Grapevine insurance attorneys need to be able to recognize when fraud or misrepresentation occurs in the insurance context.
To accuse an insurance agent or insurance company of fraud there needs to be proof of the following elements:
1) a material representation was made;
Tarrant County lawyers need to be able to understand the case facts that will get them to exemplary damages. To know the difference between the threat of and the reality of getting them based on what transpired in the case.
Texas case law clearly allows for the recovery of exemplary damages in cases involving violations of the Texas Insurance Code and violations of the Texas Deceptive Trade Practices Act (DTPA). In 1994, the Texas Supreme Court issued an opinion in the case styled, Transportation Insurance Co. v. Moriel.
In Moriel, which was a “bad faith” case, the court held that the plaintiff must show that the insurance company had “no reasonable basis” to deny or delay payment of the claim and that the insurance company committed an act that was likely to cause serious injury beyond the injury associated with the underlying breach of the insurance contract. The court suggested that punitive damages could be recovered if the insurance company denied coverage for medical care knowing the insured would suffer serious injury, or denied disability coverage with the inherent extraordinary degree of hardship that would result.
Mineral Wells insurance lawyers need to know the difference between first party claims and third party claims and how that relates to bad faith insurance claims.
The Texas common law duty of good faith and fair dealing extends protection to the insured, whether the insured obtained the insurance coverage directly or coverage was obtained some other way for the insured. The 1987, Texas Supreme Court, in the case, Arnold v. National County Mutual Fire Insurance Co. recognized a common law duty of good faith and fair dealing owed to an insured, which arises from the “special relationship” established by the insurance contract. In the 1988 case, Aranda v. Insurance Company of North America, the Texas Supreme Court extended this duty of good faith and fair dealing to a worker insured under a workers’ compensation policy purchased by his employer.
An injured third party claimant lacks standing to sue the negligent driver’s liability insurance company for breach of the duty of good faith and fair dealing. We know this from the 1994 Texas Supreme Court case, Allstate Insurance Company v. Watson.
Dallas insurance lawyers should be able to discuss all of the enclosed with you.
The Texas Insurance Code, Section 542.055, says an insurance company shall acknowledge receipt of a claim within 15 days after they receive notice of a claim and begin its investigation and request from the claimant all they reasonably need at that time to further their investigation. So what happens after that?
No additional deadlines are triggered until the insurance company receives all items, statements, and forms reasonably required by the insurance company. Once the insurance company receives that information, seven new responsibilities arise:
Parker County lawyers who handle insurance cases need to know some of the duties imposed on insurance companies when handling a claim for benefits.
The Texas Prompt Payment of Claims Act is found in the Texas Insurance Code. It details the duties imposed on an insurance company when a claim is made.
When an insurance company receives notice of a claim from one of its insureds, there are four duties that are imposed on them.
Here is some information that all Dallas and Fort Worth insurance lawyers should know.
The Texas Insurance Code sections and Deceptive Trade Practices Act(DTPA) were adopted together by the Texas Legislature in the 1970’s as part of a reform legislation package. They are interrelated and incorporate each other.
Texas Insurance Code, Section 541.008 tells us the provisions of the Code are to be liberally construed and applied to promote its underlying purposes to define and prohibit unfair and deceptive practices in the business of insurance.
Dallas insurance lawyers need to know insurance misrepresentation when they see it. The Texas Insurance Code Section 541.061(2) makes it illegal for an insurance company to fail to disclose relevant information. The Texas DTPA does the same thing in Section 17.46(b)(24). There are several sections of the insurance code that make misrepresentation illegal, most of which is found in Chapter 541.
Section 541 prohibits making any statement, whether it is oral or in writing, misrepresenting the terms of a policy, the benefits, advantages, or dividends of a policy, among other things. The purpose of the statute of in preventing one insurer to make misrepresentations in efforts to induce a policyholder from changing to another company.
Section 541.052 prohibits making any advertisement or statement containing any assertion, representation, or statement with respect to the business of insurance or with respect to any person in the conduct of his insurance business that is untrue, deceptive, or misleading, whether it be oral or in writing.
Dallas insurance attorneys should know examples of the ways insurance companies commit bad faith insurance code violations with their insured customers.
Most of these violations can be found in Chapter 541 of the Texas Insurance Code. The Texas Department of Insurance is a place to go to file a complaint when the insurance company commits an unlawful act. But for the consumer who really wants something done about a wrong an insurance company commits, it is necessary to seek the assistance of an experienced Insurance Law Attorney.
Here are some examples of unfair settlement practices found in the Texas Insurance Code, Section 541.060:
Dallas insurance lawyers will find that misrepresentations by insurance agents and companies are a big area of litigation in insurance cases.
One of the most common reasons for an insurance dispute is the complaint that someone misrepresented something. Sometimes it is the company saying the insured made misrepresentations in the insurance application and other times it the insured saying the insurance agent or the company made a misrepresentation. After a claim is made, the insured may feel that the coverage accepted by the insurance company is less that the coverage promised at the time of the sale. Depending on the facts of the case, a representation by the insurance company or its agent may lead to liability for breach of contract, unfair insurance practices, deceptive trade practices, negligence or fraud.
There is a Houston [14th] Court of Appeals case decided in 2003, which says an insurance company can sue one of its own agents for misrepresentation, if the agents conduct results in liability for the insurance company. This happens quite frequently.
Parker County lawyers need to have a basic understanding of how to see bad faith insurance when it happens.
To understand the different ways disputes can arise, it is helpful to consider the sequence of events that are likely to occur. To do this, try to divide the purchase of insurance into the initial sale of the policy by an agent and the the subsequent handling of a claim when one is made. Here is a further breakdown.
A) The sale of the policy. To begin with, the consumer and insurance company and insurance company agent must communicate to establish an insurance contract relationship. Disputes may arise over what was asked for by the person trying to purchase insurance, who was represented by the agent, or the timeliness of the insurance company or agent in providing coverage. Issues may also arise about the honesty of the applicant or the agent in discussing information requested by the insurance company.
Dallas Fort Worth Insurance Lawyer Blog