Car buyers in Grand Prairie, Fort Worth, Arlington, Dallas, Grapevine, Keller, Saginaw, and other Tarrant County cities should pay attention to this case. It shows how complicated some of the “Credit Disability Insurance” policies can be.
The opinion in the case was issued by the Houston Court of Appeals, First District, in December of 2011. The style of the case is, Bernice Hudspeth v. Enterprise Life Insurance Company. Here is some background.
On July 5, 2003, Hudspeth purchased a car from a dealership. In conjunction with that purchase, she also bought a disability insurance policy to cover her car payments in the event of her disability. It was a “reducing” policy, meaning that the value of the insurance declined when each car payment was made reducing the balance owed on the vehicle. The back of the credit insurance contract contained the following provision defining disability in a section entitled “DISABILITY INSURANCE COVERAGE”:
TOTAL DISABILITY: means Disability resulting from sickness or injury and which begins while the coverage is in force and causes the insured to be unable to perform the usualy and customary duties of the Insured’s current occupation at the time the disability occurs. The definition changes after twelve (12) consecutive months of Total Disability and requires that the insured be unable to perform the duties of any occupation for which the insured is reasonably qualified by education, training or experience. The Company will not pay disability benefits on the Insured’s behalf unless a doctor of medicine or osteopathy who is licensed by the State Board of Medical Examiners certifies the Insured’s Total Disability to the Company. The insured will be required to give the Company written proof of continuing Total Disability at monthly intervals in order to justify the continuing payment of benefits.
The following provisions related to specific claim procedures are included in a section entitled “RULES FOR FILING A DISABILITY CLAIM”:
NOTICE OF CLAIM: Written notice of the Insured’s claim must be furnished within 20 days after the loss occurs or as soon as reasonably possible.
CLAIM FORMS: The Company will furnish a claim form for filing proof of loss within 15 days, upon request. If a claim form is not received within 15 days, the claimant may submit written proof of disability signed by a licensed physician including the date and cause of the total disability to the Company.
PROOF OF LOSS: Written proof of loss must be furnished to the Company within 90 days. Any subsequent written proof of the continuation of the disability must be furnished to the insurer at such intervals as the insurer may reasonably require. Failure to furnish such proof within the time required shall not [illegible] nor reduce any claim if it was not reasonably possible to give proof within such time, provided such proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity, later than one year from the time proof is otherwise required.
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This writer is going to stop now with the conditions in the policy. The reader needs to know why people such as Hudspeth are forced to seek the assistance of experienced Insurance Law Attorneys to preserve their rights.
In this case, the claim was denied. Hudspeth had to hire an attorney who was forced to file a lawsuit on behalf of Hudspeth. During the law suit there were at least two motions for summary judgment filed. These being attempts to get the case thrown out of court. The conditions listed above are only a partial list of the conditions.
Hudspeth, who became very ill and was unable to work due to a diagnoses of cancer and subsequent surgery, lost her normal health insurance and was forced to see government medical care. Due to the change in medical providers she had complications with getting paperwork properly completed by physicians who were primarily interested in providing medical care, not filling out continuing forms for insurance companies. Thus, this was one of several reasons why Hudspeth was unable to dot all the i’s and cross all the t’s that Enterprise was requiring for Hudspeth to receive benefits.
In the end, Hudspeth prevailed on some of her claims and had less than satisfactory results on other parts. Getting help as soon as it becomes obvious that a claim is not getting processed promptly is key to getting the entire case resolved in a more satisfactory way.
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