Dallas Fort Worth Insurance Lawyer Blog

Insurance Claims And Cause Of Loss And Experts

January 11, 2025 | Mark S. Humphreys

Insurance claims usually don’t need an expert to testify but an attorney handling these types of claims needs to know when to hire an expert. This is illustrated in a 2024 opinion from the Fort Worth Court of Appeals. The opinion is styled State Farm Lloyds v. John Hilmi.

Hilmi had his home and contents insured by State Farm. Helms asserts a lightening strike caused almost $200,000 of personal property at his home to be ‘fried”. State Farm disagreed and this lawsuit was filed against State Farm for breach of contract and violations of the Texas Insurance Code.

A jury trial was conducted and resulted in a favorable verdict for Hilmi. State Farm appealed and this Court reversed the judgment. The opinion should be read to get an understanding of the facts and testimony at trial. What follows is the legal logic.

Delays In Paying Claims And The Statute Of Limitations

January 4, 2025 | Mark S. Humphreys

Insurance claims, like all claims, have time periods within which lawsuits must be filed, otherwise, the statute of limitations will run. This is illustrated in a 2024 opinion from the Corpus Christi Court of Appeals. The opinion is styled, Jessica Galvin v. RVOS Farm Mutual Insurance Company.

The facts of this case are unusual and a reading of the facts helps to understand the ultimate ruling by the Court. This is a summary judgment case decided in favor of RVOS.

The controlling question in this case is when Galvan’s claims accrued. Generally, a claim accrues, and limitations begins to run, “when the defendant’s wrongful conduct causes the claimant to suffer a legal injury, which gives the claimant the right to seek a judicial remedy.” That is, a claim accrues “when injury occurs, not afterward when the full extent of the injury is known.” According to the Texas Supreme Court, “Generally, a cause of action accrues when a wrongful act causes a legal injury.”

Federal Employee Group Life Insurance

December 28, 2024 | Mark S. Humphreys

The Federal Employee Group Life Insurance (“FEGLI”) program is governed by Federal Law. This law was enacted in 1954 and is found at 5 U.S.C., section 8701. A 2024 opinion from the Northern District of Texas, Fort Worth Division, discussed FEGLI and how it applied to the case at issue. The facts are lengthy and the discussion is somewhat complicated. A reading of the opinion is necessary to comprehend and apply. The opinion is styled, Metropolitan Life Insurance Company vs. Rebecca D. Vasquez, et al.

Metropolitan Life Insurance Company (“MetLife”), as of the date of this post handles all FEGLI cases for the Federal government. The issues in most FEGLI cases are disputes over who is entitled to the life insurance proceeds. As a result, like this case, they are interpleader cases.

If you have a FEGLI case, read the opinion and seek legal help for advice.

Claim Denial And Experts

December 21, 2024 | Mark S. Humphreys

A claim being denied doesn’t necessarily mean an expert has to be hired in the case. But when an expert is needed the correct legal process must be followed. This is illustrated in a 2024 opinion from the Southern District of Texas, Houston Division. The opinion is styled, Dora Doss Thompson v. State Farm Lloyds.

This case arises out of an insurer’s denial of a property damage claim. Defendant State Farm Lloyds (“State Farm”) filed a Motion for Summary Judgment. For the reasons that follow, State Farm’s motion was granted.

Plaintiff Dora Doss Thompson obtained an insurance policy (“Policy”) from State Farm, covering wind and hail damage occurring between April 12, 2021 and April 12, 2022 at her home located at 21014 Pricewood Manor Court, Cypress, Texas 77433 (the “Property”). Thompson claims that a September 28, 2021 storm caused significant wind and hail damage to her Property.

Insurance Coverage And Willful Acts

December 14, 2024 | Mark S. Humphreys

Insurance usually covers accident that happen or acts of God, negligence, etc., things that are Unintentional. Policies will rarely cover willful or intentional conduct that causes harm.

The above is illustrated in a 2024 opinion from the Eastern District of Texas, Sherman Division. The opinion is styled, Jacksonville, Realty, LLC v. Certain Underwriters At Lloyds.

The Plaintiff, Jacksonville, filed a summary judgement seeks the Court to rule that the policy contract had been broken by the Defendant. The policy at issue is an errors and omissions policy. Miller Title acted as the escrow agent for a real estate transaction between Jacksonville and IBF Retail I, LLC. As part of the transaction, IBF deposited $2,750,000 in earnest money with Miller Title.

Late Payment Claims And Death

December 7, 2024 | Mark S. Humphreys

Insurance claims that are not timely paid and in violation of the Texas Prompt Payment of Claims Act, do those claims survive the death of the insured? This topic is discussed in a 2024 opinion from the Eastern District of Texas, Beaumont Division. The opinion is styled, Brenda barron, Temporary Administratrix Of The Estate Of Larry Barron, Deceased v. Century Surety Company, d/b/a Century Insurance Group.

The issue here is whether an insured’s claim for statutory interest and attorney fees under chapter 542 of the Texas Insurance Code survives their death. In February 2021, Larry Barron’s commercial building was damaged by a winter storm. The building was insured by Century. After Century refused to pay all of Barron’s claim, he sued Century for breach of contract, statutory bad faith, and statutory interest and attorney fees under chapter 542. Following the parties’ motions for summary judgment, the court dismissed his claim for bad faith.

Sadly, Larry Barron passed away on December 17, 2023. Brenda Barron replaced him in this lawsuit as the administratrix of his estate. In Century’s present motion for summary judgment, it argues that none of the insured’s extra-contractual claims survive his death. In response, Barron says that at least the claim for statutory bad faith should survive. But because that claim has already been dismissed, the undersigned only needs to address the remaining extra-contractual claims for statutory damages and attorney fees under chapter 542.

Cooperation Requirement With Insurance Company

November 30, 2024 | Mark S. Humphreys

Cooperating with the your own insurance company when making a claim for policy benefits is almost always a requirement in the policy. An opinion discussing this was issued by the Tyler Court of Appeals in 2024. The opinion is styled, Kenneth R. Cade v. State Farm Lloyds.

On April 18, 2019, a windstorm blew a large tree onto a portion of Cade’s house that was insured by State Farm. Cade eventually made a claim for damage to the structure and contents. Several inspections were made and payment was made totaling approximately $30,000. The personal property claim was not made until about 18 months later, claiming several items of personal property were damaged or destroyed. A lawsuit resulted after State Farm denied paying further damages citing a lack of cooperation by Cade with the claim. State Farm filed a motion for summary judgement which was granted.

The opinion details many more of the facts and testimony in the case which should be read. This article will cite the law related to this type of claim.

Insurance Agents And Lawsuits

November 23, 2024 | Mark S. Humphreys

Insurance agents who make mistakes in selling an insurance policy will sometimes end up being sued along with the insurance company issuing the policy. From a strategy point of view it is often times desirable to sue the agent to keep the lawsuit from being litigated in Federal Court. Here is a 2024 opinion dealing with how to sue the agent correctly. The opinion is from the Eastern District of Texas, Judge Campbell Barker. The opinion is styled, William McCalister v. United States Liability Insurance Company et al.

At issue in this insurance-coverage dispute is plaintiff ’s motion to remand the case back to state court for lack of subject-matter jurisdiction. This hinges on whether plaintiff improperly joined defendant Amanda DeShazo, the insurance agent who sold the policy to plaintiff. The petition asserted claims under the Texas Insurance Code, Section 541.061(1), the Texas Deceptive Trade Practices Act, Section 17.46(b)(5), and common-law breach of contract. Mostly these claims fit into two categories: misrepresentation and denial. The former pertains to front-end misrepresentations about the scope of the policy.

The statutory basis for removal is 28 U.S.C. § 1441(a), which provides that defendants may remove from state court “any civil action brought in a State court of which the district courts of the United States have original jurisdiction.” The relevant limitation is found in the next subsection: “A civil action otherwise removable solely on the basis of the jurisdiction under section 1332(a) of this title may not be removed if any of the parties in interest properly joined and served as defendants is a citizen of the State in which such action is brought.” As alluded to above, the basis for subject-matter jurisdiction in this case is diversity of citizenship under § 1332(a). Thus, if DeShazo was properly joined, then this court lacks jurisdiction and must remand.

Duty To Cooperate With Insurance Company

November 16, 2024 | Mark S. Humphreys

The duty to cooperate with the insurance company investigation of a claim is something a lot of people don’t realize. When it is your own insurance company, the insurance contract requires the insured to cooperate with the insurance company investigation of the claim.

This issue was the point of contention in a 2024 opinion from the Southern District of Texas, Houston Division. The opinion is styled, Raymond Funes v. Allstate Vehicle And Property Insurance Company.

In this case, the facts are generally undisputed. Plaintiff filed a claim in or around February 2021 for broken pipes at his property that was insured by Defendant. He withdrew the claim in March 2021, but then retained an attorney and pursued the claim with Defendant in February 2023. Defendant inspected the property and found that the home had been re-piped. It requested the plumbing report and or invoice for the re-piping, but Plaintiff failed to oblige. As such, Defendant denied the request for appraisal for “lack of cooperation by the insured.” Subsequently, Plaintiff brought this suit.

Bad Faith Claims And The Statute Of Limitations

November 9, 2024 | Mark S. Humphreys

Bad Faith claims have a statute of limitations and that limitations period must be strictly followed. This issue is discussed in a 2024 opinion from the Northern District of Texas, Fort Worth Division. The opinion is styled, Shalport, Inc. d/b/a Chevron #36316 v. Amguard Insurance Company.

Shalport, Inc. (“Plaintiff”) is the business owner of a Chevron gas station and convenience store (the “property”), which includes a car wash on its premises. Plaintiff owns commercial property insurance, which was issued by AmGUARD Insurance Company (“Defendant”). On or around December 1, 2021, the car wash on the property sustained severe damage. The damage to the carwash rendered it inoperative. Plaintiff submitted a claim for coverage to AmGUARD. AmGUARD acknowledged the claim and assigned it to a third-party administrator, Raphael & Associates. On April 20, 2022, Raphael & Associates sent Plaintiff a letter stating that no coverage existed under the policy and as such, no payment would be issued for the claim.

Plaintiff retained G.T.O. Car Wash to inspect the car wash and determine the monetary cost of restoring it to its pre-damaged condition. Plaintiff again asked AmGUARD to cover the cost of repairs pursuant to the policy.