Texas Windstorm Insurance Association v. Randy Jones, 512 S.W.3d 545

Randy and Debra Jones held a TWIA wind/hail policy (effective June 12, 2014–June 12, 2015) for property in Brazoria County; Jones reported an April 17, 2015 loss.
TWIA inspected the roof, identified limited hail-damaged shingles, and adjusted the loss to $3,660.31; TWIA issued a Notice of Claim Acceptance stating it "accepts coverage for the claim" and offering $740.31 (after deductible).
The Notice included guidance that disputes over the amount paid for an accepted claim must be resolved by appraisal and that a claimant must demand appraisal within 60 days.
Jones did not request appraisal; he later sued TWIA alleging breach of contract and violations of Tex. Ins. Code §§ 2210.575 & 2210.576 (but nonsuited breach of contract before appeal).
TWIA filed a plea to the jurisdiction and alternative summary-judgment motion arguing Chapter 2210 limits remedies: if TWIA accepted coverage in full, the claimant’s exclusive remedy to dispute amount is appraisal; suit is authorized only where coverage is denied.
The trial court denied TWIA’s plea; TWIA obtained permissive interlocutory review. The court of appeals reversed, holding TWIA accepted coverage in full and that Jones waived his right to contest the amount by failing to demand appraisal.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether TWIA "denied coverage" (in whole or in part) so that Jones may sue under Chapter 2210 instead of using appraisal	Jones: TWIA’s notice and forms (e.g., language referencing acceptance “in part” and a form stating “Notice of Claim Acceptance in Part and Denial in Part”) create a fact issue that TWIA partially denied coverage	TWIA: Notice unequivocally "accepts coverage for the claim" and complied with §2210.573(e) by stating the amount payable and appraisal deadline; absent any statutory-required partial-denial summary or intent-to-sue form, there was no denial of coverage	Court: TWIA accepted coverage in full; Jones’s remedy was appraisal and, having not demanded it within 60 days, he waived the right to contest the payment; dismissal affirmed

Tex. Dep’t of Parks & Wildlife v. Miranda, 133 S.W.3d 217 (Tex. 2004) (standard for plea to the jurisdiction that challenges existence of jurisdictional facts)
Mission Consol. Indep. Sch. Dist. v. Garcia, 372 S.W.3d 629 (Tex. 2012) (plea-to-jurisdiction review parallels summary-judgment standards)
Tex. Ass’n of Bus. v. Tex. Air Control Bd., 852 S.W.2d 440 (Tex. 1993) (plaintiff bears burden to allege facts establishing jurisdiction)
CMH Homes v. Perez, 340 S.W.3d 444 (Tex. 2011) (scope of permissive interlocutory appeal is narrowly construed)
KLN Steel Prods. Co. v. CNA Ins. Cos., 278 S.W.3d 429 (Tex. App.—San Antonio 2008) (insured’s initial burden to show claim falls within policy coverage)
GEICO Gen. Ins. Co. v. Austin Power, Inc., 357 S.W.3d 821 (Tex. App.—Houston [14th Dist.] 2012) (insurer’s duty to defend where pleadings potentially fall within coverage)