Breaking NewsLaw.com and associated brands will be offline for scheduled maintenance Friday Feb. 26 9 PM US EST to Saturday Feb. 27 6 AM EST. We apologize for the inconvenience.

 

DeLaGarza v. State Farm Mutual Automobile Insurance Co.

The insurer's second payment was made in an effort to resolve litigation rather than to satisfy an accepted claim. The insured cites no authority and makes no argument for the proposition that the deadlines established by Texas Insurance Code Article 21.55 apply to the litigation process.

X

Thank you for sharing!

Your article was successfully shared with the contacts you provided.
Click here for the full text of this decision FACTS:Juan DeLaGarza was insured under a Texas Personal Auto Policy issued by State Farm Mutual Automobile Insurance Coy. Through his attorney, he sent State Farm a letter stating he had been injured in a car accident as a result of the negligence of an uninsured driver. The letter further stated that it was “formal notice” of DeLaGarza’s claim for benefits under the personal injury protection and uninsured motorist provisions of his insurance policy. State Farm acknowledged receipt of the claim and requested supporting documentation including medical bills and the names and addresses of his medical providers and signed authorization to release information relating to the uninsured motorist claim. State Farm received DeLaGarza’s medical records and bills, with a demand that State Farm tender payment of the $25,000 uninsured motorist protection policy limits in exchange for which DeLaGarza would release State Farm from any further liability on the claim. No signed authorization was included. State Farm stated it was “unable to accept” DeLaGarza’s offer to settle the matter for $25,000, but offered to settle the claim for $10,000. State Farm’s offer to settle for $10,000 was verbally rejected by a paralegal working with DeLaGarza’s attorney. DeLaGarza filed suit against the company and asserted that he was entitled to both the full policy limits and additional damages and attorney’s fees under Texas Insurance Code Article 21.55. Approximately three weeks after DeLaGarza filed suit, State Farm sent him a check for $10,000. After discovery was conducted, State Farm sent DeLaGarza a second check for $15,000 representing the balance of the benefits available to him under the policy. Because the policy limits had been paid, the only claim left in the suit was for additional damages under Article 21.55 for delay in handling and paying the claim. State Farm moved for summary judgment and argued that the undisputed facts showed the company met all the requirements and deadlines for handling DeLaGarza’s claim under Article 21.55. The trial court ultimately granted State Farm’s motion for summary judgment and ruled that DeLaGarza take nothing by his claims. HOLDING:Affirmed. DeLaGarza contends on appeal the trial court erred in granting summary judgment on his claim under Article 21.55 because the evidence did not conclusively establish that State Farm complied with the article’s requirements. The court disagreed and points out that the evidence shows that DeLaGarza first notified State Farm of his claim under the policy on Oct. 18, 2002. Under Article 21.55, State Farm was required to acknowledge receipt of the claim, begin an investigation, and request documentation from DeLaGarza within 15 days. State Farm did this by letter dated Oct. 25 in which State Farm stated it was reviewing the claim and needed DeLaGarza’s medical records and bills. DeLaGarza suggests State Farm failed to meet this deadline because it did not respond to his demand letter until March 27, 2003, 21 days after State Farm received the demand letter. Even assuming State Farm’s duty to accept or reject the claim was triggered by DeLaGarza’s demand letter, the court holds that the company met the deadline because it responded within 15 business days as required by Article 21.55. DeLaGarza next argues that State Farm’s March 27 letter offering to settle his claim for $10,000 was an outright “acceptance” of his claim under 4 of Article 21.55 thus requiring State Farm to send payment within five business days. Because State Farm did not send any payment until after this suit was filed, DeLaGarza argues State Farm failed to meet a mandatory deadline. The court holds that 21.55 was not intended to eliminate an insurer’s right to dispute all or part of an insured’s claim. State Farm’s March 27 letter informed DeLaGarza that the company was accepting only part of his claim based on the information it had received to date. The court concludes that State Farm had the right under 4 to dispute part of DeLaGarza’s claim and to condition its payment of the accepted part of the claim on DeLaGarza sending the company notification of his willingness to settle. DeLaGarza never sent State Farm any notice that he was willing to settle his claims for $10,000. Under the clear terms of 4, therefore, State Farm did not fail to meet the deadline for making payment because the duty to send payment never arose. Finally, DeLaGarza argues State Farm was not entitled to summary judgment on his claims under Article 21.55 because the company did not show it sent the second payment of $15,000 within five business days of accepting the remainder of his claim. At the time State Farm made the $15,000 payment, however, DeLaGarza had already filed suit and alleged his claims under Article 21.55. The second payment was made in an effort to resolve litigation rather than to satisfy an accepted claim. DeLaGarza cites no authority and makes no argument for the proposition that the deadlines established by Article 21.55 apply to the litigation process. Absent persuasive argument or authority, the court declines to extend the law in this manner. The court concludes that State Farm established that it met all the deadlines and requirements of Article 21.55 as a matter of law and the trial court properly granted summary judgment in favor of State Farm on this claim. OPINION:Morris, J.; Morris, Francis, and Lang-Miers, JJ.

Want to continue reading?
Become a Free ALM Digital Reader.

Benefits of a Digital Membership:

  • Free access to 1 article* every 30 days
  • Access to the entire ALM network of websites
  • Unlimited access to the ALM suite of newsletters
  • Build custom alerts on any search topic of your choosing
  • Search by a wide range of topics

*May exclude premium content
Already have an account?

Trending Stories

 

Featured Product

Global Briefing

A weekly, curated selection of our international content from around the globe, across the business of law, in-house, regulatory, technology and more, with expert insights from our senior editors.

Learn More

More from ALM

 

ALM Legal Publication Newsletters

Sign Up Today and Never Miss Another Story.

As part of your digital membership, you can sign up for an unlimited number of a wide range of complimentary newsletters. Visit your My Account page to make your selections. Get the timely legal news and critical analysis you cannot afford to miss. Tailored just for you. In your inbox. Every day.

Privacy Policy

About Us / Contact Us / Site Map / Advertise With Us/ Customer Service / Terms of Service/ FAQ / Privacy Policy

Publications

Law Topics

Rankings

More

Law.com

Copyright © 2021 ALM Media Properties, LLC. All Rights Reserved.