When policyholders file an insurance coverage declare, they count on 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 modify from state to state. A current case delivered to my consideration by lawyer Steve Badger involving house 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 robust protection.
Ebony Mitchell had house 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 injury 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 strategy to federal courtroom, the place Mitchell misplaced earlier than the matter even went to a jury.
Mitchell’s greatest downside was proving what a part of her damages have been really brought on by the windstorm. Texas legislation is totally different from different states and requires policyholders to separate coated damages from non-covered ones—basically inserting the burden of proof that parts of loss are coated from these which might be excluded. Which means that if an insurance coverage firm claims among the injury got here from an uncovered supply, the burden falls on the policyholder to indicate in any other case.
This authorized idea falls underneath Texas’ distinctive view of the concurrent causation doctrine. No person else follows it, and I’ve identified that the insurance coverage trade doesn’t educate its adjusters this methodology of loss adjustment underneath all threat insurance policies. Not surprisingly, it has change into a favourite device for insurance coverage firms seeking to keep away from paying claims in Texas. If coated and uncovered damages are blended collectively and might’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 known 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 brought on the damages. The courtroom dominated that with out proof of authorship or an knowledgeable explaining how the injury was associated to the windstorm, the estimate was nugatory as proof.
Though Mitchell later tried to repair the error by submitting an affidavit confirming the estimate’s authenticity, the courtroom wasn’t moved. The choose 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 injury—it’s about proving what brought on it. Too typically, policyholders deal with the price of repairs with out correctly documenting the trigger. Insurance coverage firms 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, in contrast to courts in different states, will doubtless facet with the insurer.
Policyholders, their representatives, and even contractors working within the insurance coverage restoration house should be proactive. They need to be sure that their reviews embody not simply restore prices but additionally a transparent and possible clarification of what brought on the injury. Policyholders and public adjusters should collect sturdy documentation that segregates coated damages from excluded ones.
Attorneys ought to anticipate the Texas concurrent causation protection and be prepared with knowledgeable testimony that may break it down. The policyholder on this case was represented by the Dick Regulation Agency. Steve Badger has been protecting a operating commentary about this legislation agency on his LinkedIn messaging. Policyholders ought to rigorously choose counsel primarily based on popularity, expertise and outcomes quite than pithy promoting with implied reference to at least one’s genitals.
Some insurance coverage firms aren’t within the enterprise of constructing funds straightforward and are in search of methods to forestall paying any greater than is required. If you wish to win the battle for protection, you want greater than only a displaying of injury through the coverage interval and an estimate if the loss happens in Texas.
In Texas, you want proof that holds up underneath authorized scrutiny underneath this woefully mistaken and uniquely utilized protection rule. In any other case, the insurer will at all times have the higher hand in causation circumstances. Texas policyholders who perceive this actuality and put together accordingly will stand a significantly better likelihood of securing the protection they rightfully deserve.
For these wanting to check the therapy of causation in Texas, we have now written many articles about this. I’d recommend State Farm Wins Texas Worn-Out Roof Injury Case: Lesson About Texas Hail Injury Instances, Professional Testimony, and the Very Distinctive Texas Concurrent Causation Rule, and a publish 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).
