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  • Joaquin Cerda VS. Germania Farm Mutual Insurance AssociationInjury or Damage - Other (OCA) document preview
  • Joaquin Cerda VS. Germania Farm Mutual Insurance AssociationInjury or Damage - Other (OCA) document preview
  • Joaquin Cerda VS. Germania Farm Mutual Insurance AssociationInjury or Damage - Other (OCA) document preview
  • Joaquin Cerda VS. Germania Farm Mutual Insurance AssociationInjury or Damage - Other (OCA) document preview
  • Joaquin Cerda VS. Germania Farm Mutual Insurance AssociationInjury or Damage - Other (OCA) document preview
  • Joaquin Cerda VS. Germania Farm Mutual Insurance AssociationInjury or Damage - Other (OCA) document preview
  • Joaquin Cerda VS. Germania Farm Mutual Insurance AssociationInjury or Damage - Other (OCA) document preview
  • Joaquin Cerda VS. Germania Farm Mutual Insurance AssociationInjury or Damage - Other (OCA) document preview
						
                                

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Electronically Filed 1/29/2024 2:51 PM Hidalgo County District Clerks Reviewed By: Dana Cavazos CAUSE NO. C-4738-23-A § JOAQUIN CERDA, § IN THE DISTRICT COURT Plaintiff, § § § V. § 92ND JUDICIAL DISTRICT § § 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 PLAINTIFF’S REPLY TO DEFENDANT’S RESPONSE 1 |8 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), PLAINTIFF’S REPLY TO DEFENDANT’S RESPONSE 2 |8 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 PLAINTIFF’S REPLY TO DEFENDANT’S RESPONSE 3 |8 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). PLAINTIFF’S REPLY TO DEFENDANT’S RESPONSE 5 |8 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 PLAINTIFF’S REPLY TO DEFENDANT’S RESPONSE 6 |8 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