Dallas Fort Worth Insurance Lawyer Blog

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.

Homeowner’s Claim And Damage Segregation

November 2, 2024 | Mark S. Humphreys

Here is a 2024 opinion from the Western District of Texas, Austin Division, that deals with segregating damages in a homeowners claim. The opinion is styled, David Espinoza v. State Farm Lloyds.

Espinoza had a State Farm homeowners policy in force when a storm caused damage to his home. The claim was partially paid but State Farm but denied as to the full claim with State Farm alleging some of the damages were caused by matters not covered by the policy. State Farm filed a motion for summary judgment based on Plaintiff being unable to segregate the covered damages from the uncovered damages.

For an insurance company to be liable for a breach of its duty to satisfy a claim presented by its insured, the insured must prove that its claim falls within the insuring agreement of the policy.

Life Insurance – State Law Versus Federal Law

October 26, 2024 | Mark S. Humphreys

Most life insurance policies are regulated by State Law. But, what if the life insurance policy at issue is governed by Federal Law? It’s simple, Federal Law pre-empts State Law. This is illustrated in the 2001, United States Supreme Court opinion styled, Egelhoff v. Egelhoff.

The Egelhoff opinion, the Supreme Court held that the Employee Retirement Income Security Act (ERISA) preempts a state law that revokes a life insurance policy beneficiary designation when spouses divorce. The state statute as issue in the Egelhoff opinion provided that if the life insurance beneficiary designation of an ex-spouse was made before the divorce, that designation was considered revoked. Because the insurance was part of an employee benefit plan, the Supreme Court held that ERISA preempted state law so that the benefits would be paid in accordance with the plan documents. The insured had not changed the beneficiary designation according to the plan, so his ex-wife received the benefits. Texas has a statute which would be prevented, that statute being Texas Family Code, section 9.301.

Homeowners Claim Where Insurance Company Says It’s Arson

October 19, 2024 | Mark S. Humphreys

Here is a 2024 opinion from the Southern District of Texas, Houston Division, wherein the insurance company, State Farm Lloyd’s, is refusing to pay the claim because State Farm believes the insured cause the fire on purpose in an effort to collect insurance monies. The opinion is styled, Raynelle King v. State Farm Lloyds.

On November 18, 2018, a late-night fire broke out in King’s home, and King filed a claim with State Farm. Arson investigators later found gasoline residue in debris samples from the room where the fire started. King was apparently in considerable financial distress at the time. As a result, State Farm denied King’s claim alleging that she had set fire to her own home. King sued, arguing that State Farm wrongfully denied her claim. State Farm has now filed a Motion for Summary Judgment. State Farm asks the Court to find that King committed arson and therefore cannot recover under the policy. After careful review, the Court finds that there is a genuine dispute of material fact, and State Farm is not entitled to judgment as a matter of law. The Court, therefore, DENIES the Motion.

On the night of November 18, 2018, Plaintiff King’s house caught fire, which caused extensive damage. At the time, King held a homeowner’s insurance policy from State Farm that covered fire loss, among other things. King submitted a claim for damages under her policy, which State Farm denied. King sued State Farm for failing to pay out her insurance policy. She asserts various causes of action under

Statute Of Limitations On First Party Insurance Claims

October 12, 2024 | Mark S. Humphreys

It is important to understand the time frame under which lawsuits must be filed. As part of that, reading the insurance policy is vital. A 2024 opinion from the Western District of Texas, Del Rio Division, discusses limitation periods written into insurance policies. The opinion is styled, Antonio Caballero v. Allstate Vehicle And Property Insurance Company .

This case was decided on the summary judgment motion filed by Allstate.

This matter arises from an insurance claim. The Plaintiff alleges hail storm property damage in excess of $20o,000. The Plaintiff filed a claim with the Defendant on December 13, 2018. The Defendant denied the Plaintiff’s claim on October 11, 2019. The Plaintiff filed suit in Texas state court on August 21, 2023, asserting: violations of the Texas Insurance Code and breach of contract among other causes of action.

Life Insurance – Who Gets The Benefits

October 5, 2024 | Mark S. Humphreys

Here are a few cases discussing who is entitled to life insurance benefits. All life insurance attorneys have to know these cases.

The Forth Worth Court of Appeals said in a 1994 opinion styled, Street v. Skipper, that one spouse can designate his or her estate as the beneficiary of the policy, at the expense of the other spouse, absent any showing of actual or constructive fraud.

According to the Eastland Court of Appeals in a 1981 opinion styled, Pilot Life Insurane Co v. Koch, policies may contain provisions automatically divesting a spouse of any interest in the proceeds, if the parties are “legally separated” or divorced.

Claims Denial For Failure To Cooperate

September 28, 2024 | Mark S. Humphreys

An insured under an insurance policy has a duty to cooperate with an insurance company investigation of a claim. This issue is discussed in the 2024 opinion, Henry & Lydia Ansah v. Nationwide Property and Casualty Insurance Company. The opinion is from the Southern District of Texas, Houston Division.

The Plaintiff’s allege that Nationwide underpaid their property insurance claim. Nationwide ended up filing a motion for summary judgement arguing the Plaintiffs are not entitled to further coverage because they failed to make the damaged property available for inspection or to document the damages.

On February 18, 2021, Defendant received from Plaintiffs a claim for damages to their dwelling and personal property caused by a freeze event that occurred the day before. On March 5, 2021, Defendant contacted Plaintiffs to discuss their claim and the claims process. Defendant began investigating Plaintiffs’ claim and paid $87,122.07 for dwelling damage and at least $35,984.83 personal property damage. Plaintiffs disputed Defendant’s valuation of their loss and invoked the Policy’s appraisal provision. The appraisers determined that the actual cash value of the dwelling damage was $78,936.05 less than what Defendant had paid.

Hail Damage Claims And The Texas Insurance Code

September 21, 2024 | Mark S. Humphreys

Here is a 2024 opinion from the Northern District of Texas, Amarillo Division, that deals with an important procedural in hail damage claims. The opinion is styled, Lotus Sky, LLC v. Lexington Insurance Company and Constitution Insurance Company.

This case arises from a hail damage insurance claim. Lotus Sky sued Lexington for breach of contract and various violations of the Texas Insurance Code. In response Lexington filed a Verified Plea as a Motion to Abate.

Accordingly, because this lawsuit is based on an insurance claim arising from alleged wind and hail damage, this lawsuit triggers compliance with Section 542A.003 of the Texas Insurance Code. Relevant to the Motion before the Court, Lotus Sky was required to provide presuit notice to Lexington at least 60

Claims Denial Due To Misrepresentation

September 14, 2024 | Mark S. Humphreys

A misrepresentation in an insurance application is grounds for denial of a claim but it is not necessarily a win for the insurance company. This issue is discussed in a recent opinion from the Texas 14th Court of Appeals. The opinion is styled, Jose Palma v. Allied Trust Insurance Co.

This case was a summary judgment win for the insurance company but there is a clear distinction with this case and the vast majority of cases regarding misrepresentations.

Palma purchased an insurance policy for his home with appellee. During the policy period, there was a fire at Palma’s home. Palma submitted an insurance claim under the policy. Allied investigated and found that Palma had a prior conviction for insurance fraud that was not disclosed on his application for