Insurance suit alleges TWIA denied claim

Kelly Holleran Mar. 4, 2009, 2:51am

A Jefferson County couple has filed suit against Texas Windstorm Insurance Association and two adjusters, alleging they were not paid money to which they were entitled after Hurricane Ike destroyed sections of their home.

When Benjamin and Tina Baker's property at 17969 Camellia Drive in Beaumont sustained roof, water, wind and structural damages on Sept. 13 during Hurricane Ike, they submitted a claim to TWIA, which had insured their property, according to the complaint filed Feb. 24 in Jefferson County District Court.

The Bakers requested TWIA cover the cost of repairs, plus additional living expenses, the suit states.

However, TWIA denied the Bakers claim for the repairs of their property, even though the policy provided coverage for losses, they claim.

It denied the repairs after assigning two adjusters -- Diana Orta and Reggie Warren -- to adjust the claim.

TWIA told the Bakers it would not pay the full proceeds of the policy, although demand was made for it, which constitutes a breach of the insurance contract, the suit states.

"Defendants TWIA, Orta and Warren misrepresented to Plaintiffs that the damage to the property was not covered under the policy, even though the damage was caused by a covered occurrence," the suit states.

TWIA, Orta and Warren also failed to make an attempt to settle the Smiths' claim in a fair manner, a violation of the Texas Insurance Code, unfair settlement practices, he claims.

The company and the adjusters failed to explain the reason for their offer of an inadequate settlement, another violation of the Texas Insurance Code, according to the complaint.

TWIA, Orta and Warren failed to affirm or deny coverage of the claim within a reasonable time frame, the suit states.

They refused to fully compensate the Bakers, even though they did not conduct a reasonable investigation, which constitutes another violation of the Texas Unfair Competition and Unfair Practices Act, the Bakers allege.

TWIA, Orta and Warren are liable for common law fraud because each of their representations contained facts they knew were false, according to the complaint.

They also committed numerous violations of the Texas Unfair Settlement Practices.

TWIA breached its contract with the Bakers by refusing to pay the policy, according to the suit.

The Bakers are seeking unspecified actual, treble, punitive and exemplary damages, plus attorney's fees, costs, pre- and post-judgment interest and other relief the court deems just.

Michael R. Ramsey and Gregory F. Cox of The Mostyn Law Firm in Beaumont and J. Steve Mostyn of The Mostyn Law Firm in Houston will be representing them.

The case has been assigned to Judge Gary Sanderson, 60th District Court.

Case No. B183-375

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