Insured people in Grand Prairie, Weatherford, Arlington, Mansfield, Carrollton, Mesquite, Garland, Fort Worth, Dallas, or anywhere else in the State of Texas would want to know if it is possible to beat an insurance company if you get into a fight with them. The short answer is “heck yeah” you can beat them. Just hire an experienced Insurance Law Attorney.
The Seattle Post-Intelligencer ran an article that published on February 9, 2011, that tells the story of one person beating their insurance company after the insurance company denied their claim for benefits. The article is written by Vanessa Ho and is titled, “Elderly Woman Beats Insurer Over Denied Benefits.”
The article in part said:
Four years after an insurance company denied benefits to a woman in a Kirkland nursing home, the state Court of Appeals ruled that the company had erred in denying coverage.
The ruling came after the woman, Evelyn Bushnell, died, and after her son had complained to the company, complained to the state insurance commissioner, filed a lawsuit, and lost.
“We’re pleased with the result,” said Leroy Bushnell’s attorney. “The client is pleased. It restored his faith in the system correcting wrongs.”
In 1986, Bushnell bought a nursing-care policy for his mother from the Medico Insurance Company in Nebraska. Bushnell paid the monthly premiums on time for more than 20 years.
In 2007, his mom had a stroke, needed full-time skilled nursing care, and was admitted to the Lake Vue Gardens Convalescent Center in Kirkland. But when Bushnell submitted a claim for benefits, Medico denied coverage.
The company said Evelyn Bushnell had not been in the hospital for at least three days before going to the home – a requirement in Medico’s policy. Such a requirement was banned in Washington in 1987, after the Legislature passed the Long-Term Care Insurance Act.
Bushnell argued the law trumped Medico’s hospital-stay requirement after he renewed the policy. Medico said the original policy – signed before the law took effect – was valid. The company also said the policy had lapsed, and that Evelyn Bushnell wasn’t covered when she went to the nursing home.
In 2009, a King County Superior Court judge dismissed Leroy Bushnell’s lawsuit.
On Monday, the Court of Appeals partially reversed that decision, ruling that Medico’s hospital-stay requirement was invalid, because a new contract was formed every time Bushnell renewed his premiums. The court also ruled that the Bushnell’s policy was in effect and had not lapsed.
Bushnell had also accused Medico of acting in “bad faith” when it denied coverage, which if true, would allow him to collect enhanced damages. The judges remanded that issue to the lower court.
In Texas, had the same thing happened and the court had remanded the case for a determination of whether or not the insurance company had acted in “bad faith,” the Texas Insurance Code, Section 541.152, would come into play.
Section 541.152 says:
(a) A plaintiff who prevails in an action under this subchapter may obtain:
(1) the amount of actual damages plus court costs and reasonable and necessary attorneys’ fees;
(2) an order enjoining the act or failure to act complained of; or (3) any other relief the court determines is proper.
(b) On a finding by the trier of fact that the defendant knowingly committed the act complained of, the trier of fact may award an amount not to exceed three times the amount of actual damages.
There are many other sections of the Texas Insurance Code that come into play when an insurance company is dealing with one of its insureds. These various sections are to protect the public against insurance companies who attempt to take advantage of people who in a normal situation simply do not understand their rights when dealing with an insurance company.
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