June 15, 2024

7th Circuit: State Farm calculates $89k less than the complete award not evidence of bad faith

The second circuit US Court of Appeal ruled at the beginning of this month that a previous state farm calculated above $14,000 below the independent of the company and almost $89,000 below the complete umpire compensation is not evidence of bad faith.

Amy St Eve, the Circuit Judge wrote that the best scenario was the inadequacy of the first inspection carried out by the state farm but it is enough to indicate bad faith.

The court discovered that the appraisal clause of the policy of the Indiana Jones condo complex was clear and should be enacted.

The 3-0 verdict by Circuit Judges, St Eve, Frank Easterbrook and David Hamilton in Villas at Winding Ridge v. State Farm confirmed a US court verdict in March to offer State Farm a motion for conclusive judgement.

The case incorporated the idea of Winding Ridge’s “Residential Community Association Policy” but there is value in recognizing that motorists and body shops offered parallels to problems and policy statements that can develop in auto cases.

According to Winding Ridge’s residential Policy on the 1st of July 2012 -13

In a situation where you and we are in disagreement concerning the worth of the property of the value of the loss, you can develop a written request for compensation for the loss. If both parties opt for a professional and fair appraiser, both parties should inform the other of the identity of the appraiser in 20 days after a written request of the appraisal is received.

An umpire should then be chosen by the two appraisers. If an umpire is not agreed upon by both appraisers within 15 days, the request can then be raised by either to be chosen by a judge in a court under his jurisdiction. The worth of the property will be separately indicated by the appraisers together with the value of the loss.

If they are both in disagreement, their differences will both be submitted to the umpire. This agreement will be binding as long as it is agreed by both parties.

This is also a common practice in auto policies too.

Winding Ridge, in 2014 employed Rocklane Company as a contractor to evaluate the roof of a 33-building complex that is about 9 to 16 years old. Winding Ridge filed a claim after Rocklane discovered that hail damages affected 12 out of the roof of the complex.

Eric Meador, the State Farm adjuster paid a visit to the site and also in agreement with the hail damage but without any shingles. He calculated about $65,713.54 as damage costs.

Winding Ridge was not in agreement and decided to employ Mathew Latham, a public adjuster from Crossroads Claim Consulting who had written for above $1.975 million covering what is recognized by the appeals court as “complete replacement for every shingle metal vents, caps, flashings, decking, gutters and downspouts on each of the 33 buildings”.

Meador examined the site and also employed engineer Doug Brown to carry out the same evaluation. Brown discovered that there was no practical destruction to shingles and granules losses indicated by Latham which are only typical ageing and scorching and Meador did not budge from the initial calculation

In September 2015, Winding Ridge requested an appraisal, which State Farm agreed. The independent appraiser from State Farm, Michael Scott indicated about $79,921.80 without any complete shingle replacement. The independent appraiser from Winding Ridge, Garret Kurt indicated $676,842.07, which incorporates complete shingle replacement or only about 13 buildings.

The services of Al Kalemba of Illiana Claims were both agreed by the appraisers to serve as the umpire. About $154,391,77 was recommended in May 2016, which incorporates what the appeal court considered as 1. 20% repair funds for shingles on 13 buildings. 2. The cost of replacing soft metal issues on the entire 33 buildings.

A letter dated November 2013 was provided by Kurt from shingle producer, GAF which indicated that the shingle has been discontinued by OEM and the options available for a replacement won’t be a fit to the color of the old shingles. But the court stated that State Farm was never aware of this.

Kalemba was adamant on his motion that he was only asked to evaluate the damage and similar problems as it pertains to the policy coverage issues that are absent from the appraisal process.

Kalemba’s decision was approved by Scott and there was a cut by State Farm in the amount requested in the check.

About $1.5milion loan had been collected by Winding Ridge for the renovation of the shingles on the entire 33 buildings and eventually filed a lawsuit against State Farm for $1.5 million, in addition to both the loan and interest on prejudgment with claims of bad faith, contract violation and promissory estoppel.

Winding Ridge indicated and appealed that the policy was not clear which was rejected by the court. The complex also filed a motion that the umpire erroneously ascertained the number of damages.

Steve stated that there was no outstanding condition indicated  by Winding Ridge like unfairness, collusion, fraud, exhibition of injustice or misfeasance that would require pushing the compensation aside and also the simple occurrence of coverage arguments (such as matching shingles) plus the amount to loss of dispute is not enough to ward off an appraisal award.

St Eve and all other judges were also not in agreement with the condo concerning the existence of the material issues. She indicated that an appraiser from the winding ridge was able to discover a complete shingles restoration on 13 roofs and both the umpire and the appraiser from State Farm were in agreement that there were necessary replacements on some damages in the 13 roofs.

St Eve wrote that the compensation granted the Winding Ridge on 20% shingle restoration of the buildings, the idea that all the shingles were restored by Winding Ridge on the entire 33 buildings for $1.5 million independently during the time the claim was yet to be approved has no obligation towards State Farm or meant there was a violation by State Farm under the policy.

She also wrote that the complete claim was also absolved by the final award, which goes beyond the 13 buildings in the claim.

The judgment by St. Eve also indicated that automotive policyholders are not supposed to leave crucial information that is important to the claim. The court stated that even if the proof was available before the decision of the umpire, there won’t be a do-over of the process of appraisal. When evaluating the discovery from GAT that there was no existence of any corresponding shingles. Eve wrote:

The matching shingles contention by Winding Ridge was unexpected. In April 2014, the initial claim was received by the State Farm. The property was assessed a countless number of times before an appraisal was requested by Winding Ridge.

The umpire and the appraisers throughout the process assessed the property and a proposed award was finalized on April 30th, 2016. But on the 20th of May 2016, an appraiser from Winding Ridge reported that the original shingles have been discontinued by the shingle producer.

This issue could be indicated by Winding Ridge on the 18th of November 2015, six months before the report when a letter was provided by the shingle producer GAF that there no direct replacements for the shingles. Winding Ridges didn’t. Allowing uncertainties like this would undoubtedly defeat the purpose of initially binding the appraisal.

The court also rejected Winding Ridge’s argument that there would have been matching roofs in the absence of the hail damage. Since the issue had not been raised before the district court by the condo (St Eve indicated that it is impossible to raise an issue before the appeal court if it is not previously brought before a lower court.

Not a claim of bad faith

Steve wrote concerning the bad that State Farm passed through the required appraisal process and made the payment requested by the umpire.

She continued that there no proof to show any delay in payment from State Farm to Winding Ridge misled Winding Ridge or carried out any unjust edge over Winding Ridge to trigger the settlement of the claim. But the main question is if there was any unproven refusal from State Farm for the payment of policy proceeds to Winding Ridge.

Eve stated that bad faith in Indiana requires a complainant to provide evidence that the illegitimacy of the insurance provider was known and responsible for it.

She wrote that it was a huge burden of evidence when declaring this in Inman v. State Farm at the Indiana Supreme Court.

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