Whether the insured's claims based upon the adjustor's inadequate inspection after Hurricane Ike stated a claim was at issue in Stewart v. Nationwide Prop. & Cas. Ins. Co., 2011 U.S. DIst. LEXIS 111465 (S.D. Tex. Sept. 29, 2011).
Based on the complaint's allegations, the insured's home suffered extensive damage from Hurricane Ike when a tree limb fell on part of the roof, allowing water to enter. Nationwide assigned an adjuster to the claim, who did not perform a thorough investigation. Although damage for the entire roof was claimed, the adjuster failed to inspect the attic area under the damaged roof and did not inspect the potential roof damage over the main part of the house. Nationwide's payment only covered a portion of the roof and interior coverage for only a couple of rooms in the house. Nationwide also failed to give a reasonable explanation for its non-payment of particular damage claims.
Ruling on the motion to dismiss, the court dismissed fraud claims because the insured did not take any action in reliance on the adjustor's misrepresentations and inadequate inspection.
Claims based on the breach of the duty of good faith and fair dealing survived the motion to dismiss, however. The complaint alleged that the investigation and evaluation were unreasonable, as Nationwide knew or should have known that its liability was reasonably clear based on the inspection and the reported damages.
Claims under the Texas Insurance Code were also adequately pled. Nationwide failed to provide a reasonable explanation of its offer of a compromise settlement of the claim. Nor had an adequate investigation been performed. Finally, allegations that Nationwide delayed payment of the claim following its receipt of all items, statements, and forms adequately stated a claim.
