In a latest resolution, 1 a federal decide famous the next in a Texas hail injury declare dispute:
Individuals in North Texas have not less than just a few frequent experiences between them: being dissatisfied within the Dallas Cowboys, shedding Luka Dončić to the Lakers, and being in a hailstorm. This case arises from one other expertise many in North Texas have had: a denial of insurance coverage protection after a storm.
I counsel that one cause for this frequent expertise is that Texas has a singular rule that solely it follows on learn how to deal with exclusions.
The decide dominated in favor of Nationwide Basic Insurance coverage Firm in a hail injury dispute with Managed Homeowners Group LLC. The ruling, which granted abstract judgment to the insurance coverage firm, highlights the important thing Texas authorized requirements and evidentiary burden that policyholders and their representatives should meet when pursuing insurance coverage claims involving concurrent causes of loss, akin to hail and wear-and-tear.
Managed Homeowners alleged {that a} September 2023 storm broken the constructing and that Nationwide had didn’t correctly examine the location and pay out the declare. The insurance coverage firm initially denied the declare. A reinspection was performed after the policyholder submitted a proper discover and demand in accordance with the Texas Insurance coverage Code. The second inspection reversed the denial, however the insurer’s estimate nonetheless fell beneath the coverage’s deductible, successfully leading to no payout.
The court docket’s evaluation targeted on a elementary Texas precept that when each lined and non-covered occasions probably trigger damages, the policyholder bears the burden of segregating the damages. Texas courts deal with this because the doctrine of concurrent causation. This Texas view requires the insured to current competent proof demonstrating what portion of the loss is attributable to a lined trigger. On this case, the court docket discovered that Managed Homeowners failed to take action. Whereas the policyholder claimed the loss resulted from the September 2023 hailstorm, their proof failed to differentiate how a lot of the injury was brought on by prior climate occasions or deterioration unrelated to the declare.
All different jurisdictions place this burden on the insurance coverage firm. Even insurance coverage firms instruct adjusters of their coaching manuals that insurers bear the burden of proving exclusions beneath an all-risk coverage. Texas courts have been persuaded in any other case.
Compounding the issue was the inadequacy of the policyholder’s skilled testimony. The court docket struck key elements of Phil Mayfield’s testimony, an skilled retained by Managed Homeowners. Mayfield attributed the injury solely to the September storm however didn’t present a dependable scientific foundation for excluding different storms or growing old as potential causes. He admitted to relying closely on the proprietor’s assertion and his personal instinct. The court docket famous that this method lacked the methodological rigor required beneath the Daubert commonplace for skilled testimony. In essence, Mayfield’s conclusions weren’t supported by unbiased evaluation or information ample to get rid of various explanations.
Merely asserting that injury was brought on by a storm is just not sufficient. When there may be any chance of prior injury, different climate occasions, or long-term deterioration, claimants should deliver ahead clear, credible proof that separates what is roofed from what is just not. That always requires an in depth inspection, use of dependable climate information, and skilled evaluation grounded in details fairly than assumptions.
The case additionally highlights the significance of selecting certified and methodologically sound specialists. Courts scrutinize skilled opinions rigorously, and counting on unsupported opinions or anecdotal statements can backfire.
Thought For The Day
“There wouldn’t be no Alamo, no Cowboys, and no Texas Rangers if it wasn’t for Texas.”
—Willie Nelson
1 Managed Homeowners Group v. Nationwide Gen Ins. Co., No. 3:24-cv-1336 (N.D. Tex. June 27, 2025).
