Preview
Electronically Filed
1/29/2024 2:51 PM
Hidalgo County District Clerks
Reviewed By: Dana Cavazos
CAUSE NO. C-4738-23-A
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JOAQUIN CERDA, § IN THE DISTRICT COURT
Plaintiff, §
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V. § 92ND JUDICIAL DISTRICT
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GERMANIA FARM MUTUAL INSURANCE §
ASSOCIATION, § HIDALGO COUNTY, TEXAS
Defendant. §
PLAINTIFF’S REPLY TO DEFENDANT’S RESPONSE TO PLAINTIFF’S MOTION FOR
PARTIAL SUMMARY JUDGMENT
TO THE HONORABLE JUDGE AND JURY OF SAID COURT:
COMES NOW, Joaquin Cerda (“Plaintiff”), in the above-styled and numbered
cause, and files this Reply to Defendant’s Germania Farm Mutual Insurance
Association (“Defendant”), Response to Plaintiff’s Motion for Partial Summary
Judgment, and would show the Court as follows:
I. SUMMARY OF ARGUMENT
1.1 This litigation illustrates a significant deviation from justice, instigated
by Defendant Germania Insurance’s improper conduct. Germania’s late and
erroneous invocation of the appraisal process constitutes a clear waiver of this right.
This position is supported by In re Universal Underwriters of Texas Ins. Co., 345
S.W.3d 404, 408 (Tex. 2011), which underscores the importance of timely and precise
execution in insurance procedures. Additionally, the profound discrepancy in damage
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Electronically Filed
1/29/2024 2:51 PM
Hidalgo County District Clerks
Reviewed By: Dana Cavazos
assessments, highlighted by Plaintiff’s adjuster’s report citing damages over $75,000
compared to Germania’s mere $24,091.93, not only suggests a breach of contract but
also evidences bad faith, aligning with USAA Texas Lloyds Co. v. Menchaca, 545
S.W.3d 479 (Tex. 2018). The case further demonstrates Defendant Germania’s
disregard for the duty of good faith and fair dealing, as they bypassed the crucial step
of re-inspection mandated by Texas Insurance Code Sec. 542A.004. This neglect is in
stark contrast to the principles established in Arnold v. Nat’l Cnty. Mut. Fire Ins. Co.,
725 S.W.2d 165 (Tex. 1987). Consequently, this scenario presents a substantial risk
of prejudice to the Plaintiff, a blue-collar worker, if appraisal is compelled at this
juncture, echoing the concerns raised in G.A. Stowers Furniture Company v.
American Indemnity Company, 15 S.W.2d 544, 548 (Tex. Comm’n App. 1929).
Therefore, granting the Plaintiff's motion for partial summary judgment is
imperative to uphold the principles of justice and prevent the potential exploitation
of policyholders by insurers.
II. ARGUMENT & AUTHORITIES
a. DEFENDANT GERMANIA IMPROPER INVOCATION OF APPRAISAL AND WAIVER OF
RIGHTS.
2.1 Defendant’s delayed and materially inaccurate invocation of the
appraisal process, as highlighted in Plaintiff's Motion for Partial Summary Judgment
(Exhibit F), constitutes a waiver of their right to invoke appraisal. According to Texas
Insurance Code Sec. 542A.003, the deadline for such invocation is strictly set, and the
Defendant’s actions post-deadline are not permissible. This is reinforced by the case
of In re Universal Underwriters of Texas Insurance Co., 345 S.W.3d 404 (Tex. 2011),
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Electronically Filed
1/29/2024 2:51 PM
Hidalgo County District Clerks
Reviewed By: Dana Cavazos
which emphasizes the necessity of timely and accurate communication in insurance
proceedings.
2.2 Defendant has waived its right to invoke appraisal. As established in
In re Universal Underwriters of Texas Ins. Co., 345 S.W.3d 404, 408 (Tex. 2011), the
right to appraisal can be waived by actions inconsistent with the right or which
indicate an intent not to assert it. Here, the Defendant’s attempt to invoke appraisal
was untimely and materially incorrect, notably with an incorrect claim number and
date of loss. Such errors are not mere oversights but significantly impact the essence
of the appraisal, potentially leading to an incorrect assessment of the claim. (See
Plaintiff’s Motion for Partial Summary Judgment—Exhibit F).
b. DEFENDANT GERMANIA IS LIABLE FOR BREACH OF CONTRACT FOR FAILING TO
PROVIDE COMPLETE COVERAGE FOR A COVERED PERIL UNDER THE POLICY
2.3 The vast difference in the damage assessment reports – Plaintiff’s
independent adjuster finding over $75,000 in damages (See Plaintiff’s Motion for
Partial Summary Judgment—Exhibit D) versus Defendant’s $24,091.93 (See
Defendant’s Response—Exhibit D) – is not just a matter of differing opinions but
indicative of a potential breach of contract and bad faith. The case of USAA Texas
Lloyds Co. v. Menchaca, 545 S.W.3d 479 (Tex. 2018), supports this argument,
establishing that an insurer’s failure to pay a claim that it owes can constitute a
breach of contract.
2.4 Under Texas law, as stated in Gilbert Tex. Constr. L.P. v. Underwriters
at Lloyd’s London, 327 S.W.3d 118 (Tex. 2010), insurance policies are construed
according to their terms. Here, the Plaintiff’s independent adjuster’s report, which
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Electronically Filed
1/29/2024 2:51 PM
Hidalgo County District Clerks
Reviewed By: Dana Cavazos
identified substantially more damage than the Defendant’s assessment, suggests a
potential breach of contract and bad faith. The significant discrepancy in damage
assessments indicates that the Defendant’s coverage was grossly inadequate, raising
questions about the Defendant’s adherence to the policy terms and obligations.
c. THE NECESSITY OF RE-INSPECTION AND GOOD FAITH OBLIGATIONS
DEFENDANT GERMANIA VIOLATED THE TEXAS INSURANCE CODE
2.5 A cause of action for breach of the duty of good faith and fair dealing is
stated when it is alleged that there is no reasonable basis for denial of a claim or
delay in payment or a failure on the part of the insurer to determine whether there
is any reasonable basis for the denial or delay. Arnold pleaded and produced
sufficient summary judgment proof to raise an issue of material fact that NCM had
no reasonable basis for its refusal to pay his uninsured motorist claim and with actual
knowledge of that, forced him to a trial on the accident before it would pay the claim.
Arnold v. Nat’l Cnty. Mut. Fire Ins. Co., 725 S.W.2d 165, 167 (Tex. 1987), holding
modified by Murray v. San Jacinto Agency, Inc., 800 S.W.2d 826 (Tex. 1990).
2.6 Under Texas Insurance Code Sec. 542A.004, insurers are obligated to
conduct reasonable re-inspections in claim disputes. The Defendant’s decision to
bypass this step and proceed directly to appraisal is contrary to the principles of good
faith and fair dealing, a cornerstone in insurance law as elucidated in Arnold v.
National County Mutual Fire Insurance Co., 725 S.W.2d 165 (Tex. 1987).
2.7 Defendant’s actions are in violation of Texas Insurance Code Sec.
542A.004. This section emphasizes the importance of inspection and good faith in
claim handling. The Defendant’s failure to conduct a proper and timely inspection,
PLAINTIFF’S REPLY TO DEFENDANT’S RESPONSE 4 |8
Electronically Filed
1/29/2024 2:51 PM
Hidalgo County District Clerks
Reviewed By: Dana Cavazos
as well as the late and incorrect invocation of appraisal, goes against the statute’s
spirit. This reinforces Plaintiff’s position that litigation should continue, and the
motion for partial summary judgment should be granted.
d. APPRAISAL AT THIS STAGE IN LITIGATION WILL BE PREJUDICIAL TO PLAINTIFF
2.8 Compelling appraisal at this stage would be inappropriate and
prejudicial to the Plaintiff. It would impose additional financial burdens on the
Plaintiff, a blue-collar worker, and contravene the principle that justice delayed is
justice denied. Defendant, by contrast, is in a more advantageous position, and
granting appraisal would unfairly benefit them at the Plaintiff’s expense.
2.9 In the insurance context a special relationship arises out of the parties’
unequal bargaining power and the nature of insurance contracts which would allow
unscrupulous insurers to take advantage of their insureds’ misfortunes in bargaining
for settlement or resolution of claims. In addition, without such cause of action
insurers can arbitrarily deny coverage and delay payment of a claim with not more
penalty than interest on the amount owed. An insurance company has exclusive
control over the evaluation, processing and denial of claims. For these reasons a duty
is imposed that “[An] indemnity company is held to that degree of care and diligence
which a man of ordinary care and prudence would exercise in the management of his
own business.” G.A. Stowers Furniture Company v. American Indemnity Company,
15 S.W.2d 544, 548 (Tex. Comm’n App. 1929, holding approved); Arnold v. Nat’l Cnty.
Mut. Fire Ins. Co., 725 S.W.2d 165, 167 (Tex. 1987); holding modified by Murray v.
San Jacinto Agency, Inc., 800 S.W.2d 826 (Tex. 1990).
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Electronically Filed
1/29/2024 2:51 PM
Hidalgo County District Clerks
Reviewed By: Dana Cavazos
III. CONCLUSION AND PRAYER FOR RELIEF
3.1 In conclusion, this Court should recognize the Defendant Germania
Insurance’s deviation from the procedural and substantive standards set by Texas
law, particularly in the appraisal process and in fulfilling their contractual
obligations. Defendant’s actions have not only compromised the Plaintiff’s right to a
fair claim assessment but also risk setting a detrimental precedent in insurance
practices.
3.2 WHEREFORE, PREMISES CONSIDERED, Plaintiff respectfully
requests that this Honorable Court: Grant Plaintiff’s Motion for Partial Summary
Judgment due to Defendant Germania’s improper invocation of appraisal and waiver
of rights, and their breach of contract in failing to provide complete coverage for a
covered peril under the policy.
i. Award Plaintiff reasonable attorneys’ fees incurred in this action, as
permissible and just under Texas law.
ii. Apply pre-judgment and post-judgment interest at the maximum
rate allowed by law on the awarded damages.
iii. Prohibit appraisal at this stage in litigation as it would be prejudicial
to the Plaintiff and impose undue financial burdens.
iv. Grant any other relief that this Court deems just and proper under
the circumstances.
v. Plaintiff prays for justice and fair treatment in the light of the
evidence and arguments presented, and for a ruling that upholds the
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Electronically Filed
1/29/2024 2:51 PM
Hidalgo County District Clerks
Reviewed By: Dana Cavazos
integrity of the contractual and legal obligations of insurers to their
policyholders.
Respectfully submitted,
By: _____________________
GERARDO ACEVEDO JR.
ACEVEDO LAW GROUP, PLLC
State Bar No. 24120358
S.D. Tex. Bar No. 3781868
605 W Palma Vista Dr.,
Palmview, Texas 78572
P: (956) 240-1216
E: gera@texaslawace.com
ATTORNEY FOR PLAINTIFF
PLAINTIFF’S REPLY TO DEFENDANT’S RESPONSE 7 |8
Electronically Filed
1/29/2024 2:51 PM
Hidalgo County District Clerks
Reviewed By: Dana Cavazos
CERTIFICATE OF SERVICE
I hereby certify in accordance with Texas Rules of Civil Procedure, Rules 21(d)
and 21a(e), that the aforementioned document(s) were served on the parties listed
below on January 26, 2024:
Zuleida Lopez-Habbouche
Roerig, Oliveira & Fisher, L.L.P
10225 N 10 Street McAllen, Texas 78504
th
P: (956) 393-6300
F: (956) 386-1625
E: zlopez@rofllp.com
By: _____________________
GERARDO ACEVEDO JR.
PLAINTIFF’S REPLY TO DEFENDANT’S RESPONSE 8 |8
Automated Certificate of eService
This automated certificate of service was created by the efiling system.
The filer served this document via email generated by the efiling system
on the date and to the persons listed below. The rules governing
certificates of service have not changed. Filers must still provide a
certificate of service that complies with all applicable rules.
Gerardo Acevedo Jr. on behalf of Gerardo Acevedo Jr.
Bar No. 24120358
gera@texaslawace.com
Envelope ID: 83903880
Filing Code Description: Motion (No Fee)
Filing Description: Motion
Status as of 1/30/2024 8:31 AM CST
Case Contacts
Name BarNumber Email TimestampSubmitted Status
Gerardo Acevedo Jr. gera@texaslawace.com 1/29/2024 2:51:54 PM SENT
Minerva Rivera admin@texaslawace.com 1/29/2024 2:51:54 PM SENT
ZL vvicinaiz@rofllp.com 1/29/2024 2:51:54 PM SENT
Associated Case Party: Germania Farm Mutual Insurance Association
Name BarNumber Email TimestampSubmitted Status
Zuleida Lopez-Habbouche zlopez@rofllp.com 1/29/2024 2:51:54 PM SENT
Leslie Hernandez leslieh@rofllp.com 1/29/2024 2:51:54 PM SENT