The Western District, San Antonio Division issued an opinion in a case that helps an insurance company keep his client’s case out of Federal Court by suing the insurance agent. The opinion is styled, The New World Baptist Church, LLC v. Nationwide Property and Casualty Insurance Company, Kevin P. McLoughlin,…
Most insurance lawyers want to keep their cases out of Federal Court. One way of doing this, if the opportunity exists, is to find fault with the way an adjuster handled the claim. This is illustrated in a Northern District, Dallas Division opinion styled, Arlington Heights Memorial Post No. 8234…
ERISA lawyers will fight whether a prescribed treatment is medically necessary on a routine basis. The courts will interpret the policies in favor of the insurer. This case is from the Northern District, Dallas Division. It is styled, Charlize Marie Baker v. Aetna Life Insurance Co., et al. Baker, who…
As strange as this one may seem, it is actually fairly common. This is a Southern District, Houston Division opinion styled, Gavion et al v. ACE American Insurance Company. In 2009, Gavion swerved into the path of a train. He was driving under the policy of his mother’s employer. A…
The case discussed here is from the Houston Division, Southern District. The style of the case is Connecticut General Life Insurance Company, et al v. Elite Center For Minimally Invasive Surgery LLC, et al. This is a Motion for Clarification. Connecticut (Cigna) sued under ERISA, Section 502(a)(3) to enforce and…
The Fort Worth court of Appeals issued an opinion in May 2017, that illustrates the wrong way to pursue a claim and lawsuit for storm and hail damage. The opinion is styled, Richard Seim and Linda Seim v. Allstate Texas Lloyds and Lisa Scott. This a motion for en banc…
Either the insurance company or the insured has a right to demand an appraisal in lots of property insurance contracts. The Waco Court of Appeals issued an opinion recently that discusses these appraisal clauses. The case is styled, In Re GuideOne Mutual Insurance Company. This case is a writ of…
Lawyers handling Employee Retirement Income Security Act (ERISA) cases need to read this 5th Circuit opinion. It is styled, Ariana M. v. Humana Health Plan of Texas, Incorporated. Ariana is a dependent eligible for benefits under the Eyesys Vision Inc. group health plan administered by Humana. The plan’s benefits include…
Stephenville insurance lawyers know that Credit Life and Disability claims are denied way too often. The reason for denial is almost always the allegation that there was a misrepresentation in the policy application. This issue is discussed in a 1983, Houston Court of Appeals [1st Dist.] opinion. The opinion is…
As all insurance attorneys should know, intent to deceive is a requirement that has to be proved for an insurance company to deny a claim based on a misrepresentation. Even when faced with irrefutable evidence of a misrepresentation, intent to deceive still has to be proved. Due to the inherent…