Dallas Fort Worth Insurance Lawyer Blog

Interpreting An Insurance Policy – Court Rules

March 29, 2025 | Mark S. Humphreys

Interpreting an insurance policy is a cause for many lawsuits. This is illustrated in a January 2025 opinion from the United States Court of Appeals for the Fifth Circuit. The opinion is styled, Andre Huizar v. Benchmark Insurance Company.

On summary judgment, the district court dismissed Huizar’s breach of contract and related extracontractual claims against his insurer, Benchmark. For the following reasons, the Court AFFIRMED.

In January 2021, Huizar applied for a home insurance policy for 833 Baker Drive in Tomball, Texas (the “Property”) with Benchmark. In his application, Huizar represented that the property was owner-occupied, was built in 1982, was not vacant or unoccupied or for sale or under construction, and that there was no unrepaired damage to the roofs or other structures. He signed the application, acknowledging that the information he provided was correct and that if it was false or misleading the policy would be null and void. Based on the information provided, Benchmark issued the homeowner’s

Hail Damages Claims And Bad Faith Insurance

March 22, 2025 | Mark S. Humphreys

Claiming roof damage is not as simple as it may appear at first glance. A December 2024 opinion from the Eastern District of Texas, Tyler Division, discusses what the courts look at in roof damage claims wherein the insurance company claims the damage is pre-existing or caused for reasons other than hail damage and whether that denial is cause for a “bad faith” claim. The style of the opinion is Winterfield United Methodist Church v. Church Mutual Insurance Company.

The facts and legal history of the case can be gleamed from reading the opinion. This is a summary judgment decision.

Plaintiff argues that under Texas law, an insurer cannot investigate a claim in a manner calculated to construct a pretextual, “outcome oriented” basis to deny the claim. Plaintiff explains several ways that Defendant engaged in such conduct, including: (1) Defendant ordered its engineer to perform a second inspection even though the first inspection identified hail damage; (2) Defendant withheld the engineer report from Plaintiff for several weeks; (3) Defendant retained an engineer to “rubberstamp” its predetermined outcome without first inspecting the property himself even though its independent adjuster had already found covered damages; (4) Defendant intentionally minimized the adjuster’s findings of hail damage; (5) Defendant continued to send out its engineer to reinspect the property until the estimated damages fell below the deductible amount; and (6) Defendant withheld the underwriting file of the property from the independent adjuster and engineer.

Roof Damage – Segregating Damages

March 15, 2025 | Mark S. Humphreys

Claiming roof damage is not as simple as it may appear at first glance. A December 2024 opinion from the Eastern District of Texas, Tyler Division, discusses what the courts look at in roof damage claims wherein the insurance company claims the damage is pre-existing or caused for reasons other than hail damage. The style of the opinion is Winterfield United Methodist Church v. Church Mutual Insurance Company.

The facts and legal history of the case can be gleamed from reading the opinion. This is a summary judgment decision.

Because an insured can recover only for covered events, the burden of segregating the damage attributable solely to the covered event is a coverage issue for which the insured carries the burden of proof. Under certain circumstances, a plaintiff’s failure to segregate is fatal on summary judgment. An insured may carry its burden by producing evidence demonstrating that the loss came solely from a covered loss or producing evidence that a jury could use to reasonably segregate covered and non-covered losses. The Court then pointed out all the evidence produced by the Plaintiff. For these reasons, the court finds that Plaintiff has produced sufficient evidence attributing the church’s claimed damage to solely the January 2022 storm to survive summary judgment.

What Can Insurance Companies Do And Not Do

March 8, 2025 | Mark S. Humphreys

The answer to the title of this article is not easy. The Texas Insurance Code is about 300 pages long as of the date of this article with another 500 pages of Index and even more for Supplements. On top of the preceding, rules and statutes governing insurance are found in other books of statutes such as the Penal Code, Family Code, Transportation Code, and others.

Chapter 1651 of the Texas Insurance Code deals with long-term care insurance policies.

Medicare supplement policies are governed in part by Chapter 1652 of the Texas Insurance Code.

Accidental Death Policies – Be Careful

March 1, 2025 | Mark S. Humphreys

Accidental Death policies are common. The great thing about these types of policies is how cheap the premiums are. A person can usually buy a million dollars with of coverage yet pay less than $50.00 a month in premiums.

Here’s there is a downside to this types of policies and it’s a big downside. These policies rarely pay!

Accidental death policies almost always exclude death coverage when alcohol or drugs caused or contributed to the death. The “contributed to the death” is the operative language. The same language deals with pre-existing health issues the deceased may have had. The same language will deal with “conditions of the body”. And other language in the policy excludes almost all deaths except those deaths that result in an immediate death.

Credit Life And Health Insurance Policies

February 22, 2025 | Mark S. Humphreys

Credit life insurance polices are common in situations where a person is purchasing something on credit. Examples include cars, motor homes, houses, etc. These policies are usually purchased at the time of purchase is offered when the paperwork for the sell is being processed.

This type of policy is often times ripe for misrepresentations made by the seller of the policy. Mistakes are also made by the purchaser of the policy. In both cases, the buyer is not really paying attention to the terms of the policy or the questions being asked. The purchase of the policy is secondary to must purchasers who are primary interested in the thing they are purchasing such as that car, motor home, or house.

There are many parts of the Texas Insurance Code that deal in a general way with the purchase and sell of these policies. However, Texas Insurance Code, Section 1153.052 deals specifically with these Credit policies.

Homeowners Claim For Water Damage

February 15, 2025 | Mark S. Humphreys

Here is a homeowners claim for water damage. The law is specific to the facts of the case and serves as a good example of how courts look at this issues. The opinion is a 2024 opinion from the Corpus Christi Court of Appeals and is styled, Texas Windstorm Insurance Association v. Valstay, LLC.

This is appeal by TWIA from a summary judgment.

The question before this Court is which party, the insured or the insurer, carries the burden of proof to show that the complained of damage occurred within one year of the claim being filed pursuant to § 2210.573(a) of the Texas Insurance Code: That provision states: “Subject to [§] 2210.205(b), an insured must file a claim under an association policy not later than the first anniversary of the date on which the damage to property that is the basis of the claim occurs.” TWIA argues that the one-year deadline is a prerequisite to suit, making it Valstay’s burden to prove it filed a timely claim. In response,Valstay argues that the one-year deadline is an affirmative defense held by TWIA, which TWIA carries the burden to prove. The Court agreed with Valstay.

Home Owner Claims – Water

February 8, 2025 | Mark S. Humphreys

Home owner claims for water damage are tricky. Most people will rarely read the homeowner policy they purchase. And most people do not realize that many homeowner policies do not cover water losses. Here is a 2024 opinion from the United State Fifth Circuit that deals with a water claim. The opinion is styled, Rodolfo Benitez v. AmGuard Insurance Company.

After a botched pool-deck renovation caused surface water to seep into his rental property, Rodolfo Benitez brought coverage and extracontractual claims against his homeowners insurer, which were dismissed on summary judgment.

The undisputed evidence attributes Benitez’s loss to surface water and faulty workmanship, which the policy excludes from coverage.

Bad Faith Insurance Claims

February 1, 2025 | Mark S. Humphreys

Bad Faith Insurance claims in Texas are not as easy as many people think. This is illustrated in this 2024, opinion from the Western District of Texas, Austin Division. The opinion is styled, Franklin Square Condo Owner Ass’n v. Amguard Insurance Company. This is a summary judgment opinion.

After Franklin Square submitted a claim for the damage caused by the hailstorm, AmGuard sent an adjuster to inspect the property damage, notified Franklin Square that its inspector had assessed $13,034.90 in damages, and sent Franklin Square a check for an amount of $5,534.90 (the $13,034.90 in damages minus the deductible). Franklin Square indicated that they disagreed with the assessment of the roof damage. In response, AmGuard sent an engineer, Wyatt Hardenberg, to inspect the property on October 26, 2022, who found that 41 roof tiles exhibited hail damage, but observed that other cracked tiles lacked “a centralized focal (impact) point on the tile surface” as would indicate hail damage. Hardenburg further observed that the cracked tiles evidenced earlier damage than the hailstorm and that the roof had been treated with sealant prior to the hail damage, indicating “prior maintenance activities to arrest known water intrusions.” After Hardenburg’s assessment, AmGuard notified Franklin Square that it had readjusted its estimate and provided an additional check for $2,409.20 to replace the 41 cracked tiles and a broken window screen.

Franklin Square was dissatisfied with the amount paid and sued AmGuard for breach of contract damages, Insurance Code violations and bad faith the way the claim was handled. There were other issued in the case related to experts that will not be discussed here.

Life Insurance And Settlement

January 25, 2025 | Mark S. Humphreys

Life insurance cases. When is there a settlement?

Here is a 2024 opinion from the Western District of Texas, San Antonio Division that is worth reviewing. The opinion is styled, Arch Insurance Company v. Rita Candelario.

The opinion does not deal with life insurance specifically, rather it deals with an insurance situation wherein the insurance company believed an agreement had been reached via a Rule 11 agreement. A proper Texas Rule 11 of Civil Procedure Settlement Agreement is commonly used to memorialize that the respective parties have reached an agreement to settle a case.