Sending a proper notice letter is the first step in a legal process against an insurance company when an insured believes the insurer has improperly handled a claim. This is even more relevant under the new section of the Insurance Code, Section 542A.003. This is also required in Section 541.154. …
Insurance agents who do not sell the insurance policy that was requested by their customer can be held liable for selling the wrong policy or misrepresenting the policy. This is illustrated in the Northern District of Texas, Dallas Division, opinion styled, Steve and Ellen Malone v. Blue Cross and Blue…
Insurance policies are of two types of it relates to the coverage of a claim. One is called an “occurrence” policy. An occurrence policy covers losses that occur during the policy period. The other type of coverage is a “claims made” policy. A claims made policy covers claims that are…
In an ERISA case, the plan administrator, upon request, is required to give a copy of the claims file to the insured. The most common way this occurs is when a claim is denied, the plan administrator informs the insured of the denial in a written letter and in the…
Statute of Limitations issues are not usually seen in ERISA cases, but here is one. This is a 2019, opinion from the Southern District of Texas, Houston Division. It is styled, Cynthia Sternberg v. Metlife Insurance Company. This case is currently before the Court on a Rule 12(b)(6) Motion to…
How do you calculate the beginning date and end date for violation of the Texas Prompt Payment of Claims Act? The start date was calculated in the previous post. Here is a discussion on the end date for calculation. The statute does not say when the penalty stops accruing. No…
When does the time to start calculating the time a payment is due under an insurance policy claim? Good question but not an easy answer. The penalty for violation of the Texas Prompt Payment of Claims Act is an 18% penalty on the amount due and owing on the claim…
Uninsured motorist (UM) claims are in a category unto themselves. This is illustrated in a 2019, opinion styled, Ali Duhaly v. The Cincinnati Insurance Company. The opinion is from the Southern District of Texas, Houston Division. Duhaly sued Cincinnati alleging breach of contract, among various other causes of action. Duhaly…
Here is a situation where a lawsuit to which Texas Insurance Code, Section 542.006 applies. The remedy this Court applied to the case appears to be a distinction without a difference. The case is a 2019, Southern District of Texas, Laredo Division, opinion. The case is styled, Axel Brokers, Inc.…
Here are some new laws enacted in the State of Texas that went into effect on September 1, 2019. There were several transparency and consumer protection bills that were passed in the wake of Hurricane Harvey. The most significant bills were related to flood, wind, and hail, although significant legislation…