Umpire Rules

For those of you unfamiliar with insurance-related appraisal process, as an alternative method of resolving insurance disputes, you should note that most insurance policies provide that after an insurance company has had the opportunity to adjust a claim, if there is disagreement, either side may request a form of arbitration called “appraisal.” The time to request the appraisal is not limited, in most instances, and has been condoned by the courts even after law suits are filed and discovery has begun. It is common for insurance companies to assign a favorite son as their appraiser and to invite the insured-plaintiff to appoint an appraiser. The two appraisers select an Umpire, who is asked to decide the case if the appraisers are unable to agree on the amount of damages.

One would think that the appraisal process eliminates the need for the law suit, however, most policies provide that even after the appraisal process is completed, the Umpire has ruled, the case may be litigated by the insurance company. It need only refuse coverage, or deny the claim, requiring litigation. Delays by the insurance company appraiser are common place in our experience, driving to the extreme the time and cost of the adjustment process. Further delays without repairs under the first party property and casualty policy work in Texas without the real prospect of penalties for late payment. Where the prospect of penalties was present in the law suit, the delays and abuses of appraisal are seldom considered by Texas courts to justify penalties for arbitrary and capricious refusal to pay, even where the Umpire rules that the damages are due and is evident that the insurance company had no legitimate basis to refuse to pay.

Of course, by its very nature, the appraisal process calls for an expedited alternative dispute resolution process, however, because it is not final, because it leaves to the insurance company the right to accept or reject the findings and there are not any penalties for arbitrary and capricious refusal to pay in Texas, the process operates to frustrate claimants and the lawyers hired to help prosecute claims for the insured. The insurance company right to reject the appraisal process after it is completed is just one of the several obstacles placed in the way of legitimate claims. Another is the assertion without basis by insurance companies in Texas that the appraisal process should be handled like “baseball arbitration,” where the Umpire is limited to accepting either the insurance appraisal or the claimant appraisal. The recent case of Providence Lloyds Ins. Co. v. Crystal City Ind. School Dist., 877 S.W. 872 (Tex App. San Antonio 1994) shows the claim of an insurance company to baseball arbitration. In that case the appellate court reversed the trial court ruling with the following ruling against baseball arbitration:

The duty of the umpire under the terms of the insurance policy was to ascertain and determine, in the exercise of his own best judgment, the cash value of the items of property which the appraisers had disagreed, independent of the findings of the appraisers, or either of them… The umpire is required to act with the appraisers in matters of difference. He is the third appraiser. If the three are of one mind, or if two of them are is accord as to value and loss, the appraisal award is a finality. Providence Lloyds Ins. Co. v. Crystal City Ind. School Dist., 877 S.W. 2d 872 (Tex.App.-San Antonio 1994).