There is no Privity Between Adjuster & an Insured

A Claim Against an Insurer for Wrongful Conduct Cannot Be Maintained Against Its Adjuster

Post number 5321

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In Lambert v. SafePort Insurance Company, et al., Civil Action No. 25-1446 (E.D. La. Apr. 2, 2026) (Morgan, J.) Plaintiff Lisa Lambert held a homeowner’s insurance policy issued by SafePort Insurance Company covering her property against windstorms and wind damage. After two separate windstorms damaged her home (the “First Wind Claim” and “Second Wind Claim”), she promptly reported both losses and attempted to mitigate damages.

FACTUAL BACKGROUND

SageSure Insurance Managers LLC acted as the claims adjuster/manager for SafePort. In both instances:

A field adjuster inspected the property and denied coverage, attributing the damage to “foundation settling as a result of earth movement” (an excluded peril that allegedly caused water pooling on the roof).

After the second denial, an engineer retained by SageSure allegedly inspected the property, initially identified a different roof type and damage cause, but the final engineering report was altered (at the direction of SageSure and/or SafePort) to match the field adjuster’s earth-movement denial rationale.

Plaintiff alleged the alterations and misrepresentations were intentional and part of a scheme to wrongfully deny valid wind-damage claims.

PROCEDURAL BACKGROUND

Plaintiff sued both SafePort and SageSure asserting seven causes of action including Breach of contract, Breach of the duty of good faith and fair dealing. Fraud / intentional misrepresentation, Conspiracy to commit fraud, Unfair trade practices in the business of insurance, Insurance fraud, and Negligent misrepresentation

SageSure moved under Fed. R. Civ. P. 12(b)(6) to dismiss all claims against it with prejudice. Plaintiff expressly conceded in briefing that she was “not suing SageSure for breach of contract.”

LAW

General Pleading Standard (Rule 12(b)(6))

A complaint must contain sufficient factual matter, accepted as true, to state a claim that is “plausible on its face.” Legal conclusions, threadbare recitals, and naked assertions are disregarded. Dismissal is proper if the face of the complaint shows a bar to relief.

Fraud / Conspiracy Pleading Standard (Rule 9(b))

Fraud and conspiracy-to-defraud claims must be pled with particularity: the “who, what, when, where, and how” of the alleged fraud. Collective/group pleading that fails to distinguish each defendant’s role is insufficient. Malice and intent may be pled generally, but the circumstances of fraud must be specific.

DISCUSSION / ANALYSIS

The Court addressed each claim in turn and found all deficient as to SageSure:

Breach of Contract

SageSure is not the insurer; the policy declarations name SafePort. Claim dismissed (and plaintiff conceded it).

Breach of Duty of Good Faith & Fair Dealing

Statutes apply only to insurers. SageSure is an adjuster/manager, not the insurer and there was no privity.
Insurance Fraud (La. R.S. § 22:1924)

Criminal statute; no private right of action.

Unfair Trade Practices in Insurance

No private right of action.

Fraud / Intentional Misrepresentation

Negligent Misrepresentation

Louisiana law generally imposes no tort duty on an independent adjuster for claims handling. Plaintiff pled no facts fitting any narrow exception.

Failed Rule 9(b) particularity: allegations lumped SageSure, SafePort, adjusters, and the engineer together without identifying specific fraudulent statements, speakers, dates, or locations.

Independently fatal: no allegation of justifiable reliance. Plaintiff never pled she took or refrained from any action because of the alleged misrepresentation

All deficiencies were incurable on the current pleading, so dismissal was with prejudice.

CONCLUSION

SageSure’s Motion to Dismiss was granted. All seven claims against Sagesure were dismissed with prejudice. The case proceeds solely against the actual insurer, SafePort Insurance Company.

ZALMA OPINION

Insurance adjusters act as agents of insurers but are not insurers. The insured who claims the contract was breached and the insurer acted wrongfully against the insured does not allow the insured to sue the adjuster because there is no privity between the insured and the adjuster. The plaintiff could maintain her action against the insurer but not the adjuster.

(c) 2026 Barry Zalma & ClaimSchool, Inc.

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