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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Interpleader Protects All Claimants Against Life Policy and the Insurer
Who’s on First to Get Life Insurance Proceeds
Post 5184
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Interpleader Protects All Claimants Against Life Policy and the Insurer
In Metropolitan Life Insurance Company v. Selena Sanchez, et al, No. 2:24-cv-03278-TLN-CSK, United States District Court, E.D. California (September 3, 2025) the USDC applied interpleader law.
Case Overview
This case involves an interpleader action brought by the Metropolitan Life Insurance Company (Plaintiff-in-Interpleader) against Selena Sanchez and other defendants (Defendants-in-Interpleader).
Key Points
Plaintiff-in-Interpleader’s Application:
The Plaintiff-in-Interpleader...
A Claim by Any Other Name is not a Claim
Post 5182
It is Imperative that Insured Report Potential Claim to Insurers
Read the full article at https://lnkd.in/gfbwAsxw, See the full video at https://lnkd.in/gea_hgB3 and at https://lnkd.in/ghZ7gjxy, and at https://zalma.com/blog plus more than 5150 posts.
In Jeffrey B. Scott v. Certain Underwriters At Lloyd’s, London, Subscribing To Policy No. B0901li1837279, RLI Insurance Company, Certain Underwriters At Lloyds, London And The Insurance Company, Subscribing To Policy No. B0180fn2102430, No. 24-12441, United States Court of Appeals, Eleventh Circuit (August 25, 2025) the court explained the need for a claim to obtain coverage.
Case Background:
This appeal arises from a coverage dispute under a Directors & Officers (D&O) insurance policy. Jeffrey B. Scott, the plaintiff-appellant, was terminated from his role as CEO, President, and Secretary of Gemini Financial Holdings, LLC in October 2019. Following his termination, Scott threatened legal action against Gemini, and ...
A Claim by Any Other Name is not a Claim
Post 5182
It is Imperative that Insured Report Potential Claim to Insurers
Read the full article at https://lnkd.in/gfbwAsxw, See the full video at https://lnkd.in/gea_hgB3 and at https://lnkd.in/ghZ7gjxy, and at https://zalma.com/blog plus more than 5150 posts.
In Jeffrey B. Scott v. Certain Underwriters At Lloyd’s, London, Subscribing To Policy No. B0901li1837279, RLI Insurance Company, Certain Underwriters At Lloyds, London And The Insurance Company, Subscribing To Policy No. B0180fn2102430, No. 24-12441, United States Court of Appeals, Eleventh Circuit (August 25, 2025) the court explained the need for a claim to obtain coverage.
Case Background:
This appeal arises from a coverage dispute under a Directors & Officers (D&O) insurance policy. Jeffrey B. Scott, the plaintiff-appellant, was terminated from his role as CEO, President, and Secretary of Gemini Financial Holdings, LLC in October 2019. Following his termination, Scott threatened legal action against Gemini, and ...
Barry Zalma: Insurance Claims Expert Witness
Posted on September 3, 2025 by Barry Zalma
The Need for a Claims Handling Expert to Defend or Prove a Tort of Bad Faith Suit
© 2025 Barry Zalma, Esq., CFE
When I finished my three year enlistment in the US Army as a Special Agent of US Army Intelligence in 1967, I sought employment where I could use the investigative skills I learned in the Army. After some searching I was hired as a claims trainee by the Fireman’s Fund American Insurance Company. For five years, while attending law school at night while working full time as an insurance adjuster I became familiar with every aspect of the commercial insurance industry.
On January 2, 1972 I was admitted to the California Bar. I practiced law, specializing in insurance claims, insurance coverage and defense of claims against people insured and defense of insurance companies sued for breach of contract and breach of the implied covenant of good faith and fair dealing. After 45 years as an active lawyer, I asked that my license to practice law be declared inactive ...
The Need for a Claims Handling Expert to Defend or Prove a Tort of Bad Faith Suit
© 2025 Barry Zalma, Esq., CFE
When I finished my three year enlistment in the US Army as a Special Agent of US Army Intelligence in 1967, I sought employment where I could use the investigative skills I learned in the Army. After some searching I was hired as a claims trainee by the Fireman’s Fund American Insurance Company. For five years, while attending law school at night while working full time as an insurance adjuster I became familiar with every aspect of the commercial insurance industry.
On January 2, 1972 I was admitted to the California Bar. I practiced law, specializing in insurance claims, insurance coverage and defense of claims against people insured and defense of insurance companies sued for breach of contract and breach of the implied covenant of good faith and fair dealing. After 45 years as an active lawyer, I asked that my license to practice law be declared inactive and became a consultant and expert witness for lawyers representing insurers and lawyers ...
APPRAISAL AWARD SETS AMOUNT OF DAMAGES RECOVERED FROM INSURER
Post 5180
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It’s a Waste of Time to Sue Your Insurer if You Don’t Have Evidence
Evidence Required to Prove Breach of Contract
Read the full article at https://www.linkedin.com/pulse/evidence-required-prove-breach-contract-barry-zalma-esq-cfe-rfelc, see the full video at https://rumble.com/v6yd2z0-evidence-required-to-prove-breach-of-contract.html and at https://youtu.be/2ywEjs3hZsw, and at https://zalma.com/blog plus more than 5150 posts.
It’s a Waste of Time to Sue Your Insurer if You Don’t Have Evidence
In Debbie Beaty and Jonathan Hayes v. Homeowners Of America Insurance Company, No. 01-23-00844-CV, Court of Appeals of Texas, First District (August 26, 2025) Debbie Beaty and Jonathan Hayes filed a claim under their homeowner’s insurance policy with Homeowners of ...
