covered claim in Texas

2025A. Applicable Law Insurance appraisal clauses “provide a means to resolve disputes about the amount of loss for a covered claim.” In re Universal Underwriters of Tex. Ins., 345 S.W.3d at 406–07; see State Farm Lloyds v. Johnson, 290 S.W.3d 886, 888 (Tex. 2009).

2025A. Applicable Law Insurance appraisal clauses “provide a means to resolve disputes about the amount of loss for a covered claim.” In re Universal Underwriters of Tex. Ins., 345 S.W.3d at 407 ; see State Farm Lloyds v. Johnson, 290 S.W.3d 886, 888 (Tex. 2009).

2025A. Applicable Law Insurance appraisal clauses “provide a means to resolve disputes about the amount of loss for a covered claim.” In re Universal Underwriters of Tex. Ins., 345 S.W.3d at 406–07; see State Farm Lloyds v. Johnson, 290 S.W.3d 886, 888 (Tex. 2009).

2025A. Applicable Law Insurance appraisal clauses “provide a means to resolve disputes about the amount of loss for a covered claim.” In re Universal Underwriters of Tex. Ins., 345 S.W.3d at 407 ; see State Farm Lloyds v. Johnson, 290 S.W.3d 886, 888 (Tex. 2009).

2022We have held that a “plaintiff’s factual allegations that potentially support a covered claim [are] all that is needed to invoke the insurer’s duty to defend[]; whereas, the facts actually established in the underlying suit control the duty to indemnify.” Id.

2022Trinity Universal, 945 S.W.2d at 821 . 9 the duty,” id., and by recognizing the duty if the petition alleges facts that “potentially support a covered claim,” GuideOne, 197 S.W.3d at 310 (emphasis added).

2022Trinity Universal, 945 S.W.2d at 821 . 9 the duty,” id., and by recognizing the duty if the petition alleges facts that “potentially support a covered claim,” GuideOne, 197 S.W.3d at 310 (emphasis added).

2022Trinity Universal, 945 S.W.2d at 821 . 9 the duty,” id., and by recognizing the duty if the petition alleges facts that “potentially support a covered claim,” GuideOne, 197 S.W.3d at 310 (emphasis added).

2025First, courts may consider 14 “An insurer must defend its insured if a plaintiff’s factual allegations potentially support a covered claim, while the facts actually established in the underlying suit determine whether the insurer must indemnify its insured.” Zurich, 268 S.W.3d at 490 (citing GuideOne Elite Ins. v. Fielder Rd.

2021Further, “[i]f a complaint potentially includes a covered claim, the insurer must defend the entire suit.” Zurich, 268 S.W.3d at 491 .

2009The court held that the “failure to specifically list personal injury as a covered claim preclude[d] indemnity for the personal injury claim.” Id. at 15 .

2009The court held that the “failure to specifically list personal injury as a covered claim preclude[d] indemnity for the personal injury claim.” Id. at 15.

2011The court explained that a substantive change in po *729 sition for an insurer caused by a default judgment generally renders a default judgment prejudicial because “[bjefore default judgment, an insurer can escape liability for a covered claim if the plaintiff fails to meet its burden of proof,” but, “[ajfter a default judgment, ... an insurer can no longer defend against the underlying claim unless it first meets a new burden of proof on new issues.” Id. at 288 .

2011Co., 218 S.W.3d 279, 287-88 (Tex.App.-Houston [14th Dist.] 2007, pet. denied) (explaining that substantive change in position for an insurer caused by a default judgment generally renders a default judgment prejudicial because "[bjefore default judgment, an insurer can escape liability for a covered claim if the plaintiff fails to meet its burden of proof,” but, ‘‘[ajfter a default judgment, ... an insurer can no longer defend against the underlying claim unless it first meets a new burden of proof on new issues”). 10 .

2018In the Causation Motion, the District asserted the following grounds: (1) Appraisal clauses in Texas property-insurance policies provide a method to resolve disputes regarding a covered claim, and, if invoked, these clauses bind the parties to have the extent or amount of loss determined by appraisal. 2 See Zhu, 543 S.W.3d at 433 ; Lundstrom v. USAA, 192 S.W.3d 78, 87 (Tex. App.—Houston [14th Dist.] 2006, pet. denied). 3 See Zhu, 543 S.W.3d at 433 . 4 (2) The Award determined that the “‘amount of loss’ — what was caused by windstorm and the cost to repair or replace such loss” — was $10,815,96

2018Ass’n, 154 S.W.3d 777, 786 (Tex. App.— Houston [14th] 2004, no pet.). 3 See Zhu, 543 S.W.3d at 433 ; Lundstrom v. USAA, 192 S.W.3d 78, 87 (Tex. App.—Houston [14th Dist.] 2006, pet. denied). 4 See Zhu, 543 S.W.3d at 433 . 4 (1) Appraisal clauses in Texas property-insurance policies provide a method to resolve disputes regarding a covered claim, and, if invoked, these clauses bind the parties to have the extent or amount of loss determined by appraisal. (2) The Award determined that the “‘amount of loss’ — what was caused by windstorm and the cost to repair or replace such loss” — was $10,815,96

1995See Nunez v. Autry, 884 S.W.2d 199, 202 (Tex.App.—Austin 1994, no writ) (distinguishing recovery from corporate assets of insurance company in receivership from recovery from Fund).

1995See Nunez v. Autry , 884 S.W.2d 199, 202 (Tex. App.--Austin 1994, no writ) (distinguishing recovery from corporate assets of insurance company in receivership from recovery from Fund).

2005Ass’n, 153 S.W.3d 150 , 152- 53 (Tex. App.—Austin 2004, pet. denied) (Association claims examiner determined that injured third-party’s claims “qualified as a covered claim under the Act and recommended that the Association” pay $300,000 towards settlement); Lopez v. Texas Prop. & Cas.

2005Ass'n , 153 S.W.3d 150, 152-53 (Tex. App.--Austin 2004, pet. denied) (Association claims examiner determined that injured third-party's claims "qualified as a covered claim under the Act and recommended that the Association" pay $300,000 towards settlement); Lopez v. Texas Prop. & Cas.

2020See City of Abilene, 551 S.W.3d at 344 (“In the context of an insurance contract, appraisal is not sought in equity as a substitute for inadequate monetary damages, but rather it is a procedural vehicle provided by the contract to determine the amount of loss.”); Vanguard Underwriters Ins.

2018Ass’n, 154 S.W.3d 777, 786 (Tex. App.— Houston [14th] 2004, no pet.). 3 See Zhu, 543 S.W.3d at 433 ; Lundstrom v. USAA, 192 S.W.3d 78, 87 (Tex. App.—Houston [14th Dist.] 2006, pet. denied). 4 See Zhu, 543 S.W.3d at 433 . 4 (1) Appraisal clauses in Texas property-insurance policies provide a method to resolve disputes regarding a covered claim, and, if invoked, these clauses bind the parties to have the extent or amount of loss determined by appraisal. (2) The Award determined that the “‘amount of loss’ — what was caused by windstorm and the cost to repair or replace such loss” — was $10,815,96

2015Co., 157 Cal. App. 3d 290, 296 (Cal. Ct. App. 1984) (“CIGA is given the ‘same rights as the insolvent insurer would have had if not in liquidation, including . . . the right to . . . adjust, compromise, settle, and pay a covered claim. . . .” (Ins.

2015A judicial admission “occurs when an assertion of fact is conclusively established in live pleadings.” Horizon/CMS Healthcare Corp. v. Auld, 34 S.W.3d 887, 905 (Tex. 2000).

2014Co. v. Nat’l Oilwell NOV., Inc., 355 S.W.3d 205, 210 (Tex. App.—Houston [1st Dist.] 2011, no pet.).

2014Id. at 211 .

2014Unless otherwise nonrecoverable claims are necessary to obtain all relief on a covered claim, which is not the case here, a prevailing party must segregate recoverable from unrecoverable attorney’s fees “in all cases.” Varner, 218 S.W.3d at 69 (affirming denial of attorney fees incurred to pursue related claims against third party, but concluding that attorney’s fees for defending counterclaim need not be segregated because plaintiffs were required to successfully defend that claim to fully recover on claim for which attorney’s fees were authorized).

2009Co. v. Nokia, Inc., 268 S.W.3d 487, 491 (Tex.2008) (“If a complaint potentially includes a covered claim, the insurer must defend the entire suit.”); Gehan Homes, Ltd., 146 S.W.3d at 838 (“A duty to defend any of the claims against an insured requires the insurer to defend the entire suit.”).

2008Co. v. Audiovox Corp., 294 A.D.2d 194 , 741 N.Y.S.2d 692, 692 (N.Y.App.Div.2002) (no duty to defend), with Ericsson, Inc. v. St.

2008Co. v. Audiovox Corp., 294 A.D.2d 194 , 741 N.Y.S.2d 692, 692 (N.Y.App.Div.2002) (no duty to defend), with Ericsson, Inc. v. St.

2006Standard Fire Ins. v. Fraiman, 514 S.W.2d 343, 344-46 (Tex.Civ.App.-Houston [14th Dist.] 1974, no writ).