Hinojos v. State Farm Lloyds, No. 19-0280

• Court: Supreme Court of Texas
• Citation: 619 S.W.3d 651
• Decision Date: 19 March 2021
• Parties: Louis HINOJOS, Petitioner, v. STATE FARM LLOYDS and Raul Pulido, Respondents
• Docket Number: No. 19-0280

619 S.W.3d 651

Louis HINOJOS, Petitioner,
v.
STATE FARM LLOYDS and Raul Pulido, Respondents

No. 19-0280

Supreme Court of Texas.

Argued September 17, 2020
OPINION DELIVERED: March 19, 2021

David P. Wilson, Beaumont, Andrew B. Bender, Houston, Sharon S. McCally, Chad T. Wilson, Webster, for Petitioner.

Jeffrey L. Raizner, Benjamin Wickert, Andrew P. Slania, Houston, for Amicus Curiae.

Ruben S. Robles, Angela Morrow Nickey, El Paso, Craig T. Enoch, Melissa A. Lorber, Austin, for Respondents.

Justice Bland delivered the opinion of the Court, in which Chief Justice Hecht, Justice Lehrmann, Justice Boyd, Justice Devine, Justice Busby, and Justice Huddle joined.

The Texas Prompt Payment of Claims Act, codified in Insurance Code Chapter 542, imposes deadlines on insurers to pay valid claims.¹ If an insurer fails to comply with Chapter 542, then it is liable for statutory interest on the amount of the claim and attorney's fees.² The insurer in this case accepted a homeowner's claim and paid part of it before the statutory deadline.

Dissatisfied with that amount, the homeowner sued, seeking full payment of the claim plus interest and attorney's fees under Chapter 542. While suit was pending—and after the statutory deadline for payment had passed—the insurer invoked the policy's appraisal process. The appraisers awarded the homeowner substantially more than the amount the insurer had paid.

The insurer paid the difference and then moved for summary judgment on the homeowner's Chapter 542 claim, contending that its payment of the appraisal

619 S.W.3d 653

award precluded liability. Without the benefit of our decisions in Barbara Technologies Corp. v. State Farm Lloyds³ and Alvarez v. State Farm Lloyds ,⁴ the trial court granted summary judgment, and the court of appeals affirmed.⁵ We granted the homeowner's petition for review.

Applying Barbara Technologies and Alvarez , we hold that payment of an appraisal award does not absolve the insurer of statutory liability when an insurer accepts a claim but pays only part of the amount it owes within the statutory deadline. Because the insurer in this case did not pay the amount that "must be paid"⁶ on the claim before the statutory deadline, it was not entitled to summary judgment. Accordingly, we reverse the judgment of the court of appeals and remand the case to the trial court.

I

Chapter 542, subchapter B, imposes liability when an insurance company misses a statutory payment deadline for a documented claim that it owes under an insurance policy.⁷ In the statute, the Legislature instructs that the subchapter's provisions be "liberally construed to promote the prompt payment of insurance claims."⁸

When an insurer receives a claim, it has fifteen days to acknowledge its receipt, begin an investigation, and request from the claimant all "items, statements, and forms" that the insurer reasonably believes are necessary to evaluate the claim.⁹ Within a further fifteen business days of receiving the "items, statements, and forms," the insurer must inform the claimant, in writing, whether it accepts or rejects the claim.¹⁰ If an insurer accepts the claim, in whole or in part, it has five business days to pay the insured.¹¹ To enforce these deadlines, Chapter 542 provides that a claimant may recover statutory interest and attorney's fees, in addition to the amount of the claim, when an insurer violates the statute:

if an insurer, after receiving all items, statements, and forms reasonably requested and required under Section 542.055, delays payment of the claim for a period exceeding the period specified by other applicable statutes or, if other statutes do not specify a period, for more than 60 days, the insurer shall pay damages and other items as provided by Section 542.060.¹²

Section 542.060(a), in turn, sets out that interest accrues at 18% per year and assesses attorney's fees against a liable insurer:

if an insurer that is liable for a claim under an insurance policy is not in compliance with this subchapter, the insurer is liable to pay the holder of the policy ..., in addition to the amount of the claim, interest on the amount of the claim at the rate of 18 percent a year as damages, together with reasonable and necessary attorney's fees.¹³

619 S.W.3d 654

This case stems from a dispute over State Farm Lloyds' liability for statutory damages under section 542.060(a).

II

After a summer wind and hail storm in 2013, Louis Hinojos reported a claim to State Farm for damage to his home. A State Farm adjuster inspected the home on June 12, nine days after Hinojos reported the claim. The adjuster valued the damage at $755.02, an amount below Hinojos's policy deductible. On June 20, State Farm informed Hinojos that, because the value of the claim was below his policy's deductible, State Farm owed nothing on the claim. Hinojos requested a second inspection. At the second inspection, the adjuster identified additional damage. On August 7, State Farm sent Hinojos a letter agreeing that there was "covered damage" in the amount of $3,859.22. The letter enclosed payment of $1,995.11, reflecting State Farm's assessment of the value of the claim, less the deductible and depreciation.

Hinojos sued State Farm and its adjuster the following February.¹⁴ Among other claims, Hinojos alleged that State Farm had violated Chapter 542 by delaying payment on the claim.¹⁵

Nearly two years after Hinojos submitted his claim, and fifteen months after he filed suit, State Farm invoked the policy's appraisal clause. The appraisal process results in a binding determination of the amount owed for a covered loss under the policy:

If you and we fail to agree on the amount of loss, either one can demand that the amount of the loss be set by appraisal. If either makes a written demand for appraisal, each shall select a competent disinterested appraiser.... The appraisers shall then set the amount of the loss. If the appraisers submit a written report of an agreement to us, the amount agreed upon shall be the amount of the loss....

The appraisers valued Hinojos's loss at $38,269.95 on a replacement cost basis and $26,259.86 on an actual cash basis. Within a week of the appraisers' decision, and about two-and-a-half years after Hinojos submitted his claim, State Farm tendered an additional $22,974.75, reflecting payment of the appraisal award net of the earlier payment it made to Hinojos, the deductible, and depreciation.

Following the appraisal, State Farm moved for summary judgment, contending that "timely tendering of the appraisal award precludes prompt payment damages under Chapter 542 of the Texas Insurance Code." Hinojos responded that State Farm was subject to statutory liability because it had "failed to issue any payment within the deadlines provided by section 542.057."¹⁶ In the alternative, Hinojos argued that, even if State Farm's first payment was timely, State Farm is liable for statutory interest on the difference between

619 S.W.3d 655

the appraisal award and the partial payment "for the period August 7, 2013 to the present." The trial court granted summary judgment.

Hinojos appealed, contending that "the payment of the appraisal award should allow him to receive interest penalties under the statute because the appraisal payment was ultimately paid outside the sixty-day statutory-window."¹⁷ The court of appeals rejected this reasoning and affirmed. It concluded that "because State Farm made a reasonable payment on Hinojos's claim within the sixty-day statutory limit," State Farm had not violated Chapter 542.¹⁸

Hinojos petitioned for review. He argues that "[w]hile State Farm paid part of the claim ‘not later than the fifth business day after the notice was made,’ it did not pay the rest of the claim within the statutory time frame." In response, State Farm asserts that it "undisputedly paid Hinojos's claim within 60 days after receiving all information required to evaluate the claim," notwithstanding the fact that it later paid more on that claim after the appraisal. We granted review.

III

The parties agree on the key facts: (1) State Farm "accepted" Hinojos's claim and paid some money toward that claim within the statutory window; and (2) State Farm fully paid the amount it owed to satisfy the claim after the deadline had passed.¹⁹ The issue presented is whether State Farm can avoid liability under Chapter 542 as a matter of law based on these facts.

After the court of appeals in this case ruled, we decided Barbara Technologies Corp. v. State Farm Lloyds.²⁰ In that case, State Farm rejected a claim because it valued the property damage below the policy's deductible.²¹ State Farm later paid the claimant an appraisal award.²² We held that the payment of an appraisal award does not foreclose prompt payment damages when an insurer rejects an insurance claim.²³ An appraisal payment, we concluded, "is neither an acknowledgment of liability nor a determination of liability under the policy for purposes of TPPCA damages under section 542.060"²⁴ and "has no bearing on any deadlines."²⁵ Thus, "[n]othing in the TPPCA would excuse an insurer...