Policy Limit is the Most an Insured Can Recover for a Loss
Post 5174
Read the full article at https://www.linkedin.com/pulse/insurer-free-liability-claims-consultant-barry-zalma-esq-cfe-dqrbc, see the full video at https://rumble.com/v6y1wvu-insurer-free-of-liability-claims-consultant-not.html and at https://youtu.be/Te7UsKzhGNU, and at https://zalma.com/blog plus more than 5150 posts.
Water Damage Special Limit of Liability Enforced
In Abraham & Co. Inc v. Markel Insurance Company And Hirschfield Risk Services, Inc. D/B/A H&H Claims Consultants, No. 14-24-00242-CV, Court of Appeals of Texas, Fourteenth District (August 19, 2025) dealt with damages caused by Winter Storm Uri in February 2021 when pipes at Abraham's location burst, causing water damage to numerous rugs.
KEY FACTS:
Insurance Policy:
Markel issued an insurance policy to Abraham, effective from November 16, 2020, to November 16, 2021, with a liability limit of $2 million for covered property and a special limit of $750,000 for water damage.
Claim and Dispute:
Abraham filed a claim under the policy and Markel paid only $750,000 based on an endorsement limiting liability for water damage.
Legal Proceedings:
Abraham filed suit against Markel for breach of contract and other claims, and against H&H for negligence and violations of the Texas Insurance Code.
LEGAL CONCLUSIONS:
Coverage Limit:
The trial court concluded that the policy's unambiguous language limited the coverage for Abraham's claim to $750,000.
Negligence Claims:
The Court of Appeals concluded that the trial court did not err in granting summary judgment for H&H on the negligent claims handling but erred in dismissing Abraham's general negligence claim.
Extra-Contractual Claims:
The trial court did not err in granting summary judgment on Abraham's extra-contractual claims against Markel and H&H.
CONCLUSIONS:
It was undisputed that Abraham's claim was based on a loss caused by water damage and that Markel has paid $750,000 on this claim and the trial court did not err in granting summary judgment and dismissing with prejudice Abraham's breach-of-contract claim against Markel.
To the extent the trial court granted summary judgment as to Abraham's claim for negligent claims handling, dismissed the claim, and determined that H&H cannot be liable based on a theory of negligent claims handling, the trial court did not err, and the Court of Appeals affirmed the trial court's judgment.
To the extent the trial court granted summary judgment as to Abraham's General Negligence Claim, dismissed the claim, and determined that H&H cannot be liable on a theory of general negligence, the trial court erred and the Court of Appeals reversed the trial court's judgment and remanded the case for further proceedings.
Did The Trial Court Err In Granting Summary Judgment As To Abraham's Negligence Claims Against H&H?
In part of its first issue and in its second issue Abraham challenges the trial court's granting of summary judgment as to its negligence claims against H&H, the claims consultants.
To the extent the trial court granted summary judgment as to Abraham's claim for negligent claims handling, dismissed the claim, and determined that H&H cannot be liable based on a theory of negligent claims handling, the trial court did not err, and the trial court's judgment was affirmed. To the extent the trial court granted summary judgment as to Abraham's General Negligence Claim, dismissed the claim, and determined that H&H cannot be liable on a theory of general negligence, the trial court erred.
ZALMA OPINION
Many insurance companies do not have a claims staff to deal with all claims and retain the services of independent claims adjusters and consultants like H&H. The Court of Appeals found that everything that the insurer did was appropriate it still allowed the case to go forward against H&H who only can act as an agent of the insurer and, if it acted negligently, it can be liable for any damages resulting from its negligence. How, if the claim was handled appropriately and the insured paid the limit of liability of the policy, the claims handler could be negligent is difficult to prognosticate.
(c) 2025 Barry Zalma & ClaimSchool, Inc.
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Anti-Public Adjuster Clause Is Effective in New York
Post number 5301
Read the full article at https://www.linkedin.com/pulse/public-adjusters-attempt-represent-insured-subject-zalma-esq-cfe-rubfc, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.
Insurers May Contractually Prevent an Insured from Hiring a Public Adjuster
In Peter Barbato & North Jersey Public Adjusters Inc. v. Interstate Fire & Casualty Company, et al, No. 25-cv-5312 (JGK), United States District Court, S.D. New York (December 15, 2025) the plaintiffs, Peter Barbato and North Jersey Public Adjusters, Inc. (“NJPA”), filed suit against several insurance companies, including Interstate Fire & Casualty Company, Independent Specialty Insurance Company, and certain Underwriters at Lloyd’s of London.
FACTS
NJPA is a New Jersey-based public adjusting firm licensed in New York. The dispute centers on ...
Anti-Public Adjuster Clause Is Effective in New York
Post number 5301
Read the full article at https://www.linkedin.com/pulse/public-adjusters-attempt-represent-insured-subject-zalma-esq-cfe-rubfc, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.
Insurers May Contractually Prevent an Insured from Hiring a Public Adjuster
In Peter Barbato & North Jersey Public Adjusters Inc. v. Interstate Fire & Casualty Company, et al, No. 25-cv-5312 (JGK), United States District Court, S.D. New York (December 15, 2025) the plaintiffs, Peter Barbato and North Jersey Public Adjusters, Inc. (“NJPA”), filed suit against several insurance companies, including Interstate Fire & Casualty Company, Independent Specialty Insurance Company, and certain Underwriters at Lloyd’s of London.
FACTS
NJPA is a New Jersey-based public adjusting firm licensed in New York. The dispute centers on ...
Proof of Highly Contaminated Water is Required for Extra Payments
Post number 5300
Read the full article at https://www.linkedin.com/pulse/acting-your-own-lawyer-foolish-barry-zalma-esq-cfe-mbg0c, see the video at and at and at https://zalma.com/blog plus more than 5300 posts.
Acting as Your Own Lawyer is Foolish
Evidence of Breach of Contract Survives Dismissal of All Other Charges
In Lee Lifeng Hsu and Jane Yuchen Hsu v. State Farm Fire And Casualty Company, C. A. No. N24C-09-020 CLS, Superior Court of Delaware (February 27, 2026) a claim to State Farm who paid approximately $61,000 after assessments but denied coverage for additional items including ceramic tiles, the kitchen floor ceiling, underlayment plywood, and numerous personal property items resulted in suit by the Hsu’s acting in pro per.
Facts
Lee Lifeng Hsu and Jane Yuchen Hsu (“Plaintiffs”) purchased a homeowners’ insurance policy from State Farm Fire...
Insurance Condition Requires Following the Intent of the Parties
Post number 5307
Principles of Contract Interpretation Compels Reading Contract as Written
Read the full article at https://www.linkedin.com/pulse/portable-storage-containers-buildings-barry-zalma-esq-cfe-fkg1c and at https://zalma.com/blog.
In Eastside Floor Supplies, Ltd. v. SCS Agency, Inc., Hanover Insurance Company, et al., No. 2024-01501, Index No. 609883/19, 2026 NY Slip Op 01488, Supreme Court of New York, Second Department (March 18, 2026)
In May 2019, a fire damaged business personal property belonging to the plaintiffs, which was stored in portable storage containers at their Manhattan premises. At the time of the fire, the plaintiffs were insured under a businessowners insurance policy (BOP) issued by the defendant Hanover Insurance Company which provided general coverage for business personal property, and which included a specific extension for “Business Personal Property Temporarily in Portable Storage Units” (the portable storage ...
ERISA Saves Fraudulent Claims Suit
Post number 5306
Read the full article at https://www.linkedin.com/pulse/failure-provide-well-pled-facts-defeats-most-action-zalma-esq-cfe-b4zuc and at https://zalma.com/blog plus more than 5300 posts.
Allegations of Fraudulent Insurance Billing Must be Pleaded with Specificity
In Genesis Laboratory Management LLC v. United Healthcare Services, Inc. and Oxford Health Plans, Inc., No. 21cv12057 (EP) (JSA), United States District Court, D. New Jersey (March 13, 2026) Genesis Laboratory Management LLC (“Genesis”), a New Jersey-based molecular diagnostic and anatomic pathology laboratory, provided COVID-19 related testing services and submitted claims for reimbursement as an out-of-network provider to United Healthcare Services, Inc. (“United”) and Oxford Health Insurance, Inc. (“Oxford”). Metropolitan Healthcare Billing, LLC (“Metropolitan”), owned by the same individual as Genesis, handled the billing for Genesis.
FACTUAL BACKGROUND
United and Oxford, who administer both ERISA and ...
ERISA Saves Fraudulent Claims Suit
Post number 5306
Read the full article at https://www.linkedin.com/pulse/failure-provide-well-pled-facts-defeats-most-action-zalma-esq-cfe-b4zuc and at https://zalma.com/blog plus more than 5300 posts.
Allegations of Fraudulent Insurance Billing Must be Pleaded with Specificity
In Genesis Laboratory Management LLC v. United Healthcare Services, Inc. and Oxford Health Plans, Inc., No. 21cv12057 (EP) (JSA), United States District Court, D. New Jersey (March 13, 2026) Genesis Laboratory Management LLC (“Genesis”), a New Jersey-based molecular diagnostic and anatomic pathology laboratory, provided COVID-19 related testing services and submitted claims for reimbursement as an out-of-network provider to United Healthcare Services, Inc. (“United”) and Oxford Health Insurance, Inc. (“Oxford”). Metropolitan Healthcare Billing, LLC (“Metropolitan”), owned by the same individual as Genesis, handled the billing for Genesis.
FACTUAL BACKGROUND
United and Oxford, who administer both ERISA and ...
