving all documentation needed to resolve the claim. If the insurer does not do so, it is liable for an 18% penalty on the amount that was not timely paid, plus attorney’s fees. Id. § 542.060.
We must decide whether a payment made to comply with an appraisal award, which in most if not all cases is going to be paid after the 60-day window, is subject to this penalty. No reported Texas case has ever subjected such a payment to the statute. Earlier this year, a state court of appeals held that “full and timely payment of an appraisal award under the policy precludes an award of penalties under the Insurance Code’s prompt payment provisions.” Hurst, 2017 WL 2258243 at *5 (citing In re Slavonic Mut. Fire Ins. Ass’n, 308 S.W.3d 556, 563 (Tex. App.—Houston [14th Dist.] 2010, no pet.), overruled on other grounds by In re Universal Underwriters of Tex. Ins. Co., 345 S.W.3d 404 (Tex. 2011)); see also Garcia, 514 S.W.3d at 274–75; Breshears v. State Farm Lloyds, 155 S.W.3d 340, 344–45 (Tex. App.—Corpus Christi 2004, pet. denied). We recently held the same. Quibodeaux, 655 Fed. App’x at 988 (5th Cir. 2016) (holding that a “plaintiff may not seek Chapter 542 damages for any delay in payment between an initial payment and the insurer’s timely payment of an appraisal award”); see also Blum’s Furniture Co., 459 Fed. App’x at 368–69; McEntyre v. State Farm Lloyds, Inc., 2016 WL 6071598, at *6 (E.D. Tex. Oct. 17, 2016).
Mainali does find support for its view in one district court decision. See Graber v. State Farm Lloyds, 2015 WL 3755030 (N.D. Tex. June 15, 2015). The most fundamental problem with Graber is that it did not recognize an Erie court’s duty to follow state courts’ interpretation of state law rather than the interpretation the federal court thinks makes the most sense. Rideau v. Keller Indep. Sch. Dist., 819 F.3d 155, 165 (5th Cir. 2016) (explaining that on a state law question “we must defer to the prevailing view of the state intermediate courts, even more so if that view is uniform, unless convinced by other persuasive data that the highest court of the state would decide otherwise . . . .” (quotation and citation omitted)). Further, the primary authority Graber relied on was the rejection of a “good faith” defense to the Prompt Payment of Claims Act in a nonappraisal case. Graber, 2015 WL 3755030 at[*10] (citing Higginbotham v. State Farm Mut. Auto Ins. Co., 103 F.3d 456, 461 (5th Cir. 1997)). Higginbotham considered an insurer’s outright rejection, based on a reasonable defense, of a claim rather than an alleged underpayment followed by a timely postappraisal payment. See 103 F.3d at 458, 461. The different situation in which that ruling arose is not enough to divine that the Supreme Court of Texas would disagree with all the lower courts in the state that have addressed the issue in the context of postappraisal payments. Covington was not trying to avoid payment of the claim; it was invoking a contractually agreed to mechanism for assessing the amount it owed.
We must defer to the view of the Texas courts that have confronted the same question this case poses. Breshears, 155 S.W.3d at 345 (“The Breshears also argue that by invoking the appraisal process, State Farm did not notify them as to whether it intended to pay their claim within the time required by the code. We disagree.”). At a minimum under those state court decisions, there is no statutory violation because Covington made a preappraisal award that was undeniably reasonable. Id. (rejecting prompt payment claim because the insurer “complied with the insurance code, and provided a reasonable payment within a reasonable time”). In fact, it was more than the panel found due ($389,255, above the awarded $387,925). Only because of an allocation issue relating to the building award did Covington—out of an abundance of caution—issue an additional $15,175.82 to Mainali after the appraisal. Covington did not violate the Prompt Payment of Claims Act.
*** The judgement of the district court is AFFIRMED.
FIFTH CIRCUIT RULE 39
39.1 Taxable Rates. The cost of reproducing necessary copies of the brief, appendices, or record excerpts shall be taxed at a rate not higher than $0.15 per page, including cover, index, and internal pages, for any for of reproduction costs. The cost of the binding required by 5 T H C IR . R. 32.2.3that mandates that briefs must lie reasonably flat when open shall be a taxable cost but not limited to the foregoing rate. This rate is intended to approximate the current cost of the most economical acceptable method of reproduction generally available; and the clerk shall, at reasonable intervals, examine and review it to reflect current rates. Taxable costs will be authorized for up to 15 copies for a brief and 10 copies of an appendix or record excerpts, unless the clerk gives advance approval for additional copies.
39.2 Nonrecovery of Mailing and Com m ercial Delivery Service Costs. Mailing and commercial delivery fees incurred in transmitting briefs are not recoverable as taxable costs.
39.3 Tim e for Filing Bills of Costs. The clerk must receive bills of costs and any objections within the times set forth in F ED . R. A PP . P. 39(D ). See 5 T H C IR . R. 26.1.
F ED . R. A P P . P. 39. COSTS
(a) Against Whom Assessed. The following rules apply unless the law provides or the court orders otherwise;
(1) if an appeal is dismissed, costs are taxed against the appellant, unless the parties agree otherwise;
(2) if a judgment is affirmed, costs are taxed against the appellant;
(3) if a judgment is reversed, costs are taxed against the appellee;
(4) if a judgment is affirmed in part, reversed in part, modified, or vacated, costs are taxed only as the court orders.
(b) Costs For and Against the United States. Costs for or against the United States, its agency or officer will be assessed under Rule 39(a) only if authorized by law.
©) Costs of Copies Each court of appeals must, by local rule, fix the maximum rate for taxing the cost of producing necessary copies of a brief or appendix, or copies of records authorized by rule 30(f). The rate must not exceed that generally charged for such work in the area where the clerk’s office is located and should encourage economical methods of copying.
(d) Bill of costs: Objections; Insertion in Mandate.
(1) A party who wants costs taxed must – within 14 days after entry of judgment – file with the circuit clerk, with proof of service, an itemized and verified bill of costs.
(2) Objections must be filed within 14 days after service of the bill of costs, unless the court extends the time.
(3) The clerk must prepare and certify an itemized statement of costs for insertion in the mandate, but issuance of the mandate must not be delayed for taxing costs. If the mandate issues before costs are finally determined, the district clerk must – upon the circuit clerk’s request – add the statement of costs, or any amendment of it, to the mandate.
(e) Costs of Appeal Taxable in the District Court. The following costs on appeal are taxable in the district court for the benefit of the party entitled to costs under this rule:
(1) the preparation and transmission of the record;
(2) the reporter’s transcript, if needed to determine the appeal;
(3) premiums paid for a supersedeas bond or other bond to preserve rights pending appeal; and (4) the fee for filing the notice of appeal.
APPENDIX B
Richardson East Baptist Church v. Philadelphia Indemnity..., Not Reported in... 2016 WL 1242480
2016 WL 1242480 Only the Westlaw citation is currently available. SEE TX R RAP RULE 47.2 FOR DESIGNATION AND SIGNING OF OPINIONS.
Court of Appeals of Texas, Dallas.
Richardson East Baptist Church, Appellant v. Philadelphia Indemnity Insurance Company and James Greenhaw, Appellees
No. 05–14–01491–CV
| Opinion Filed March 30, 2016 Synopsis Background: Insured property owner brought action against insurer and adjustor for breach of contract, violations of Insurance Code, breach of duty of good faith and fair dealing, and conspiracy. The 298th Judicial District Court, Dallas County, entered take-nothing judgment. Insured appealed. Holdings: The Court of Appeals, Myers, J., held that: [1] e-mails from claims adjuster to insurer, relaying conversations held with representatives of insured, did not constitute a demand for appraisal of insured's loss from hail damage to building, as asserted by insured in breach of contract claim alleging insurer breached policy's appraisal procedure; [2] statements of insurer's employee that insurer would not agree to an appraisal until insured provided some expert evidence pointing out the alleged additional hail damage not found by insurer's expert did not impose a condition precedent to insured's right to invoke the appraisal process, as could constitute breach of insurance contract; [3] liability of insurer was not reasonably clear, and thus insurer's alleged undervaluing of insured's loss was not a violation of provision of Insurance Code prohibiting an insurer from not attempting in good faith to effect a prompt, fair, and equitable settlement of a claim submitted in which liability had become reasonably clear. Affirmed.
West Headnotes (7) [1] Insurance Demand
E-mails from claims adjuster to insurer, relaying conversations held with representatives of insured, did not constitute a demand for appraisal of insured's loss from hail damage to building, as asserted by insured in breach of contract claim alleging insurer breached policy's appraisal procedure, where insured's representative merely stated that he was “likely” to invoke appraisal.
© 2017 Thomson Reuters. No claim to original U.S. Government Works. 1 Richardson East Baptist Church v. Philadelphia Indemnity..., Not Reported in... 2016 WL 1242480 Cases that cite this headnote [2] Insurance Contracts Statements of insurer's employee that insurer would not agree to an appraisal, following hail damage to insured's property, until insured provided some expert evidence pointing out the alleged additional hail damage not found by insurer's expert did not impose a condition precedent to insured's right to invoke the appraisal process, as could constitute breach of insurance contract, where there was no evidence that such statements were communicated to insured before insurer invoked appraisal process. Cases that cite this headnote [3] Insurance Subjects and scope of appraisal Insurance Award Fact that appraisal award was substantially higher than insurer's initial payment on insured's loss from hail damage to building was not evidence that insurer intentionally or purposefully undervalued insured's loss, as asserted by insured in breach of contract action against insurer, where policy's appraisal clause did not state that appraisal would determine whether a breach of contract had occurred. Cases that cite this headnote [4] Insurance Settlement Duties; Bad Faith An insurer's reliance on the opinion of its experts, absent evidence of knowledge of the unreliability of the expert's opinion, does not violate any duty. Cases that cite this headnote [5] Insurance Duty to settle or pay Insurance Investigations and inspections There was no evidence that insurer engaged in a practice of delaying full payment of claims, as could support insured's action against insurer for violation of Insurance Code through alleged failure to implement reasonable standards for the prompt investigation of claims. Tex. Ins. Code Ann. § 542.003(b)(3).