Redo v. State Farm Fire & Casualty Company

IN THE UNITED STATES DISTRICT COURT

FOR THE WESTERN DISTRICT OF OKLAHOMA

ARMA LENE “TONI” REDO, )

)

Plaintiff, )

)

v. ) Case No. CIV-23-455-D

)

STATE FARM FIRE AND CASUALTY )

COMPANY, )

)

Defendant. )

ORDER

Before the Court is Defendant State Farm Fire and Casualty Company’s Motion for

Summary Judgment and Brief in Support [Doc. No. 33]. Plaintiff filed a response [Doc.

No. 38], and State Farm filed a reply [Doc. No. 41]. The matter is fully briefed and at issue.

INTRODUCTION

Plaintiff alleges that her property suffered storm damage on or about April 15, 2022,

during the term of Plaintiff’s home insurance policy issued by State Farm. Plaintiff first

submitted a property damage claim on July 19, 2022, and allegedly reported that she did

not know the date of loss. However, State Farm contends that Plaintiff reported July 19 as

her date of loss and subsequently attempted to change the date of loss to April 15. Upon

inspecting Plaintiff’s property, State Farm’s claim representative found evidence of interior

water damage to several areas of the home, but did not find hail damage to the roof that

would be consistent with a July 19 date of loss. Ultimately, State Farm paid $2,638.29 for

the estimated repairs for interior water damage (minus Plaintiff’s deductible and

depreciation)1, but it did not pay for any hail or storm damage to the roof.

Thereafter, Plaintiff filed this action, alleging that State Farm breached its contract

with Plaintiff by failing to pay for storm damage covered under the home insurance policy.

Further, Plaintiff alleges that State Farm breached its duty of good faith and fair dealing

when it “focused myopically on a fabricated date of loss; failed to consider significant hail

storms near the time that [Plaintiff] noticed damage that she submitted as a hail and water

leak claim; ignored [Plaintiff’s] statement that she did not know the date of loss;

misrepresented to [Plaintiff] there was no hail damage (despite known hail damage);

violated the twenty-four month coverage period derived from 36 O.S. § 1250.5(7); required

a second claim with another deductible over a fictitious date of loss issue; and imposed an

extracontractual ‘exclusion’ of hail ‘damage.’” [Doc. No. 38, at 24-25].

In the present motion, State Farm seeks summary judgment in its favor with respect

to Plaintiff’s claims of breach of contract, bad faith, and punitive damages.

STANDARD OF DECISION

Summary judgment is proper “if the movant shows that there is no genuine dispute

as to any material fact and the movant is entitled to judgment as a matter of law.” FED. R.

CIV. P. 56(a). In deciding whether summary judgment is proper, courts do not weigh the

evidence and determine the truth of the matter asserted, but determine only whether there

is a genuine issue for trial. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249 (1986). A

1 An additional $11,716.53 was available to Plaintiff as recoverable depreciation.

material fact is one that “might affect the outcome of the suit under the governing law.”

Anderson, 477 U.S. at 248. A dispute is genuine if the facts and evidence are such that a

reasonable juror could return a verdict for either party. Id. In evaluating a motion for

summary judgment, a district court must consider the evidence in the light most favorable

to the nonmoving party and draw all reasonable inferences from those facts in favor of that

party. See Sylvia v. Wisler, 875 F.3d 1307, 1328 (10th Cir. 2017).

The movant bears the initial burden of demonstrating the absence of a dispute of

material fact warranting summary judgment. Celotex Corp. v. Catrett, 477 U.S. 317, 322-

23 (1986). If the movant carries this burden, the nonmovant must then go beyond the

pleadings and “set forth specific facts” that would be admissible in evidence and that show

a genuine issue for trial. See Anderson, 477 U.S. at 248; Celotex, 477 U.S. at 324. “To

accomplish this, the facts must be identified by reference to affidavits, deposition

transcripts, or specific exhibits incorporated therein.” Adler v. Wal-Mart Stores, Inc., 144

F.3d 664, 671 (10th Cir. 1998); FED. R. CIV. P. 56(c)(1)(A). The relevant inquiry is whether

the facts and evidence identified by the parties present “a sufficient disagreement to require

submission to a jury or whether it is so one-sided that one party must prevail as a matter of

law.” Anderson, 477 U.S. at 251-52.

UNDISPUTED MATERIAL FACTS

Plaintiff’s property was insured by State Farm, Policy No. 36-CB-DO13-8. The

policy covered accidental direct physical loss to the property; and excluded coverage for

various perils, to include “wear, tear, decay, marring, scratching, deterioration, inherent

vice, latent defect, or mechanical breakdown.” [Policy, Doc. No. 33-2, at 24, 27]. The

policy was in effect from January 31, 2022, to January 31, 2023 [Doc. No. 33-2, at 6].

Plaintiff reported a hail and water damage claim on or about July 19, 2022 [Def.’s

UMF No. 1]. The “facts of loss” section in State Farm’s claim file reads: “final hail damage

to the roof, causing interior leak in the pool room, pantry and kitchen, water damage to the

flooring in the kitchen.” [Doc. No. 38-2, at 2]. Hail is listed as the probable cause. Id. State

Farm’s claim file further reflects the following:

Indicate the kind(s) of loss being reported: Hail, Water

Where did the water come from? Heavy Rain/Storm

[Doc. No. 33-1, at 13]. On the day Plaintiff’s claim was submitted, an AccuWeather report

was generated in the claim file, which report “provides three years of hail history based on

the Date Reported and Loss Location…” [Doc. No. 33-1, at 11]. The AccuWeather report

provides:

Date of Hail: Hail Size (Inches)

06/05/2022 0.75

05/04/2022 1.0

04/15/2022 1.75

07/17/2021 1.0

07/11/2020 2.25

08/26/2019 1.5

[Doc. No. 33-1, at 11].

External claim representative Connor Hounsel inspected Plaintiff’s home on August

31, 2022 [Def.’s UMF No. 13]. Only Plaintiff and Mr. Hounsel were present [Doc. No. 33-

1, at 2]. As noted in the claim file, Mr. Hounsel inspected all roof slopes and “found NO

storm related hail damage” and found zero hail hits in each test square [Doc. No. 38-2, at

6]. Mr. Hounsel noted “[h]ail damage to turtle vents and copper dormers however

AccuWeather report shows no hail reported on this DOL.” [Doc. No. 38-2, at 6].

Plaintiff testified that Mr. Hounsel did not tell her about his findings following the

inspection on August 31, 2022 [Doc. No. 38-1, at 48 lns. 2-15]. On September 22, 2022,

State Farm sent a letter to Plaintiff, in which Mr. Hounsel explained that “[b]ased upon the

results of our discussion, site inspection and investigation, it was determined there was no

accidental direct physical loss to roof shingles.” [Doc. No. 38-14, at 2]. He adds that his

“inspection discovered damages resulting from age and deterioration,” and that “[d]amage

from these perils is excluded by your policy.” Id. Finally, Mr. Hounsel concludes that “no

payment can be issued for the non-covered damage found.” Id. at 3. In his letter, Mr.

Hounsel does not notify Plaintiff that he discovered hail damage to the turtle vents and

copper dormers on Plaintiff’s roof. Id. at 1-3.

State Farm issued a payment of $2,638.29 to Plaintiff for interior water damage,

which represented $18,963.82 in estimated damages, minus Plaintiff’s deductible and

depreciation [Def.’s UMF No. 14]. State Farm did not render any payment for the hail

damage to turtle vents and copper dormers identified by Mr. Hounsel.

On September 26, 2022, Plaintiff requested a second inspection [Doc. No. 33-1, at

3]. On October 17, 2022, a State Farm claim specialist received a call from Plaintiff’s

agent’s office inquiring what was needed for a second inspection. Id. The claim specialist

advised the agent that State Farm needed photographs of damage Plaintiff believed was

overlooked during the inspection and a contractor’s estimate. Id.

On or about November 14, 2022, State Farm received photographs of Plaintiff’s

roof from her contractor, Destiny Roofing [Def.’s UMF No. 19]. On November 16, 2022,

Destiny Roofing sent State Farm a contract for a roof replacement, estimating a total price

of $65,000.00 [Doc. No. 38-11].

On November 16, 2022, according to the claim file, State Farm claim specialist

Misty Smith reviewed the additional photographs of Plaintiff’s roof “and agreed [an]

additional inspection would be necessary.” [Doc. No. 33-1, at 3]. Ms. Smith notified

Destiny Roofing about a second inspection, and Destiny Roofing “request[ed] to be present

once scheduled.” Id. Thereafter, Ms. Smith called Plaintiff “to discuss additional inspection

and [Plaintiff] thanked [Ms. Smith] for time and appreciated the additional inspection.” Id.

After Plaintiff was notified by Ms. Smith that an additional inspection would be

scheduled, the claim was reassigned to claim representative J.R. Phillips “to review 2nd

inspection request from Destiny Roofing.” Id. Mr. Phillips decided that a second inspection

was not warranted, making the following entry in the claim file:

Initial loss filed for 7/19/22 DOL. No hail reported on that date

per AccuWeather. Inspector looked at the roof with the insured

present but no roofer. No damage was found to the roof

surface, but did find water damage to the interior. He

completed the interior repair estimate, and settled less the

deductible. No storm related damage found to the roof. Roof

leak from poor weather proofing and wear for DOL 7/19/22.

File reopened with photos from roofer of circled blemishes to

the roof. Photos show area consistent with wear, tear and

blistering and do not show damage consistent with hail. No hail

reported on the DOL, and this loss was for a leaking roof,

which resulted in interior damage including hardwood

flooring. Sending message to [Team Manager] for review, and

advise whether a 2nd inspection should take place on this

claim, or whether a 2nd claim should be filed for a date of loss

that involves hail in the area, so another inspection of the roof

could be completed. Roof appears to be 100 plus square, and

the roofer only provided 15 photos.

[Doc. No. 33-1, at 2]. Upon review, team manager Carmen Richwine agreed that a second

inspection was not warranted and stated that “[t]here was no damage identified to the roof

and the cause of the interior leak was not able to be confirmed.” Id.

The claim file further reflects that, when Mr. Phillips explained to Plaintiff via

voicemail that her request for a second inspection was denied, he “[a]dvised she could file

a new claim for hail with a specific date hail fell at her location, but from our inspection,

and the photos provided by the roofer, the roof does not exhibit any damage consistent with

hail impacts.” [Doc. No. 38-2, at 4].

DISCUSSION

I. Breach of Contract

State Farm moves for summary judgment on Plaintiff’s breach of contract claim. To

establish a breach of contract under Oklahoma law, Plaintiff must prove: “1) formation of

a contract; 2) breach of the contract; and 3) damages as a direct result of the breach.” Digital

Design Grp., Inc. v. Info. Builders, Inc., 24 P.3d 834, 843 (Okla. 2001). State Farm provides

that the policy covers accidental direct physical loss to the property, including damages

caused by wind and hail, but does not provide coverage for ordinary wear and tear [Doc.

No. 33, at 18].

State Farm contends that an inspection of Plaintiff’s roof revealed “zero hail hits in

any of [the] test squares” and no “storm-related damage to any slope.” [Doc. No. 33, at 18].

Although State Farm’s external claim representative did “note[] hail damage to turtle vents

and copper dormers” on the roof, State Farm asserts it did not extend coverage for

Plaintiff’s roof because “no storm-related damage was found on the shingles that coincided

with the July 19, 2022 date of loss reported by Plaintiff.” Id. at 18-19. State Farm extended

coverage for “leaks caused by wind-driven rain” and ultimately made payment to Plaintiff

in the amount of $2,638.29, the cost of the estimated repairs to the interior, minus Plaintiff’s

deductible and depreciation. Id. at 19.

In response, Plaintiff argues that State Farm is improperly focusing on July 19 as

the date of loss when Plaintiff merely reported the claim on July 19 and told State Farm

that she did not know when the loss occurred. Before Plaintiff’s property was inspected by

State Farm, State Farm knew, as reflected in its claim file, that “[Named Insured] DID

NOT KNOW THE DOL.” [Doc. No. 38-2, at 9]. Plaintiff has submitted a report by Sean

Wiley, which includes photographs of purported hail damage to Plaintiff’s roof and an

opinion by Mr. Wiley that the extensive hail damage is consistent with the storm that

occurred on April 15, 2022, during the term of Plaintiff’s policy [Doc. No. 38-9]. Mr. Wiley

opines that “[t]he asphalt shingled roof surface and associated metals were damaged by

hail and such damage is easily visible and distinguishable from blisters.” [Doc. No. 38-9,

at 19].

Viewing the summary judgment record and all reasonable inferences therefrom in

favor of Plaintiff, the Court finds there is a genuine dispute of material facts regarding

whether Plaintiff’s roof suffered hail damage covered under the policy. Accordingly,

Defendant’s motion for summary judgment is denied as to Plaintiff’s breach of contract

claim.

II. Bad Faith

State Farm argues it is also entitled to summary judgment on Plaintiff’s bad faith

claim. Plaintiff contends that State Farm breached its duty of good faith and fair dealing

because State Farm “focused myopically on a fabricated date of loss; failed to consider

significant hail storms near the time that [Plaintiff] noticed damage that she submitted as a

hail and water leak claim; ignored [Plaintiff’s] statement that she did not know the date of

loss; misrepresented to [Plaintiff] there was no hail damage (despite known hail damage);

violated the twenty-four month coverage period derived from 36 O.S. § 1250.5(7); required

a second claim with another deductible over a fictitious date of loss issue; and imposed an

extracontractual ‘exclusion’ of hail ‘damage.’” [Doc. No. 38, at 24-25].

Under Oklahoma law, an insurer has an implied duty to deal fairly and act in good

faith toward its insured, and the violation of that duty gives rise to an action in tort.

Christian v. Am. Home Assurance Co., 577 P.2d 899, 904 (Okla. 1977); see also Badillo v.

Mid Century Ins. Co., 121 P.3d 1080, 1093 (Okla. 2005) (recognizing an “implied-in-law

duty to act in good faith and deal fairly with the insured to ensure that the policy benefits

are received.”). “[A]n insurer’s right to resist payment or resort to a judicial forum to

resolve a legitimate dispute” is well-established. Gov’t Emps. Ins. Co. v. Quine, 264 P.3d

1245, 1249 (Okla. 2011); see also Ball v. Wilshire Ins. Co., 221 P.3d 717, 725 (Okla. 2009);

Brown v. Patel, 157 P.3d 117, 126-27 (Okla. 2007). “However, when presented with a claim

by its insured, an insurer ‘must conduct an investigation reasonably appropriate under the

circumstances’ and ‘the claim must be paid promptly unless the insurer has a reasonable

belief that the claim is legally or factually insufficient.’” Newport v. USAA, 11 P.3d 190,

195 (Okla. 2000) (citation omitted). An insurer’s duty “to timely and properly investigate

an insurance claim is intrinsic to an insurer’s contractual duty to timely pay a valid claim.”

Brown, 157 P.3d at 122 (emphasis in original). “[I]f there is conflicting evidence from

which different inferences may be drawn regarding the reasonableness of [an] insurer’s

conduct, then what is reasonable is always a question to be determined by the trier of fact

by a consideration of the circumstances in each case.” McCorkle v. Great Atl. Ins. Co., 637

P.2d 583, 587 (Okla. 1981).

Upon consideration of the summary judgement record, viewed in the light most

favorable to Plaintiff pursuant to Rule 56, the Court finds that genuine disputes of material

facts preclude summary judgment on the issue of bad faith conduct. Plaintiff has presented

minimally sufficient facts from which reasonable jurors could find that State Farm did not

conduct a reasonable investigation under the circumstances. Plaintiff notified State Farm

that she did not know the specific date of loss associated with her hail and water damage

claim, which was reported on July 19, 2022. Notwithstanding that Plaintiff’s claim always

included a claim for hail damage, State Farm apparently relied on the date Plaintiff

submitted her claim to deny coverage for hail damage since no hail fell at Plaintiff’s

property on that date. When Plaintiff asked State Farm for a second roof inspection for the

hail damage, State Farm knew that 1) Plaintiff did not know the precise date of loss; 2) the

roof showed evidence of hail damage, at least with respect to soft-metal components; and

3) an Accuweather report reflected a storm in Plaintiff’s area that produced 1.75-inch hail

on April 15, 2022, during the term of Plaintiff’s policy. However, State Farm refused to

perform a second inspection, stating that the pictures submitted by Plaintiff’s roofer did not

warrant another inspection. This statement was contradicted by State Farm’s own claim

specialist, who noted in Plaintiff’s claim file that she had reviewed the “photos received

11/14 previously and agreed additional inspection would be necessary.” [Doc. No. 38-2, at

5]. After notifying Plaintiff that State Farm would be conducting a second roof inspection

with Plaintiff’s roofer present, State Farm subsequently re-assigned the file to J.R. Phillips,

who decided that a second roof inspection was not warranted, which decision was

confirmed by his team manager.

Despite being called to inspect Plaintiff’s roof for a hail and water damage claim,

external claim representative Connor Hounsel testified that he’s “not there to document

could-have-been hail,” but rather “to document damages related to the claim of loss, which,

again, was wind-driven rain, water damage to the interior.” [Doc. No. 38-5, at 133, lns. 8-

20]. Although Mr. Hounsel identified hail damage to the soft-metal components of

Plaintiff’s roof, State Farm told Plaintiff that there was no hail damage to her roof shingles,

and no covered damage to her roof [Doc. No. 38-14, at 2-3]. Thereafter, Mr. Phillips left a

voicemail for Plaintiff, “advis[ing] she could file a new claim for hail, with a specific date

hail fell at her location, but from our inspection, and the photos provided by the roofer, the

roof does not exhibit any damage consistent with hail impacts.” [Doc. No. 33-1, at 2]. Mr.

Phillips confirmed in his deposition that a second claim would have been subject to a

second deductible [Doc. No. 33-6, at 54 lns. 6-16].

Viewing the summary judgment record in the light most favorable to Plaintiff, the

Court finds that the reasonableness of State Farm’s conduct to ensure that Plaintiff received

the benefits of her insurance policy is reasonably subject to different conclusions.

Accordingly, State Farm is not entitled to summary judgment with respect to Plaintiff’s bad

faith claim.

III. Punitive Damages

Finally, State Farm contends that it is entitled to summary judgment on Plaintiff’s

claim for punitive damages. For punitive damages, “there must be evidence, at a minimum,

of reckless disregard toward another’s rights from which malice and evil intent may be

inferred.” Badillo, 121 P.3d at 1106. Viewing the facts and reasonable inferences therefrom

in Plaintiff’s favor, the Court finds that the genuine disputes of material facts with respect

to Plaintiff’s bad faith claim preclude summary judgment on punitive damages. At this

juncture, the Court finds that a summary adjudication on punitive damages would be

premature, and the Court will instead rule on whether punitive damages will be submitted

to the jury based on the evidence offered at trial and with the benefit of a complete trial

record.

CONCLUSION

IT IS THEREFORE ORDERED that Defendant State Farm Fire and Casualty

Company’s Motion for Summary Judgment and Brief in Support [Doc. No. 33] is

DENIED. Within 10 days of this Order, the parties shall submit a joint status report or

proposed scheduling order for the remaining unexpired deadlines.

IT IS SO ORDERED this 2" day of May, 2025.

Md, OO,"

by Q: Qa

TIMOTHY D. DeGIUSTI

Chief United States District Judge

12