PJC Business

C ONTRACTS

PJC 101.57

PJC 101.57 Insurance Contracts—Compliance—Specific Policy Language QUESTION ______ Did Insurer, Inc. fail to comply with the agreement? Insurer, Inc. failed to comply with the agreement if it failed to pay for [ all ] the damages, if any, [ that were caused (partly/solely) by/that resulted from/ because of ] the [ description of covered loss, event, or cause ]. [Insert instructions and definitions, if appropriate.] Answer “Yes” or “No.” Answer: _______________ COMMENT When to use. The above question may be submitted to determine whether the insurer breached the agreement by failing to pay a covered loss. Conditioned on an affirmative answer, this question will be followed by PJC 101.58, which submits causation and policy benefits as damages. Additional questions are required for any alleged consequential damages and attorney’s fees, as set out in PJC 115.3–115.5 and PJC 115.60. Because nonpayment of an excluded loss is not a failure to comply with the agree ment, this question should not be used when the application of an exclusion is the sole disputed issue. Instead, PJC 101.59 should be used in such a case. The word all should be included if the insurer has paid benefits but there is a dis pute about whether the insurer paid all that was owed. If the existence of an agreement is disputed, PJC 101.1 should be submitted before this question. Source of question. The above question is based on PJC 101.2 and is adapted from jury questions based on specific policy language mentioned in the following cases: National Union Fire Insurance Co. of Pittsburgh v. Hudson Energy Co. , 811 S.W.2d 552, 554–55 & n.3 (Tex. 1991); Union Mutual Life Insurance Co. v. Meyer , 502 S.W.2d 676, 677–79 (Tex. 1973); Employers Mutual Casualty Co. of Des Moines, Iowa v. Nelson , 361 S.W.2d 704, 706–07 (Tex. 1962); and Telepak v. United Services Automobile Ass’n , 887 S.W.2d 506, 507 (Tex. App.—San Antonio 1994, writ denied). Broad-form submission. PJC 101.57 is a broad-form question designed to be accompanied by one or more appropriate instructions. Tex. R. Civ. P. 277 requires that

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