State Bar Article – Why You Should Care About Appraisals
WHY YOU SHOULD CARE ABOUT APPRAISALS
(AND WHAT HAPPENS WHEN YOU DO NOT)
By: Mark A. Ticer
Appraisal is an option/process frequently found in many insurance policies but most commonly used in the property damage context. The language of most polices states that appraisal is mandatory when properly demanded by the insurer or insured. Appraisal when properly used is binding on the parties as to the amount of loss only. All too frequently though appraisal is improperly invoked, employed, and carried out almost exclusively by insurers and appraisers to the detriment of the insured. Appraisals are carried out without attorneys, typically just between the insurer and the insured.
To many, appraisal may sound like a quick way to get the insured paid or save the insurer much expense in litigation costs. Reading the appraisal provision in an insurance policy appears simple. After all, it only deals with the amount of loss right? So why should you care about appraisal?
Whether representing the insured or the insurer you do not want your client to find itself in a situation where appraisers/umpires have become some super experts whose conclusions result in a forfeiture of a trial on the merits, a waiver of coverage, liability, or causation, or wasted and/or unnecessary effort and expense. In the worst cases, you do not want to be an appellant who seeks to untangle the confusion and misuse of an appraisal award.. Better stated, you should care about appraisal because all to frequently, it is inappropriately invoked by one side or the other, courts often misconstrue its use, appraisers/umpire overstep their authority, and/or the selection of appraisers/umpires is fraught with deceit, unfairness, and a lack of independence.
This paper will first address the basics of appraisal in Texas and then discuss the Johnson case before the Texas Supreme Court which would greatly expand the availability of appraisal, making it like arbitration without the arbitrator. See State Farms Lloyds v. Johnson, Case No. 06-1071, argued before the Supreme Court of Texas on January 15, 2008.
Appraisal is not arbitration. In arbitration, all contested issues are submitted to an arbitrator(s) for resolution while in appraisal only the amount of loss is to be decided by two (2) appraisers and an umpire, if necessary. Arbitration and appraisal are alike in that arbitrators, appraisers, and umpires are to be impartial, independent, and free from bias. Arbitration is formal in nature functioning somewhat like a court while appraisal is an informal process conducted by two (2) appraisers who theoretically determine solely the amount of loss. If the two (2) appraisers disagree, then an umpire is chosen by the parties to resolve differences; if the appraisers cannot agree on an umpire then frequently a court is petitioned to appoint one.
The appraisal language in a policy typically reads as follows:
Appraisal. If you and we fail to agree on the actual cash value, amount of loss, or cost of repair or replacement, either can make a written demand for appraisal. Each will then select a competent, independent, appraiser and notify the other of the appraiser’s identity within 20 days of receipt of the written demand. The two appraisers will choose an umpire. If they cannot agree upon an umpire within 15 days, you or we may request that the choice be made by a judge of a district court of a judicial district where the loss occurred. The two appraisers will then set the amount of loss, stating separately the actual cash value and loss to each item.
If the appraisers fail to agree, they will submit their differences to the umpire. An itemized decision agreed to by any two of these three and filed with us will set the amount of loss. Such award shall be binding on you and us.
Each party will pay its own appraiser and bear the other expenses of the appraisal and umpire equally.
Appraisal to be is used to determine the amount of loss, nothing more. Ideally, this clause can be invoked by either party when a determination of the amount of loss is all that is at issue. For example, you inherited your grandmother’s fine silver including utensils and plates. These items are stolen from your home. You claim the items taken are worth over $10,000. The insurer asserts the value is $1,000. Your homeowners’ insurer acknowledges coverage. The use of appraisal in this instance would be appropriate.
Appraisal does not apply in the third party liability context. In other words, a third party making a claim against an insured is not required to engage in the appraisal process with the third party’s insurer.
The Law Regarding Appraisal in Texas
A. The Basics
Appraisal is not arbitration. In Re Allstate Ins. Co., 85 S.W.3d 193, 195 (Tex. 2002); Scottish Union National Ins. Co. vs. Clancy, 71 Tex. 5, 8 S.W.3d 630, 631 (1988). In theory, appraisal is to be used to provide a simple, speedy, inexpensive, and fair method of determining the amount of loss only. Fire Ass’n vs. Ballard, 112 S.W.2d 532, 534 (Tex. Civ. App. – Waco 1938, no writ). If a lawsuit is filed and one party properly demands appraisal, abatement is not required. In Re Allstate Ins. Co. at 85 S.W.3d 193, 195 (Tex. 2002). If appraisal is properly invoked, carried
out, and awarded, the amount of loss is binding on the insurer and the insured. Clancy, 8 S.W. at 631; Standard Fire Ins. Co. vs. Fraiman, 514 S.W.2d 343, 344-345 (Tex. Civ. App. – Houston [14th Dist.] 1974, no writ).
Appraisal clauses were traditionally inserted for the insurer’s benefit and may be waived. Ins. Service Co. vs. Brodie, 337 S.W.2d 414, 415 (Tex. Civ. App. – Fort Worth 1960, writ ref’d n.r.e.). However, either the insurer and/or the insured though may invoke appraisal. The insurer “will not be permitted to use this clause oppressively, or in bad faith.” Id. at 417.
B. When Is Appraisal Appropriate?
Absent agreement between the parties, appraisal is only to be used to determine the amount of loss. Wells vs. American States Preferred Ins. Co., 919 S.W.2d 679, 684 (Tex. App. – Dallas 1996, writ denied). Appraisers and umpires have no authority or power in an appraisal to determine “questions of causation, coverage, or liability…” Id. If there is only one case and one issue that you take away from this article, it should be the Wells case and the fact that appraisal cannot be used to determine causation, coverage, or liability.
Appraisal is not appropriate where an insurer claims only partial damage while the insured claims total damage. Glen Fall Ins. Co. vs. Peters, 386 S.W.2d 529, 532 (Tex. 1965). “Whether a building is an actual total loss…depends upon whether a reasonably prudent owner, uninsured, desiring to rebuild, would have used the remnant for restoring the building.” Id. at 531. This is more than a question of the amount of loss. Once the issue of total loss versus partial loss is decided, appraisal is proper. Id. at 532. If the loss is total then appraisal is inapplicable. Id.
It is this writer’s experience that appraisers and insurers, at least in the past, frequently misused appraisal to determine causation and coverage. (The irony of this experience though is State Farm Lloyds v. Johnson, 204 SW3d 897 (Tex. App. – Dallas 2006, pet. granted) where State Farm alleges that the insured is improperly seeking appraisal. Johnson is discussed infra). For example, appraisal is frequently invoked by insurers in roof damage claims. A dispute will arise over whether the roof was damaged by hail (a covered peril) or ordinary wear and tear (not covered). The appraisers and umpires will get on a roof in an appraisal and one appraiser may decide that hail caused the damage resulting in a total loss while the other appraiser will make a finding of no hail damage. See generally Germania Farm Mutual Ins. Assoc. v. Williams, 2002 WL 32341841 (Tex. App. – Eastland 2002, no pet.). The umpire will typically side with one appraiser or the other. In this circumstance, appraisal is invalid because the appraisers and umpire are making a determination concerning causation and ultimately coverage. These determinations have no place in an appraisal, yet they appear with frequency.
Insurers wanting a quick resolution on a claim are sometimes guilty of using appraisal to determine causation and coverage. It has not uncommon for an adjuster to make a written demand for appraisal and state that the appraisers and umpire will decide the amount of hail damage and when the loss occurred. These statements should invalidate the appraisal process if challenged. The appraisers and umpire all too often accommodate this sort of demand. Williams, supra. But see Johnson discussed infra. The participants compliance with these terms in the appraisal does not validate the appraisal award or waive the insured’s subsequent objection. Wells, 919 S.W.2d at 685.
Some appraisers and/or umpires simply could care less what their duties are; they will make their findings as they see fit. Germania, supra. (that is appraisers and umpires used over and over). Repeatedly used appraisers hired by an insurer who are supposedly professional will make all sorts of findings which are contrary to the appraisal process. In one case, an appraiser who had signed an oath as an appraiser to only determine the amount of loss testified that appraisers have to decide what is hail damage and what is not and that if the memorandum of appraisal had the wrong date of loss, the appraiser should change same.
The misuse of appraisal is apparent.
C. The Demand For Appraisal and Memorandums of Appraisal
The appraisal language requires that a demand for appraisal must be in writing. The language also addresses certain time limits for naming appraisers and umpires, how appraisal is to be accomplished, who pays, and appointment of an umpire. In addition, insurers sometimes use a written memorandum of appraisal for the appraisers and/or umpire to sign. The memorandum often includes the property damaged, the date of loss, the cause of the loss, and sometimes an oath for an appraiser to sign. The typical policy language though does not mandate any memorandum of appraisal.
While a memorandum of appraisal is not required, its use cannot be underestimated. A proper memorandum specifies the parameters of an appraisal including the appraiser’s duty of only affixing the amount of loss. The memorandum avoids waiver issues including arguments that the parties agreed to allow the appraisers to determine causation, coverage, and/or liability. A memorandum can also include an oath for appraisers and umpires to be disinterested, impartial, and competent. In sum, a properly drafted memorandum eliminates wiggle room and subsequent misunderstandings. It can avoid fraud and misrepresentation claims.
Logically, one would think an insurer would want these protections to eliminate uncertainty. Yet, one insurance defense lawyer has said form memorandums of appraisal may cause undue problems: “As a result, the adjuster is given this sound legal advice concerning such form: “Throw every one of them in the trash.” Bowman, R., “An Overview of the Appraisal Clause in Texas” (October 21, 1996), p. 8. (Ironically Mr. Bowman is the insured’s lawyer in Johnson). Perhaps the writer was concerned that the memorandum of appraisal form can be misused. Regardless, a properly drafted memorandum of appraisal protects all parties.
D. Timeliness and Wavier In Demanding Appraisal
While policy language does not address the timing of appraisal, the Texas courts have addressed this issue. The demand for appraisal must be made within a reasonable time. American Fire Ins. Co. vs. Stuart, 38 S.W. 395 (Tex. Civ. App. – 1996, no writ) (58 day delay); Boston Ins. Co. vs. Kurley, 281 S.W. 275 (Tex. Civ. App. – Eastland 1926, no writ) (59 day delay). An insurer must move promptly to determine the amount of loss. Brodie, 337 S.W.2d at 417. The reasoning of these cases demonstrate that once an insurer or insured recognizes that a dispute over the amount of loss exists and is not capable of resolution, the proponent of appraisal should promptly demand appraisal and do so in writing. Otherwise, appraisal can be waived.
Furthermore, the demand for appraisal must be invoked properly; that is, the demand must not only be timely but in substantial compliance with the terms of the policy. In Brodie, the insurer improperly appointed one individual and two companies as appraisers. Id. The Court found this appointment not in compliance. Id. Brodie filed suit some forty-two (42) days after the insurer demanded appraisal. Id. The demand for appraisal took place seventy-two (72) days after the adjuster had viewed and examined the loss. Id. at 416. The Brodie court agreed the demand for appraisal was untimely, waived, and not in compliance with the policy.
Again, it is this writer’s experience that insurers with repeated frequency do not seek appraisal in a
timely manner. Appraisal is demanded often months after it is readily apparent that there is a disagreement on the amount of loss between the insurer and the insured. In other cases, the insurer demands appraisal after suit is filed. Texas authorities clearly support the argument in these circumstances that any right to appraisal has been waived for a lack of timeliness.
Waiver of the appraisal clause can occur in other ways. An acceptance of a proof of loss waives appraisal. Springfield Fire & Marine Ins. Co. vs. Cannon, 46 S.W. 375 (Tex. Civ. App. 1898, no writ); Stuart, 38 S.W. at 395. Likewise, retention of a proof of loss for unreasonable time without demanding appraisal waives this condition. Gulf Ins. Co. vs. Carroll, 330 S.W.2d 227, 231 (Tex. Civ. App. – Waco 1959, no writ); Kurley, supra; and American Central Ins. Co. vs. Heath, 29 Tex. 445, 69 S.W. 235 (Tex. Civ. App. – 1902, no writ). An insurer who demands appraisal and fails to participate any further has waived the condition. Northern Assurance Co. vs. Samuels, 33 S.W. 239 (Tex. Civ. App. – 1895, no writ). Where an invalid appraisal has occurred, no further appraisal is required. Security Ins. Co. vs. Kelley, 196 S.W.2d 874, 878 (Tex. Civ. App. – Amarillo 1917, writ ref’d); Wells, 919 S.W.2d at 686-687. And obviously, where the insurer flatly denies the claim, the appraisal clause is waived.
The prudent practitioner should evaluate all demands for appraisal on the basis of timeliness and waiver.
E. The Requirement of Competent and Disinterested Appraisers
If ever there is a more abused area of appraisal, it is the requirement of a competent and disinterested appraiser. Insurers hire their pet appraisers over and over and see no problem with this practice. Insureds who are unrepresented and unfamiliar with the appraisal process are convinced by their roofers to hire them (that is those that will do the roofing work) to act as the insured’s appraiser. One side may act out of ignorance while the other acts out of manipulation. The result is usually disagreement with an umpire’s participation required or even a nonbinding appraisal.
The appraiser is not beholden to either party to the appraisal, not required to represent either party’s views or position, and not to be biased. Pennsylvania Fire Ins. Co. vs. W.T. Waggoner Estate, 39 S.W.2d 593, 594-595 (Tex. Comm’n App. 1931, no writ). An appraiser is not the selecting party’s expert or independent contractor.
The purpose of the clause is to secure a fair and impartial tribunal to settle the differences submitted to them. In their selection it is not contemplated that they shall represent either party to the controversy or be a partisan in the cause or either, nor is an appraiser expected to sustain the views or to be further the interest of the party who may have named him. And this is true, not only with respect to estimating the amount of loss but also with reference to the selection of an umpire. They are to act
in a quasi-judicial capacity and as a court selected by the parties free from all partiality and bias in favor of either party, so as to do equal justice between them. The tribunal, having been selected to act instead of the court and in the place of the court, must, like a court, be impartial and nonpartisan. For the term “dispecuniary interest, but requires the appraiser to be not biased or prejudiced.” And, if this provision of the policy was not carried out in this spirit and for this purpose, neither party is precluded from going to the courts, notwithstanding the agreement to submit their differences to the board of appraisers.
Id. quoting Delaware Underwriters vs. Brock, 109 Tex. 925, 211 S.W.2d 779,780 (1919).
Disinterested means without bias and prejudice as well as without pecuniary interest. W.T. Waggoner Estate, 39 S.W.2d at 595. Consequently, those who repeatedly perform appraisals on behalf of the same party certainly call into question issues of bias and prejudice. Thus far only one Texas case has directly addressed the bias and prejudice argument. In Holt vs. State Farm Lloyds, the insurer sought to enforce an appraisal award as an affirmative defense to Plaintiff’s breach of contract and extracontractual claims. 1999 WL 261923 (N.D. Tex. 1999) at p. 1. At issue was whether Tim Marshall of Haag Engineering who received
approximately one quarter of his income from State Farm appraisal work was biased and/or prejudiced. Id. at p. 4. The District Court declined to grant State Farm’s summary judgment given Plaintiff’s evidence, finding a fact issue for the jury existed. Id. Holt is the only case applying Texas law specifically addressing this issue although the W.T. Waggoner Estate case includes a finding of a biased appraiser and umpire which invalidated an appraisal. W.T. Waggoner Estate, 39 S.W.2d 594. But see Gardner v. State Farm Lloyds, 76 SW3d 140 (Tex. App. – Houston [1st Dist.] 2002, no pet) (no fact issue on summary judgment regarding independence of appraiser) and Bunting v. State Farms Lloyds, 2000 WL 191672 (N.D. Tex. 2000) (insufficient evidence to raise a fact issue regarding appraiser’s independence).
W.T. Waggoner Estate does hold that the inadequacy of an award may be considered as a factor in evaluating bias and prejudice of an appraiser or umpire. Id. at 595. This factor alone though is insufficient to establish bias and prejudice and subsequent cases have not embraced W.T. Waggoner Estate. Hennessey vs. Vanguard Ins. Co., 895 S.W.2d 794, 798-799 (Tex. App. – Amarillo 1995, writ denied). However, in May vs. Foremost Ins. Co., 627 S.W. 2d 230, 233-234 (Tex. App. – San Antonio 1981, no writ), an appellate court denied enforcement of an appraisal award based on the insurer’s summary judgment motion because of a continuing business relationship between the insurer and appraiser. The insurer was accused of acting in a concert with the appraiser in order to object to an umpire previously agreed upon. Id.
Other jurisdictions have different rules. In Michigan, an appraiser who has been asked to participate as an appraiser by the same Plaintiff on an ongoing basis is not evidence of bias. Northern Assurance Co. vs. Melinsky, 213 N.W. 70, 71 (Mich. 1927). In contrast, prior relationships may be considered in Pennsylvania. Land vs. State Farm Mut. Ins. Co., 600 A.2d 605, 607 (Pa. Super Ct. 1991). In California, an insurer must disclose any current dealings with an appraiser. Gibers vs. State Farm General Ins. Co., 45 Cal. Rptr. 2d 725, 728 (Ct. App. 1995).
The lesson regarding bias and prejudice seems obvious. The more appraisals and the more longstanding relationship between an appraiser and the selecting party, the more likely a finding of bias and prejudice will be found or at least create a fact issue to prevent enforcement of an appraisal award. Compare Holt, supra with Gardner and Bunting, supra. This is fertile ground to challenge an appraisal determination.
Competency should also not be overlooked. An engineer is likely not competent as an appraiser for a jewelry case and a roofer probably will not suffice as an expert on foundations. These choices seem obvious. Yet, do not assume every roofer or engineer is competent to evaluate replacement for a roof damaged by hail. A public adjuster by virtue of his profession is not competent to address all areas of home damage merely because he must now hold a license. The moral to this story is: carefully examine every appraiser’s competency (expertise) in his/her appointment and subsequent award. A Robinson type challenge should be
available to the party objecting to competency. See E.I. Dupont de Nemours & Co., Inc. v. Robinson, 923 SW2d 549 (Tex. 1995). In a summary judgment proceeding to enforce an appraisal decision, the appraiser’s competency must be established. Competency is mandated by the policy.
F. Grounds for Avoiding An Appraisal Award
At the outset, prudent counsel should seek to prevent an improper claim from going to appraisal where issues of coverage, liability, and causation exist. This includes the use of injunctive relief. Undoing an appraisal is analogous to attempting to preserve privileged documents once they have already been produced. It is frequently an uphill battle with the obvious bias in preserving the appraisal award. Many trial courts view appraisal like mediated settlement agreements. With the necessary evidence, appraisal awards can be set aside, hopefully before reaching an appellate court.
Case law provides three (3) basic instances where an appraisal award may be disregarded: (1) when the award was made without authority; (2) when the award was the result of fraud, accident, or mistake; and (3) when the award was not made in substantial compliance with the terms of the contract. Providence Lloyds vs. Crystal City Indep. School Dist., 877 S.W. 872, 875 (Tex. App. – San Antonio 1994, no writ); Hennessey, 895 S.W.2d at 798. All of these exceptions overlap each other. Providence, 877 S.W.2d at 878. Significantly, every reasonable presumption will be indulged in favor of an appraisal award. Hennessey, 895
S.W.2d at 798. However, in a summary judgment proceeding this presumption will not override summary judgment principles: that is all reasonable inferences will be indulged in favor of the nonmovant and the evidence will be viewed in the light most favorable to the nonmovant. Mays, 627 S.W.2d at 233-234; Hennessey, 895 S.W.2d at 798.
Several cases in Texas have addressed an appraisal award made without authority. Unless the appraisers disagree about the amount of loss, an umpire has no authority to sign an appraisal award. Fisch vs. Transcontinental Ins. Co., 356 S.W.2d 186, 189-190 (Tex. Civ. App. – Houston 1962, writ ref’d n.r.e.) In Fisch, the record was silent as to whether there were any differences between the two (2) appraisers. Id. at 189. The Court of Appeals reversed a directed verdict in favor of the insurer because there was no evidence of any disagreement between the appraisers and therefore any award signed by the umpire was without authority. Id. at 189-190. “An appraiser’s acts in excess of the authority conferred upon him by the appraisal agreement is not binding on the parties.” Id. at 190.
For those who frequently oppose appraisal, the Wells case provides an excellent example of appraisers/umpires acting outside their authority. The Wells made a claim for foundation damage with their insurer, American States. Wells, 919 S.W.2d at 681. Id. The insurer denied the claim, demanded appraisal, and then sued to enforce appraisal. Id. The Wells counterclaimed for breach of contract and other claims. Id. The trial court abated the counterclaims until appraisal was
completed. Id. Two appraisers and an umpire determined the damage was $22,875.94 but one appraiser and an umpire determined the foundation damage was not caused by a plumbing leak. Id. The lack of a plumbing leak precluded coverage and the trial court entered summary judgment in favor of the insurer. Id. Before any lawsuit was filed, the parties disagreed on the cause of the foundation damage and consequently coverage. Id.
Setting aside the issues of waiver of appraisal by denying the claim and no evidence of any disagreement on amount by the appraisers, the Court of Appeals reversed summary judgment in favor of the insurer finding that the appraiser and umpire exceeded their authority in determining the amount of loss. “…we conclude further that the appraisal section of the policy, as a matter of law, did not authorize and empower the appraisal panel to determine that the plumbing leak did not cause the loss to the Wells’ property.” Id. at 685. “…we conclude that the one appraiser and the umpire exceeded their authority when they determined that the plumbing leak did not cause the Wells’ loss.” Id.
In Holt, the District Court declined to grant the insurer summary judgment on enforcement of an appraisal award. 1999 WL 261923 at p.3. There, one appraiser and an umpire entered in award for $565 for wind damage to Holt’s roof. Id. Yet, in the award was a statement: “No evidence of damaging hail in the form of splits of impacts that broke the wood shingles in the past nine (9) to twelve (12) months.” Id. This statement was “an expression of damage causation. It was made without authority because it was outside the scope of the appraisal process…” Id.
These two (2) cases illustrate an award made without authority. The appraisal award itself provided the necessary evidence to demonstrate lack of authority. However, there is no requirement that the evidence must come from the award itself though the mental processes of the appraisers and umpire are likely insufficient to establish this factor. Providence, 877 S.W.2d at 878-879.
Appraisals which are a result of fraud, accident, and mistake can also be set aside or be made unenforceable. The most frequently cited case for this category is Barnes vs. Western Alliance Ins. Co., 844 S.W.2d 264 (Tex. App. – Fort Worth 1992, writ dism’d by agr.) Barnes claimed roof hail damage to two (2) buildings he owned. Id. at 266. When Barnes and the insurer could not agree on the amount of loss, Barnes demanded appraisal. Id. at 267. An appraisal award signed by Barnes’ chosen appraiser and the umpire was entered for $402,798.00. Id. The insurer neither challenged the award nor paid it forcing Barnes to file suit to enforce the award. Id. Following a trial, the jury awarded $67,834.89 and found that the award should be set aside for fraud, accident, or mistake. Id.
In the words of the Court of Appeals, the record “reveals numerous instances in which Barnes admitted in open court that he had previously lied about the hail damage to the roof and about the repair costs.” Id. at 268-269. The evidence in addition to Barnes’ own testimony was overwhelming in substantiating fraud. Id. at 270.
While the insured was the culprit in Barnes, an insurer can be equally guilty of fraud, accident, and mistake which will invalidate an appraisal award. In Holt, the District Court raised issues concerning the use of an independent and unbiased appraiser where the appraiser performed a substantial number of appraisals in favor of the appointing insurer. Holt, 1999 WL 261923 at pp. 3-4. In May, the insurer and the appraiser colluded on the appointment of an umpire and the appointed umpire had a prior employment relationship with the insurer. May, 627 S.W.2d at 234. The Texas Supreme Court reversed summary judgment in favor of the insurer and found a fact issue existed to preclude enforcement of the appraisal award. Id.
As previously pointed out, a gross disparity in an award versus repair cost is not by itself a basis to invalidate an appraisal award. Hennessey, 895 S.W.2d at 798-799.
The last category given to set aside an appraisal award is for all practical purposes a combination of the first two and anything else not in compliance with the policy. Obviously, appraisers and umpires determining causation, liability, and coverage are not in compliance with the policy; the same is true for an award based on fraud, accident, or mistake. An example falling perhaps outside the first two (2) categories is an appraisal where a disagreement exists over a partial loss versus a total loss. See Peters, 386 S.W.2d at 532. In Hennessey, the Court of Appeals reversed a summary judgment in favor of an insurer based on an appraisal award where the memorandum of appraisal and policy language conflicted. 895 S.W.2d at 801.
Other areas of noncompliance with the policy include no written demand for appraisal, delay in proceeding with appraisal, payment of appraisers and umpire, etc.
The avoidance of an appraisal award may be accomplished. In almost all of the cases cited, the avoidance took place at the Court of Appeals. Therefore, the better practice is to avoid problems and issues before the appraisal and prevent an improper appraisal from ever going forward.
State Farms Lloyds v. Johnson and the Supremes Chance to Clarify the Use of Appraisal.
Argued recently (as in Texas Supreme Court terms) Johnson presents the Texas Supreme Court with an opportunity to clarify the law on appraisals, either by expanding its use or limiting its use strictly to determining the amount of loss, absent agreement of the parties. The irony of this case is the insurer’s adaption of the principle that appraisal should only be invoked to determine the amount of loss, not when issues of coverage, causation, and liability persist. In the past, it was this writer’s experience that insurers (specifically State Farm) frequently sought appraisal and sought to enforce appraisal awards that did far more than establish the amount of loss.
The facts in Johnson can be briefly summarized as follows: Becky Johnson (hereinafter “Johnson”) was insured under a homeowner’s policy with State Farm Lloyds (hereinafter ” State Farm”). Johnson claimed hail damage to her roof and State Farm after several inspections found only a few
shingles on the ridgeline of the roof damaged by hail. The amount of damages was according to State Farm estimated at approximately $500.00, less than Johnson’s deductible. State Farm advised that the remainder of any damage was not caused by a covered peril.
Johnson disagreed with State Farm and asserted that her entire roof needed to be replaced at a cost of $13,428.19. Johnson demanded appraisal under State Farm policy which had the traditional appraisal language limiting its use to a disagreement over the amount of loss.
State Farm refused Johnson’s request contending that appraisal was not proper where there was a disagreement over coverage, not over the amount of loss. Johnson argued that State Farm did not assert any exclusion to coverage or an excluded peril. Johnson’s position was that a dispute existed about the amount of loss, that being the entire roof not just the few shingles State Farm admitted were covered.
Johnson filed suit seeking declaratory relief including a motion to compel appraisal against State Farm which was treated as a motion for summary judgment. State Farm filed its own cross motion for summary judgment. Johnson did not sue State Farm for breach of contract or extra contractual remedies. Johnson merely sought declaratory relief. The trial court granted summary judgment in favor of State Farm and Johnson appealed.
The Dallas Court of Appeals substituting a new opinion for its original one reversed holding that the dispute concerned the “amount of loss” since “extent of loss” includes the amount of loss. “Johnson argues that the amount of loss includes a dispute over the extent of the damage as well as a determination of what it will cost to fix the damage.” Johnson v. State Farm Lloyds, 204 SW3d 897, 900 (Tex. App. – Dallas 2006, pet. granted). The Court of Appeals noted that the parties agreed there was a covered loss but disagreed on the “extent of the loss” and the cost of repairs. Id. at 902.
State Farm in arguing against appraisal relied heavily on Wells. However, the Court of Appeals attempted to distinguish Wells by saying the parties disagreed as to whether there was a covered loss at all in Wells versus State Farm’s concession that there was some damage that was covered. Id. The Dallas Court of Appeals viewed Wells narrowly holding that appraisers “exceed their authority when they make legal determinations of what is or is not a covered loss based on their determination of what caused the loss or some portion of it.” Id. at 902-903. The Court of Appeals reasoned that either party could defeat a appraisal request by asserting a coverage dispute. Id. at 903.
On review to the Supreme Court, State Farm has urged the Court that when there is an issue of coverage, causation, and/or liability, appraisal cannot be properly used. Johnson views the issue as follows: “when both the insured and the insurer agree that the insured has suffered a loss which is covered under the policy, but disagree about the amount and/or extent of such damage, is this a dispute over the amount of loss, so that when one of the parties to the contract demands appraisal, the other party is required to submit to appraisal?” Respondent Becky Ann Johnson’s Brief on the Merits, p.6.
A review of the history of appraisal and the plain meaning of the appraisal language indicates that State Farm may have the better argument. First, there is no use of the term “extent of loss” in the appraisal language. Extent does not equate with amount. Second, Wells, contrary to the Court of Appeals’ decision, had everything to do with “extent of loss”; one appraiser and the umpire determined that “damage to the dwelling related to the plumbing leak was zero.” Wells, 919 SW2d at 682. That decision goes to the essence of the “extent of her loss”. In contrast, the amount of loss was determined to be $22,875.94. Third, Johnson did not seek appraisal for the items/area where State Farm admitted were covered. The disagreement arose over the entire roof, not just the acknowledged hail damage area; any appraisal would necessarily include areas where a dispute existed over whether a loss existed. Fourth, appraisal would be of little value when both sides contest what portion of the loss is covered. For example, if an appraisal determines the roof has damage in the amount of $20,000.00 but only portions of the roof have covered damages, what value is the appraisal? Can there be a percentage application or must the insured, whose burden it is to establish coverage, show each shingle is damaged? Absent agreement on what is covered, ie the extent of the loss, appraisal is hardly useful but rather much less efficient.
To the extent that Johnson relies on Lundstrom v. United State
Automobile Assoc., 192 SW3d 78, that reliance also appears misplaced. The appraisers in Lundstrom did not apportion the loss among various causes. Id. at 89. USAA in Lundstrom agreed to appraise damages at a specific point and time that it admitted were covered. Id. The Lundstroms did not object and did not participate in the appraisal. Id at 82. Finally, the Lundstroms had already been paid a significant amount of damages by their builder and the Lundstroms failed to provide USAA with notice of loss.
Certainly, no one can predict what the Supreme Court of Texas will do. What we can say is that by the acceptance of Johnson for review, the Court will clarify the meaning of appraisal for both insurers and insured.
Eight Simple Rules for Appraisal
1. Avoid appraisal if possible (some exceptions);
2. Confirm the appraisal was not requested after a complete denial of the claim or long after a dispute was evident;
3. Stop attempts for appraisal where issues of coverage, causation, and liability are evident;
4. Obtain a written memorandum of appraisal setting out the basis for appraisal;
5. Confirm the independence and competency of the appraisers and umpires;
6. Have the appraisers and umpire sign an oath that they will carry out their
duties fairly and impartially and in accordance with their duties (can make this part of the memorandum of appraisal);
7. Make sure the record reflects any disagreement between the appraisers so the umpire’s involvement is warranted; and
8. Look for statements on the appraisal award dealing with coverage, causation, and liability.
These rules should provide some guidance on the usefulness of an appraisal. Given the frequent misuse, misunderstanding, and misapplication of appraisal, there are many minefields to avoid in order to obtain a valid appraisal award. These problems may outweigh the efficiency of the process that appraisal was intended to address. While setting aside the award may be desireable, it may be time consuming. The irony of course is that this provision is designed for a speedy and efficient resolution of a claim which theoretically both the insurer and insured seek. Unfortunately, the appraisal clause is a frequently abused and misused provision in an insurance policy. Participants would do well to abide by appraisal rules and limitations in order to achieve a valid and enforceable appraisal.