This may come as a surprise to many but here goes, — There is no such thing as “negligent claims handling” recognized by Texas courts. This is re-stated by the U.S. District Court, Western District, Austin Division, in the case styled, Thomas G. Kezar and Sylvia Kezar v. State Farm…
The 5th Circuit Court of Appeals issued an opinion regarding commercial policies that would be of interest to some businesses. The case is styled, Sierra Equipment, Incorporated v. Lexington Insurance Company. Lexington insured LWL Management for construction equipment leased from Sierra. Sierra argues that, even though it was not a…
Insurance cases involving umpire’s are a little different. The Amarillo Court of Appeals issued an opinion on May 14, 2018, styled, Mahmoud Abdalla v. Farmers Insurance Exchange. The case deals with, among other issues, when an umpire’s appraisal award can be challenged. This case is an appeal by Abdalla from…
Here are a few articles for insurance lawyers handling commercial policy cases. Commercial auto policies often contain business use exclusions that exclude coverage when a scheduled auto is used “in the business” of a lessee. A policy containing such a provision is effectively know as a “bobtail” or “non-trucking use”…
Lawyers who handle Employee Retirement Income Security Act (ERISA) claims will tell that insurance claims made on an individual policy and claims made on an ERISA plan are remarkably different. ERISA requires that the insurer or third-party claims administrator engage in a dialogue with the claimant about the claim and…
Discretionary Clauses in Employee Retirement Income Security Act (ERISA) policies — In protecting deference in the face of substantial claims procedure violations, the United States 5th Circuit’s position not only conflict with other United States Circuits but with the Texas Department of Insurance and other state insurance commissioners regarding what…
The United States 5th Circuit Court of Appeals has never found sufficient claims procedure abuse to warrant a change in the standard of review from abuse of discretion to a preponderance of the evidence in an Employee Retirement Income Security Act (ERISA) case. In that regard, the court has noted…
Lawyers handling Employee Retirement Income Act (ERISA) cases will tell you that the answer to the above question is … nothing happens. Generally, the United States Supreme Court has not allowed any remedy that is not clearly expressed within ERISA’s provision 29 U.S.C. Section 1132. Section 1132 allows for injunctive…
The Employee Retirement Income Security Act (ERISA) is governed by federal statutes. The claims procedures originate from 29 U.S.C., Section 1133 and 1135. Section 1133(1) requires that a carrier or claims administrator provide adequate notice of the reasons for denial that can be readily understood by the claimant. Section 1133(2)…
Employee Retirement Income Security Act (ERISA) issues can be more onerous than most people can imagine. Most people who get their insurance from work do not think about it except the the extent of how much it costs, the extent of coverage, and which providers are in the network. Rarely…