Articles Posted in Claims Denial

Mineral Wells lawyers who handle insurance cases need to be aware of the different ways that insurance policy cancellations work as it relates to other laws. A 1994, Waco Court of Appeals case shows a good example of this. The style of the case is, Truck Insurance Exchange v. Martin. Here is some information from that case.

On July 13, 1991, an employee of Martin was involved in a truck accident. Mr. and Mrs. Salazar were the driver and the passenger of the vehicle which was rear-ended by the eighteen-wheel Martin vehicle driven by Martin employee Terry Lawley.

The Salazars sued Martin and Lawley. Counsel provided jointly by Harco and by Truck defended Truck. The action was settled by Harco’s payment of $725,000 on behalf of Martin and Lawley. Truck did not participate in the settlement.

Tarrant County insurance lawyers need to know the circumstances that will allow coverage when a late payment of premiums is in the picture and times when the late payment does not make a difference. A 2005, Amarillo Court of Appeals case is a good opinion to read. The style of the case is, Avila v. Loya. Here are some facts.

Avila brought this appeal from a take-nothing summary judgment in favor of Loya. In her appeal, she asserts the trial court erred in granting its summary judgment because 1) issues of fact exist with regard to her claim of misrepresentations made under the Texas Insurance Code, and 2) issues of fact exist as to misrepresentations under 17.46(b)(12) of the Texas Business and Commerce Code.

Avila procured an auto insurance policy from Home State acting through the Agency, covering a policy period ending September 25, 2001, unless extended by the payment of a monthly premium. The policy contained a provision calling for the automatic termination of the policy if the insured failed to pay the continuation premium when it was due. Although a renewal notice was sent, the continuation premium was not paid by its due date. On September 28, 2001, Avila was involved in an automobile accident. On that same day, Avila’s daughter tendered a payment premium check to the Agency, the local agent of Home State. The check was accepted by the Agency which gave the daughter a liability insurance card that showed the period of Avila’s coverage with the effective date as 09/28/01 and the expiration date as 10/28/01.

Insurance lawyers in Saginaw and other Dallas and Fort Worth areas should be able to discuss with a client the significance of a Reservation of Rights letter from an insurance company and what it means. One aspect of this is discussed in a 2003, United States 5th Circuit Court of Appeals case. The case is styled, Esco Transportation Company v. General Insurance Company of America. Here is some of the relevant information from that case.

Esco’s loaded trailer containing a shipment of clothing for Sam’s Wholesale Club was stolen while it was left unattended on a public street. The tractor and trailer were eventually recovered, but not the cargo. The cargo of clothing was valued at $372,000. Esco submitted a claim for the loss of the cargo of clothing to General Insurance and, prior to receiving a response from General Insurance, filed for bankruptcy protection. General Insurance denied Esco’s claim under the “Unattended Trailer Exclusion” contained in the policy after concluding that there were no signs of forced entry into the trailer. In the denial letter, General Insurance expressly reserved all rights, privileges and defenses under the policy. After Esco filed suit for damages and a declaratory judgment of coverage, General Insurance also asserted that Esco failed to comply with the policy’s provisions for establishing loss. The policy provided that General Insurance would cover the loss “in accordance with the Tariff, Bill of Lading, or Shipping Receipt.” After the lawsuit was filed, Esco’s secured creditor substituted into the lawsuit as the real party in interest. Because neither Esco nor his successor were able to produce any document showing its legal liability, the value of the stolen cargo, or the cargo’s owner, the trial court granted summary judgment in favor of General Insurance. This appeal was filed.

The 5th Circuit Court of Appeals affirmed the district court’s grant of summary judgment in favor of General Insurance, rejecting Esco’s argument that by denying the claim based on the “Unattended Trailer Exclusion,” General Insurance had waived any other defenses to coverage. This appeals court found that in the denial letter, General Insurance did not deny the claim on one ground alone but specifically “reserved all rights, privileges and defenses under the policy.” Addressing the legal liability issue, the court noted that while the policy covered Esco’s legal liability for third party loss and Esco presented a conclusory affidavit indicating that it was required to reimburse Sam’s for the value of the cargo, there was no evidence establishing the basis for Esco’s legal liability. Thus, a condition precedent to the coverage had not been met by Esco’s successor in interest and the court saw no need to address the unattended trailer exclusion.

De Soto insurance lawyers who know, will tell you to be aware of surplus lines insurance. These policies often have exclusions to such a degree as to make the insurance meaningless. A 2014, opinion issued by the Dallas Court of Appeals certainly left one insured feeling they had been ripped-off. The style of the case is, Simon v. Tudor Insurance. Here is some of the relevant information.

This is an insurance coverage dispute.

In December 2007, Simon d/b/a Sherlock Pest signed and submitted to Hines, an insurance agent, an application for insurance entitled “Termite & Pest Control General Liability Application.” The application stated “WDI excluded.” Simon also signed an accompanying “Absolute WDI Exclusion” that read: