When policyholders file an insurance coverage declare, they anticipate their insurer to pay losses. Most policyholders have by no means learn their coverage nor would respect what it even means with nuanced protection causation guidelines making use of that fluctuate from state to state. A current case delivered to my consideration by lawyer Steve Badger involving home-owner Ebony Mitchell and Praetorian Insurance coverage Firm highlights some key classes for policyholders, public adjusters, restoration contractors, and attorneys. 1 It’s a cautionary story of how failing to show causation can sink a declare and the way insurers use the distinctive Texas view of “concurrent causation doctrine” as a strong protection.
Ebony Mitchell had home-owner’s insurance coverage with Praetorian and filed a declare after a windstorm broken her property. Mitchell claimed that Praetorian underpaid the declare. The insurer argued that a lot of the harm wasn’t from the windstorm however from non-covered causes, together with improper roof tarping and bathtub water spillover. When Mitchell pushed again, the corporate caught to its place, main her to file a lawsuit. The case made its approach to federal courtroom, the place Mitchell misplaced earlier than the matter even went to a jury.
Mitchell’s greatest drawback was proving what a part of her damages had been truly brought on by the windstorm. Texas regulation is completely different from different states and requires policyholders to separate coated damages from non-covered ones—primarily putting the burden of proof that parts of loss are coated from these which can be excluded. Because of this if an insurance coverage firm claims a number of the harm got here from an uncovered supply, the burden falls on the policyholder to point out in any other case.
This authorized idea falls below Texas’ distinctive view of the concurrent causation doctrine. No person else follows it, and I’ve identified that the insurance coverage trade doesn’t train its adjusters this methodology of loss adjustment below all danger insurance policies. Not surprisingly, it has grow to be a favourite device for insurance coverage corporations seeking to keep away from paying claims in Texas. If coated and uncovered damages are combined collectively and may’t be separated, the insurer wins by default. No different state within the union has this rule.
To help her declare, Mitchell relied closely on an estimate referred to as the “Quantum Estimate,” which detailed the prices to restore her property. However there was an issue: the estimate didn’t say who wrote it, and it didn’t clarify what triggered the damages. The courtroom dominated that with out proof of authorship or an professional explaining how the harm was associated to the windstorm, the estimate was nugatory as proof.
Despite the fact that Mitchell later tried to repair the error by submitting an affidavit confirming the estimate’s authenticity, the courtroom wasn’t moved. The decide dominated that even when the estimate was correctly authenticated, it nonetheless wouldn’t have modified the end result as a result of it didn’t set up causation. With that, the case was over, and Praetorian’s denial stood.
This case serves as a reminder that proving protection isn’t nearly displaying harm—it’s about proving what triggered it. Too usually, policyholders concentrate on the price of repairs with out correctly documenting the trigger. Insurance coverage corporations with expert counsel definitely respect that proof counts and use it to their benefit. If a declare goes to courtroom, a Texas insurer might be anticipated to argue that the policyholder hasn’t met their burden of proof. With out clear, expert-supported proof linking damages to a coated occasion, Texas courts, not like courts in different states, will seemingly aspect with the insurer.
Policyholders, their representatives, and even contractors working within the insurance coverage restoration area have to be proactive. They need to be sure that their stories embody not simply restore prices but additionally a transparent and possible clarification of what triggered the harm. Policyholders and public adjusters should collect robust documentation that segregates coated damages from excluded ones.
Attorneys ought to anticipate the Texas concurrent causation protection and be prepared with professional testimony that may break it down. The policyholder on this case was represented by the Dick Legislation Agency. Steve Badger has been maintaining a operating commentary about this regulation agency on his LinkedIn messaging. Policyholders ought to fastidiously choose counsel primarily based on fame, expertise and outcomes reasonably than pithy promoting with implied reference to 1’s genitals.
Some insurance coverage corporations aren’t within the enterprise of constructing funds simple and are in search of methods to stop paying any greater than is required. If you wish to win the battle for protection, you want greater than only a displaying of harm through the coverage interval and an estimate if the loss happens in Texas.
In Texas, you want proof that holds up below authorized scrutiny below this woefully flawed and uniquely utilized protection rule. In any other case, the insurer will at all times have the higher hand in causation instances. Texas policyholders who perceive this actuality and put together accordingly will stand a significantly better probability of securing the protection they rightfully deserve.
For these wanting to check the therapy of causation in Texas, we now have written many articles about this. I’d recommend State Farm Wins Texas Worn-Out Roof Injury Case: Lesson About Texas Hail Injury Instances, Skilled Testimony, and the Very Distinctive Texas Concurrent Causation Rule, and a put up written 14 years in the past, Concurrent Causation in Texas. Causation protection guidelines might be very advanced, and it’s particularly so in Texas.
Thought For The Day
“Don’t mess with Texas. That features its barbecue, its beer, and particularly its girls.”
—Matthew McConaughey
1 Mitchell v. Praetorian Ins. Co., 24-20205 (5th Cir. Mar. 24, 2025). (See additionally, appellate briefs or Appellant and Appellee).
