Dailey v. Certain Underwriters at Lloyds London, Subscribing to Policy Number V605436
S.D. Tex.7/19/2022
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UNITED STATES DISTRICT COURT July 19, 2022 SOUTHERN DISTRICT OF TEXAS Nathan Ochsner, Clerk HOUSTON DIVISION LAVERNE NATALIE CARROLL § DAILEY, § § Plaintiff, § VS. § CIVIL ACTION NO. 4:21-CV-1957 § CERTAIN UNDERWRITERS AT § LLOYDS LONDON, SUBSCRIBING TO § POLICY NUMBER V605436, § Defendant. MEMORANDUM OPINION AND ORDER This is a first-party insurance case involving a Lloydâs of London policy. The policyholder, Plaintiff Laverne Natalie Carroll Dailey (âDaileyâ), invoked the appraisal clause in the partiesâ insurance contract and then, dissatisfied with the result, filed this lawsuit in Texas state court seeking to set aside the appraisal award. (Dkt. 1-1). The carrier, Defendant Certain Underwriters at Lloydâs London, Subscribing to Policy Number V605436 (âEnstarâ),1 removed the case to this Court. (Dkt. 1). 1 The Court is referring to the defendant as âEnstarâ instead of âLloydâsâ because of the unique nature of lawsuits involving Lloydâs of London. Lloydâs of London âis not an insurance company but rather a self-regulating entity which operates and controls an insurance market.â Corfield v. Dallas Glen Hills LP, 355 F.3d 853, 857â58 (5th Cir. 2003). âThus, a policyholder insures at Lloydâs but not with Lloydâs.â Id. (emphasis in Corfield). The individuals and corporations who finance the Lloydâs insurance market and ultimately insure risks are called âNames,â and they group together in âSyndicatesâ that underwrite insurance policies on behalf of the Names in the Syndicate. Id. So, when an insured âreceives a Lloydâs âpolicyâ of insurance, what he has in fact received are numerous contractual commitments from each Name who has agreed to subscribe to the risk.â Id. at 859. Here, as discussed further later in this opinion, the record shows that Daileyâs policy has been fully reinsured to close by Lloydâs Syndicate 2008, the sole Name of which is SGL No. 1 Limited (âSGLâ). (Dkt. 23-1). SGL is a subsidiary of Enstar Group Limited (âEnstar Groupâ). (Dkt. 23-1). The Court will refer to SGL and Enstar Group collectively as Enstar. Dailey has filed a motion requesting that the Court remand the case to state court, while Enstar has filed a combination motion for summary judgment and motion to dismiss requesting that the Court either dismiss the case as time-barred under Federal Rule of Civil Procedure 56 or dismiss the case for failure to state a claim under Federal Rule of Civil Procedure 12(b)(6). For the reasons outlined below, Daileyâs motion to remand (Dkt. 22) is DENIED, and Enstarâs motion (Dkt. 30) is GRANTED IN PART AND DENIED AS MOOT IN PART. The Court concludes that this case is time-barred, and the case is DISMISSED WITH PREJUDICE. I. FACTUAL AND PROCEDURAL BACKGROUND Daileyâs home in Houston was damaged by Hurricane Harvey in August of 2017. (Dkt. 1-1 at p. 12; Dkt. 31-7 at p. 2). She made a claim under her homeowners insurance policy, and Enstar hired Minuteman Adjusters (âMinutemanâ) and Specialty Adjusting International (âSpecialtyâ) to handle the claim. (Dkt. 1-1 at p. 13; Dkt. 31-7 at p. 2). Specialty inspected Daileyâs home, and after that inspection Enstar paid $1,883.06 on Daileyâs claim. (Dkt. 31-5 at p. 2; Dkt. 31-7 at p. 2). Shortly thereafter, Dailey reported mold damage. (Dkt. 31-7 at p. 2). On January 5, 2018, Enstar sent a letter to Dailey denying any further payment based on a mold exclusion in Daileyâs policy. (Dkt. 31-7 at p. 2). Enstar then closed the claim. (Dkt. 31-7 at p. 2). Dailey invoked the appraisal clause in her policy on March 29, 2018. (Dkt. 31-7 at p. 3). As is common in Texas property insurance policies, the appraisal clause provided a binding method of setting the amount of a loss whereby the policyholder and the carrier would each âselect a competent, independent appraiserâ to evaluate the loss. (Dkt. 23-4 at p. 17). The two appraisers would then âchoose an umpireâ to resolve disagreements between them. (Dkt. 23-4 at p. 17). âAn itemized decision agreed to by any two of th[e] three and filed with [the carrier] w[ould] set the amount of the loss.â (Dkt. 23-4 at p. 17). âSuch award [would] be binding on [the policyholder] and [the carrier].â (Dkt. 23-4 at p. 17). In accordance with the appraisal clause, Dailey made a written demand for appraisal and designated an appraiser. (Dkt. 30-2 at p. 1). Minuteman, acting on Enstarâs behalf, agreed to go to appraisal and designated an appraiser. (Dkt. 30-3 at p. 1). The appraisers selected an umpire, who, after the inspection of Daileyâs home, agreed with Minutemanâs appraiser. (Dkt. 31-5 at p. 5). The umpire and Minutemanâs appraiser provided an itemized decision setting the âFull Replacement Costâ for the damage to Daileyâs home at $47,952.31. (Dkt. 31-5 at pp. 5-18). The award also specified that âDepreciationâ totaled $19,642.29 and that âACTUAL CASH VALUEâ (replacement cost minus depreciation) totaled $28,310.02: | DWELLING | Full Replacement Cost | $47,952.31 Depreciation | $19,642.29 | ACTUAL CASH VALUE =| $28,310.02 | Dkt. 31-5 at p. 5. 3/19 The appraisal award was signed by Minutemanâs appraiser on February 8, 2019 and signed by the umpire on February 14, 2019. (Dkt. 31-5 at p. 5). Through Minuteman, Enstar sent a letter to Dailey on February 18, 2019 enclosing payment for the appraisal award, meaning the full replacement cost ($47,952.31) less Daileyâs deductible ($11,680.58), recoverable depreciation ($19,642.29), and the prior payment of $1,883.06. (Dkt. 31-5 at p. 2). The total came to $14,746.38. (Dkt. 31-5 at p. 2). The letter explained that Dailey could make a supplemental claim for the $19,642.29 in withheld recoverable depreciation after âall covered repairs or replacement [we]re complete.â (Dkt. 31-5 at p. 2). But the letter also made clear that Enstar considered the total amount of loss to be definitively set by the appraisal award and that the only additional payment that Enstar would consider issuing would be the withheld recoverable depreciation: After applying recoverable depreciation of $19,642.29, your deductible of $11,680.58, and previous payment of $1,883.06, your Net Actual Cash Value claim is $14,746.38. Enclosed please find our check in the amount of $14,746.38. . . . Your policy states that [Enstar] will not be liable for more than the Actual Cash Value of the property until all covered repairs or replacement are complete. Actual Cash Value is defined as Replacement Cost less depreciation. If all covered repairs/replacement are made, you may make a supplemental claim for up to the amount of withheld depreciation per the policy terms and conditions for Replacement Cost coverage. Please understand further claim is [sic] subject to all policy terms and conditions, supplemental inspections, and/or documentation in support of supplemental claim. [sic] The total amount of withheld recoverable depreciation available is $19,642.29. Dkt. 31-5 at p. 2. Enstar did include language in the letter stating that it would give âfull considerationâ to âany comments or further informationâ submitted by Dailey, but the letter clarified that Enstar âd[id] not waiveâ and âexpressly reservedâ its ârights, defenses and privileges afforded by the [insurance] policy or by law[.]â (Dkt. 31-5 at p. 2). The record does not reflect any additional communication between the parties until fourteen months later, when Dailey sent a pre-litigation notice letter2 to Enstar on April 2, 2020. (Dkt. 31 at p. 8). The letter demanded that Enstar set aside the appraisal award and pay $147,502.60 to settle her claim. (Dkt. 31 at p. 8; Dkt. 31-7 at p. 3). Enstar responded by letter on May 13, 2020. (Dkt. 31-7). The letter ârespectfully declinedâ Daileyâs demand and explained that Dailey had provided âno basis for setting asideâ the appraisal award. (Dkt. 31-7 at pp. 3â4). As it did in its February 2019 letter, Enstar offered to consider âany additional informationâ provided by Dailey. (Dkt. 31-7 at p. 4). Enstar also requested a reinspection of Daileyâs home âpursuant to the Texas Insurance Code[.]â3 (Dkt. 31-7 at p. 4). However, Enstar again clarified that its statements did not constitute âa waiver of any legal claims or defensesâ and that it was not at that point âreconsidering [its] positionâ that the appraisal award was âbinding and enforceableâ and 2 See Tex. Ins. Code § 542A.003(a) (âIn addition to any other notice required by law or the applicable insurance policy, not later than the 61st day before the date a claimant files an action to which this chapter applies in which the claimant seeks damages from any person, the claimant must give written notice to the person in accordance with this section as a prerequisite to filing the action.â). 3 See Tex. Ins. Code § 542A.004 (âNot later than the 30th day after receiving a presuit notice given under Section 542A.003(a) [of the Texas Insurance Code], a person to whom notice is given may send a written request to the claimant to inspect, photograph, or evaluate, in a reasonable manner and at a reasonable time, the property that is the subject of the claim. If reasonably possible, the inspection, photography, and evaluation must be completed not later than the 60th day after the date the person receives the presuit notice.â). that Enstar had âfulfilled its contractual obligations under the insurance policy when it tendered payment in accordance with the appraisal award.â (Dkt. 31-7 at pp. 3â4). To the contrary, Enstarâs letter unequivocally stated that, âas the [appraisal] award has set the amount of loss, [Dailey], as a matter of law, cannot recover more than the appraisal award even if coverage issues are litigated.â (Dkt. 31-7 at p. 3). Enstar reinspected Daileyâs home on July 7, 2020. (Dkt. 31 at p. 8). The record does not reflect any further communications between the parties until March 3, 2021, when Dailey filed this lawsuit in Texas state court alleging breach of contract and violations of Chapters 541 and 542 of the Texas Insurance Code. (Dkt. 1-1 at pp. 15â16; Dkt. 31 at pp. 2, 8). Enstar removed the case to this Court and now seeks summary judgment on the basis of the insurance policyâs limitations provision, which reads: Suit against us. No suit or action can be brought unless the policy provisions have been complied with. Action brought against us must be started within two years and one day after the cause of action accrues. Dkt. 30-1 at p. 18. The policy defines âusâ as âthe Company providing this insuranceââhere, that is Enstar. (Dkt. 30-1 at p. 10). Dailey has requested a remand to state court based on Enstarâs alleged failure to establish that this Court has subject matter jurisdiction under the diversity jurisdiction statute, 28 U.S.C. § 1332. (Dkt. 22 at p. 1).4 4 Initially, Dailey also argued that Enstarâs removal was untimely. (Dkt. 22 at p. 2). Dailey abandoned that argument in her reply brief. (Dkt. 24 at p. 4). II. SUBJECT MATTER JURISDICTION The Court will address Daileyâs motion to remand before discussing Enstarâs motion for summary judgment. See Steel Co. v. Citizens for a Better Environment, 523 U.S. 83, 94â95 (1998) (âThe requirement that jurisdiction be established as a threshold matter springs from the nature and limits of the judicial power of the United States and is inflexible and without exception.â) (brackets and quotation marks omitted). a. The legal standard Generally, a defendant may remove to federal court any state court civil action over which the federal court would have âoriginal jurisdiction.â 28 U.S.C. § 1441(a); see Gasch v. Hartford Acc. & Indem. Co., 491 F.3d 278, 281 (5th Cir. 2007). As relevant here, federal courts have original jurisdictionâcommonly referred to as âdiversity jurisdictionââover civil actions between a citizen of a state and citizens of a foreign country in which the amount in controversy exceeds $75,000, exclusive of interest and costs. 28 U.S.C. § 1332; see also Stiftung v. Plains Marketing, L.P., 603 F.3d 295, 297 (5th Cir. 2010). The diversity statute requires âcomplete diversityâ of citizenship, meaning that a district court cannot exercise diversity jurisdiction if any plaintiff shares citizenship with any defendant. Whalen v. Carter, 954 F.2d 1087, 1094 (5th Cir. 1992). â[D]oubts regarding whether removal jurisdiction is proper should be resolved against federal jurisdiction.â Acuna v. Brown & Root Inc., 200 F.3d 335, 339 (5th Cir. 2000). The removing party therefore bears a burden of establishing by a preponderance of the evidence that removal is proper. Manguno v. Prudential Prop. & Cas. Ins. Co., 276 F.3d 720, 723 (5th Cir. 2002). A defendant meets its burden of establishing the requisite amount in controversy for diversity jurisdiction if: â(1) it is apparent from the face of the petition that the claims exceed $75,000, or, alternatively, (2) the defendant sets forth âsummary judgment type evidenceâ of facts in controversy that support a finding of the requisite amount.â Id. Once a defendant meets its burden, âremoval is proper, provided plaintiff has not shown that it is legally certain that his recovery will not exceed the amount stated in the state complaint.â De Aguilar v. Boeing Co., 47 F.3d 1404, 1412 (5th Cir. 1995). Those are the well-established general rules. The Court must keep in mind, however, that this case involves a Lloydâs of London insurance policy. As mentioned earlier in this opinion, Lloydâs is a market, not an insurance company. The individuals and corporations who finance the Lloydâs insurance market and ultimately insure risks are called âNames,â and they group together in âSyndicatesâ that underwrite insurance policies on behalf of the Names in the Syndicate. Corfield v. Dallas Glen Hills LP, 355 F.3d 853, 857â58 (5th Cir. 2003). âSome Syndicates may be composed of one Name, while others may be composed of 30,000 Names.â Those Certain Underwriters at Lloydâs London v. Sophisticated Investments Inc., No. 2:20-CV-3592, 2022 WL 507437, at *2 (E.D. Pa. Feb. 18, 2022). Each Name that subscribes to a particular policy invests in a percentage of the policy risk, and the liability among the Names is several but not joint. Corfield, 355 F.3d at 858. Moreover, usually only one Nameâa âleadâ underwriter designated to represent all of the Namesâis listed on the policy, with all other Names remaining anonymous. Id. at 858â59. As a result, policyholders bringing first-party insurance claims on Lloydâs of London policies, who often do not have the âhighly confidentialâ information regarding the identities of most of the underwriting Names, typically list as the defendant âCertain Underwriters at Lloydâs, London Subscribing toâ the number of the policy at issue. Xome Settlement Services, LLC v. Certain Underwriters at Lloydâs, London, No. 4:18-CV-837, 2020 WL 512507, at *4 & n.2 (E.D. Tex. Jan. 31, 2020). Suing âCertain Underwriters at Lloydâs, London Subscribing toâ the number of the policy at issue is considered âsynonymous with suing every Name subscribing to the policy since the Names are the underwriters[,]â which allows the policyholder to get all of the underwriters with potential liability on his or her policy into court without knowing all of their identities. Id. (collecting cases). That is what Dailey did here. b. Enstar has met its burden. Having considered the evidence in the record under the applicable legal standards, the Court concludes that Enstar has met its burden of showing that the Court has diversity jurisdiction. The Court allowed limited discovery related to the identities of the Names that subscribed to Daileyâs policy. (Dkt. 21). The resultant evidentiary record shows that Daileyâs policy was underwritten by Lloydâs Syndicate 1206. (Dkt. 23-1 at p. 4; Dkt. 23-4 at p. 8). Lloydâs Syndicate 1206âs underwriting business has been fully reinsured to close by Lloydâs Syndicate 2008. (Dkt. 23-1 at p. 4). Lloydâs Syndicate 2008âs sole Name is SGL, which is a subsidiary of Enstar Group. (Dkt. 23-1 at p. 4). SGL is domiciled in the United Kingdom, and Enstar Group is domiciled in Bermuda. (Dkt. 23-1 at p. 4). Dailey is a citizen of Texas. (Dkt. 1-1 at p. 11). Accordingly, this action is between a citizen of a state and citizens of foreign countries, and Dailey does not share citizenship with any defendant. As for the amount-in-controversy requirement, Dailey sought âmonetary relief over $200,000 but not more than $1,000,000â in her state-court pleadings. (Dkt. 1-1 at pp. 1, 10). Furthermore, in her pre-litigation notice letter, Dailey made a liquidated settlement demand of $147,502.60. (Dkt. 31-7 at p. 3). The total amount in controversy is greater than the $75,000 jurisdictional minimum, and Daileyâs policy is fully backed by one Name, SGL. The Court has subject matter jurisdiction under 28 U.S.C. § 1332. III. THE STATUTE OF LIMITATIONS Enstar seeks summary judgment under Federal Rule of Civil Procedure 56 on the affirmative defense of the statute of limitations. (Dkt. 30). a. Summary judgments In deciding a motion for summary judgment, the Court must determine whether the pleadings, the discovery and disclosure materials on file, and any affidavits show that there is no genuine issue as to any material fact and that the movant is entitled to judgment as a matter of law. Celotex Corp. v. Catrett, 477 U.S. 317, 322 (1986). The movantâs initial summary judgment burden depends on whether the movant will bear the burden of proof at trial. If the non-movant will bear the burden of proof at trial on an issue raised in a motion for summary judgment, then the initial burden falls on the movant to identify areas essential to the non-movantâs claim in which there is an absence of a genuine issue of material fact. Lincoln Gen. Ins. Co. v. Reyna, 401 F.3d 347, 349 (5th Cir. 2005). The movant need not negate the elements of the non-movantâs case. See Boudreaux v. Swift Transp. Co., 402 F.3d 536, 540 (5th Cir. 2005). The movant may meet its burden by pointing out the absence of evidence supporting the non-movantâs case. Duffy v. Leading Edge Products, Inc., 44 F.3d 308, 312 (5th Cir. 1995). However, if the movant will carry the burden of proof at trial, as is the case when the movant is either the plaintiff or a defendant asserting an affirmative defense, then the movant can only carry its initial burden by establishing beyond peradventure all of the essential elements of its claim or defense. Fontenot v. Upjohn Co., 780 F.2d 1190, 1194 (5th Cir. 1986). If the movant meets its initial burden, the non-movant must go beyond the pleadings and designate specific facts showing that there is a genuine issue of material fact for trial. Littlefield v. Forney Indep. Sch. Dist., 268 F.3d 275, 282 (5th Cir. 2001). âAn issue is material if its resolution could affect the outcome of the action. A dispute as to a material fact is genuine if the evidence is such that a reasonable jury could return a verdict for the nonmoving party.â DIRECT TV Inc. v. Robson, 420 F.3d 532, 536 (5th Cir. 2006) (citations omitted). In deciding whether a genuine and material fact issue has been created, the facts and inferences to be drawn from those facts must be reviewed in the light most favorable to the non-movant. Reaves Brokerage Co. v. Sunbelt Fruit & Vegetable Co., 336 F.3d 410, 412 (5th Cir. 2003). b. Enstar has not waived its limitations defense. Before reaching the merits of Enstarâs motion for summary judgment, the Court must address a point very briefly raised by Dailey in her response to Enstarâs motion: Enstar had not pled a limitations defense when it filed its motion for summary judgment. (Dkt. 31 at p. 2). Enstar filed an answer in state court but did not plead its limitations defense. (Dkt. 1-2 at pp. 1â7). Enstar then removed this case and moved for summary judgment on limitations. (Dkt. 1; Dkt. 30). When Dailey pointed out that Enstar had not pled a limitations defense, Enstar amended its answer to include that defense just before it filed its reply brief. (Dkt. 32; Dkt. 33). The propriety of Enstarâs amendment is not at issue. The governing docket control order allowed Enstar to amend its answer without leave of court at the time that it added its limitations defense (Dkt. 27), and Dailey has not moved to strike Enstarâs amended answer. The question raised by Daileyâs response is simply whether Enstar waived its affirmative defense by failing to plead that defense before filing its motion for summary judgment. The Court concludes that Enstar did not waive its limitations defense. Federal Rule of Civil Procedure 8(c) requires a party responding to a pleading to âaffirmatively state any avoidance or affirmative defense, including . . . statute of limitations[.]â Fed. R. Civ. P. 8(c). Failure to follow this rule can result in waiver of the affirmative defense. Allied Chemical Corp. v. Mackay, 695 F.2d 854, 855 (5th Cir. 1983). âWhere the matter is raised in the trial court in a manner that does not result in unfair surprise, however, technical failure to comply precisely with Rule 8(c) is not fatal.â Id. at 855â56. âThe defendant does not waive an affirmative defense if the issue is raised at a pragmatically sufficient time, and if the plaintiff was not prejudiced in its ability to respond.â Smith v. Travelers Casualty Insurance Co. of America, 932 F.3d 302, 309 (5th Cir. 2019) (brackets and quotation marks omitted). â[T]he prejudice inquiry considers whether the plaintiff had sufficient notice to prepare for and contest the defense, and not simply whether the defense, and evidence in support of it, were detrimental to the plaintiff (as every affirmative defense is).â Rogers v. McDorman, 521 F.3d 381, 387 (5th Cir. 2008). Enstarâs limitations defense was raised in time, and Dailey was not prejudiced in her ability to respond. In her response to Enstarâs motion, Dailey squarely contests Enstarâs limitations defense on the merits, and Dailey has not requested additional time or additional fact discovery to respond to Enstarâs motion, even though Enstar filed its motion over six months before the discovery deadline and the discovery deadline still has not passed. Cf. Lafreniere Park Foundation v. Broussard, 221 F.3d 804, 808 (5th Cir. 2000) (concluding that a res judicata defense that was never pled in an answer and was only raised in a motion for summary judgment was not waived because the opposing party filed three opposition memoranda seeking to defeat the defense on the merits). Furthermore, the parties agree on the timeline regarding Enstarâs limitations defense; there is no factual dispute regarding who said what to whom, or when or in what form those things were said. The disagreement between the parties is over the legal effects of the partiesâ various communications with each other. The Court concludes that Enstar did not waive its limitations defense. c. Daileyâs causes of action are time-barred. Dailey has pled causes of action against Enstar for breach of contract and violations of Chapters 541 and 542 of the Texas Insurance Code. (Dkt. 1-1 at pp. 15â16). Daileyâs insurance contract creates an enforceable limitations period for lawsuits against Enstar of two years and one day after the cause of action accrues. (Dkt. 30-1 at pp. 10, 18). Both parties agree that the applicable limitations period is two years and one day. (Dkt. 30 at p. 3; Dkt. 31 at p. 2). Dailey filed her state-court lawsuit on March 3, 2021. (Dkt. 1-1 at p. 1). Accordingly, Daileyâs causes of action are time-barred if they accrued before March 2, 2019. In Texas, causes of action accrue and statutes of limitations begin to run when facts come into existence that authorize a claimant to seek a judicial remedy. Smith, 932 F.3d at 311. A cause of action generally accrues when a wrongful act causes some legal injury, even if the fact of injury is not discovered until later, and even if all resulting damages have not yet occurred. Id. Generally, in first-party insurance cases such as this one, the limitations period begins to run on the date coverage is denied. Id. Although the denial- accrual date is usually a question of law, the Texas Supreme Court has acknowledged that it may present questions of fact to be determined on a case-by-case basis. Id.; see also Provident Life and Accident Insurance Co. v. Knott, 128 S.W.3d 211, 221â22 (Tex. 2003). Enstar argues that, as a matter of law, the running of limitations was triggered on February 18, 2019, when Enstar sent its letter enclosing payment of the appraisal award and informing Dailey that it would not pay any other amount except, possibly, the $19,642.29 in withheld recoverable depreciation calculated during the appraisal process. (Dkt. 30 at p. 6; Dkt. 33 at p. 3). In response to Enstarâs argument, Dailey contends that her case is one in which the denial-accrual date presents questions of fact. (Dkt. 31 at p. 3). According to Dailey, only an âoutright denialâ of a claim conclusively establishes the accrual date in a first-party insurance case, and there was no outright denial of her claim until Enstar rejected Daileyâs pre-litigation settlement demand on May 13, 2020. (Dkt. 31 at pp. 3â5). Dailey argues that Enstarâs February 18, 2019 letter âdid not deny any part of [her] claimâ and âsimply tendered payment of the appraisal award.â (Dkt. 31 at p. 3). In an unsworn declaration, Dailey testifies that she âdid not know that [Enstar] considered payment of the appraisal award the final payment on [her] claimâ until Enstar rejected Daileyâs pre-litigation settlement demand. (Dkt. 31-3). To explain her confusion, Dailey points to âspecial noteâ language in the appraisal award itself5 that she claims led her âto reasonably believe that payment of the appraisal award was simply an interim payment on her claim.â (Dkt. 31 at pp. 3â4). The Court agrees with Enstar and disagrees with Dailey. First, Daileyâs insistence that only an outright denial of a claim can conclusively establish the accrual date in a first- party insurance case brought under Texas law is simply incorrect; the date on which a carrier tendered its last payment on an insurance claim can alsoâand often doesâ conclusively establish the accrual date. See Castillo v. State Farm Lloyds, 210 Fed. Appâx 390, 393â94 & n.6 (5th Cir. 2006) (âCastillo argues that because State Farm made partial payments without any indication of finality, the statute of limitations did not begin to run until, at the earliest, July 28, 2003, when State Farm sent a letter [in response to a settlement offer from Castilloâs attorney] stating that âthe claims remained closed.â However, State Farm communicated a final determination on all of Castilloâs claims by March 31, 2003, when State Farm sent the payments on the kitchen and bathroom claims, along with 5 The language relied on by Dailey reads: SPECIAL NOTE: Nothing contained within this Agreed Appraisal shall be construed as estopping Certain Underwriters at Lloyds, London or the Named Insured from asserting coverage determinations either in denial of certain portions of the loss or, in the alternative, coverageâs [sic] afforded within the applicable policy for insurance. Dkt. 31-5 at p. 5. decision letters on both claims. This was the last payment made to Castillo.â) (footnote omitted); see also, e.g., Abedinia v. Lighthouse Property Insurance Co., No. 12-20-00183- CV, 2021 WL 4898456, at *5 (Tex. App.âTyler Oct. 20, 2021, pet. filed); Sheppard v. Travelers Lloyds of Texas Insurance Co., No. 14-08-00248-CV, 2009 WL 3294997, at *7 (Tex. App.âHouston [14th Dist.] Oct. 15, 2009, pet. denied). âFor a first party insurance breach of contract claim, the action accrues when the insurance company sends a letter to the insured detailing its decision to deny the claim or its decision to pay the claim with payment included which the insured disagrees with, as long as the insurance company never changes its position on the claim.â Tobin Endowment v. Great American Assurance Co., No. 5:20-CV-1146, 2022 WL 817895, at *5 (W.D. Tex. Mar. 17, 2022) (collecting cases) (emphasis added). Second, Enstarâs February 18, 2019 letter enclosing post-appraisal payment unequivocally stated: (1) that Enstar considered the total amount of loss to be definitively set by the appraisal award; and (2) that the only additional payment that Enstar would consider issuing to Dailey would be the withheld recoverable depreciation as calculated in the appraisal award. There is absolutely no evidence in the record indicating that Enstar ever changed its position on Daileyâs claim that Enstar set forth in the February 18, 2019 payment letter. Accordingly, Daileyâs causes of action accrued on February 18, 2019. Because there is no evidence that Enstar ever changed its position on Daileyâs claim after February 18, 2019, neither Daileyâs April 2, 2020 pre-litigation notice letter nor Enstarâs May 13, 2020 response to the pre-litigation notice letter affected the accrual date or the running of the limitations period. Castillo, 210 Fed. Appâx at 394 (âWe agree with the district court that letters from Appellantâs counsel requesting, inter alia, that State Farm reopen the claims do not toll or extend the limitations period following the claims decisions. Although State Farm was willing to review additional information submitted by Appellantâs attorney, State Farm never changed its position on any of the claims after the final decision letters were issued on March 31, 2003.â) (citation omitted); see also De Jongh v. State Farm Lloyds, 664 Fed. Appâx 405, 409 (5th Cir. 2016) (âUnder Texas law, De Jonghâs cause of action accrued on July 12, 2012, when State Farm closed the claim file. The accrual date remains unchanged, even though State Farm reopened the claim upon De Jonghâs request.â) (citation omitted). For the same reason, the pre-litigation inspection that Enstar conducted under Section 542A.004 of the Texas Insurance Code after it received Daileyâs pre-litigation notice letter did not affect the accrual date or the running of the limitations period. Pace v. Travelers Lloyds of Texas Insurance Co., 162 S.W.3d 632, 635 (Tex. App.âHouston [14th Dist.] 2005, no pet.) (â[T]o whatever extent the April 26 decision was reconsidered by Travelers based on the additional information, there is no evidence that that decision was ever expressly or impliedly withdrawn or changed, such as by making payment or otherwise taking action inconsistent with that decision.â); see also Rodriguez v. State Farm Lloyds, No. 5:17-CV-161, 2018 WL 3966270, at *3 & n.2 (S.D. Tex. Aug. 17, 2018) (âReinvestigation itself is insufficient to show a prior decisionâs withdrawal or change.â) (collecting cases). Finally, again for the same reason, Dailey cannot create a genuine issue of material fact regarding the accrual date or the running of the limitations period by swearing to her purported reliance on the âspecial noteâ language in the appraisal award itself. The âspecial noteâ language6 clarifies that the appraisal process, as is the general rule, only sets the amount of the loss and leaves liability and coverage issues for the courts. See State Farm Lloyds v. Johnson, 290 S.W.3d 886, 889â90 & n.19 (Tex. 2009) (reaffirming âthe proposition that appraisal binds the parties to have the extent or amount of the loss determined in a particular way, leaving the question of liability for such loss to be determined, if necessary, by the courtsâ) (quotation marks omitted). The âspecial noteâ language does not alter or amend the insurance policyâs stipulations that the appraisal process sets the amount of loss and is binding on Enstar and Dailey. The insurance policy unambiguously provides that it can only be amended by âattaching a written endorsement [to the policy] properly executed by [Enstarâs] authorized agent.â (Dkt. 30-1 at p. 22). In any event, the âspecial noteâ language, assuming that Enstar somehow adopted it, does not give any indication whatsoever that Enstar would at any point consider paying more than the amount of the appraisal award. Enstarâs February 18, 2019 payment letter was clear enough to put Dailey on notice of Enstarâs position regarding her claim, and Daileyâs alleged confusion about the letterâs meaning did not affect the accrual date of Daileyâs causes of action or the running of the limitations period. See Grayson v. Lexington Insurance Co., No. 3:15-CV-120, 2016 WL 4733447, at *2 (S.D. Tex. Sept. 12, 2016) (âGrayson argues that it was not clear that Lexington had a made a final decision to deny her claim until it paid only the holdback amount and not the remainder of the policy limits. This Court does not doubt that Grayson may believe that, but under the applicable law that 6 See footnote 5. belief is clearly unreasonable given the facts in this case. Consequently, the Court finds that Graysonâs breach of contract claim was untimely filed.ââ) (citation omitted). Having examined the record and the applicable law, the Court concludes as a matter of law that Daileyâs causes of action accrued on February 18, 2019. None of the communications between or actions of the parties after that date tolled or reset the limitations period. Since Dailey did not file her lawsuit until March 3, 2021, her lawsuit fell outside of the two-year-and-one-day limitations period provided in her insurance contract with Enstar. IV. CONCLUSION For the reasons outlined above, Daileyâs motion to remand (Dkt. 22) is DENIED. Enstarâs combination motion for summary judgment and motion to dismiss (Dkt. 30) is GRANTED IN PART AND DENIED AS MOOT IN PART. The Court concludes that this case is time-barred, and the case is DISMISSED WITH PREJUDICE. SIGNED at Houston, Texas on July 19, 2022. Hhoo-ae C GEORGE C. HANKS, JR. UNITED STATES DISTRICT JUDGE 19/19
Case Information
- Court
- S.D. Tex.
- Decision Date
- July 19, 2022
- Status
- Precedential