Claims Denial

Disability Policy Claim Denial

September 9, 2014 | Mark S. Humphreys

Dallas insurance lawyers who handle disability policy’s need to be aware of an opinion from the United States District Court, Houston Division. The style of the case is, Fernandez v. Mutual of Omaha Ins. Co. Here is the relevant information.

The cross-motions for summary judgment in this disability insurance dispute raise one legal issue: whether the statute of limitations bars the plaintiff’s causes of action. The answer depends on when the limitations periods began to run. If the defendant insurer’s July 27, 2009 letter to the plaintiff insured legally denied the claim, then, as the plaintiff concedes in his brief, all his causes of action are barred. If, as the plaintiff contends, the July 27, 2009 letter did not legally deny the claim, the causes of action alleged did not accrue until the policy terminated when he became 65, and the action is timely filed.

Based on the undisputed facts in the summary-judgment record, the July 27, 2009 letter repeating an earlier letter stating that the plaintiff’s benefits claim was “inactive,” legally denied the claim. The statutory and extracontractual claims had to be brought by July 27, 2011. The breach of contract claim, subject to a three-year contractual-limitations period, had to be brought by July 27, 2012. Fernandez filed this suit on September 30, 2013, well after all limitations periods had expired.

Damages For Claim Denial

August 19, 2014 | Mark S. Humphreys

Mineral Wells insurance lawyers need to be able to discuss the value of a claim with a client when asked. It is often times difficult to do so. Sometimes part of the value is easy to determine while other parts are very difficult. For instance:

If a $200,000 house burns down and your insurance company denies the claim, it is easy to calculate the base value of the claim, i.e., the $200,000 for the value of the house. Losses such as mental anguish, if it can be proved the insurance company acted improperly in a knowing and intentional manner in the denial of your claim, is harder to determine.

The United States District Court, Northern District of Texas, issued an opinion in 2008, that helps determine damages as it relates to the attorney fees incurred by the claimant due to the wrongful denial of benefits by the insurance company. The style of the case is, Trammell Crow Residential Co. v. Virginia Surety Co., Inc. Here is some of the relevant information to know.

Insurance Company Backs Down

August 7, 2014 | Mark S. Humphreys

Parker County insurance attorneys need to keep up with events happening in the insurance legal world. An article from The Texas Tribune titled, “Insurer Drops Suit Against Tyler Widow” is worth knowing about. Here is what the article tells us.

Crystal Davis, a stay-at-home mom from Tyler, got some welcome news in her battle against an insurance company that sued to cut off the workers’ compensation benefits she got after her husband was killed on the job.

Davis’ lawyer called to inform her early Thursday evening that ACE American Insurance had dropped its lawsuit against her and her children. Davis’ story was featured in The Texas Tribune’s four-part series published this week, Hurting for Work, about the struggles people face after they or their loved ones are hurt or killed on the job in Texas.

Death Benefits Denied

August 5, 2014 | Mark S. Humphreys

A Fort Worth life insurance attorney will want to know the best way to handle a situation where death benefits are denied a beneficiary. The Texas Tribune ran an article that shows how bad some situations can be. Here is what the article says.

Crystal Davis was headed to the grocery store when the text message popped up on her phone. It was from her next-door neighbor.

“Can you come home?” it said. “Something has happened.”

Accidents And Tragic Situations

August 3, 2014 | Mark S. Humphreys

Fort Worth insurance lawyers will see some pretty tragic situations where a person is ill treated by an insurance carrier. The Texas Tribune ran a story talking about tragic situations in July 2014. The title of the story is, “After Catastrophic Fall, The Fight Of One Worker’s Life.” Here is what it tells us.

Along a street lined with warehouses on the east side of Houston, nine Mexican laborers working about 20 feet off the ground are tearing up a concrete roof with hand-made pick axes.

They are chiseling it out, one mattress-sized panel at a time, then shoving the debris onto the floor below. There’s a giant pile of rubble down there, a jumble of dirty insulation, tar-covered roof decking and fire-suppression water pipes ripped from the building’s interior.

Life Insurance And Tragic Situations

August 2, 2014 | Mark S. Humphreys

Dallas life insurance attorneys will run across tragic situations in their legal practice. The Texas Tribune has published an article describing some of these situations. It is titled, “Behind Texas Miracle, A Broken System For Workers.” Here is what it tells us.

Drive almost anywhere in the vast Lone Star State and you will see evidence of the “Texas miracle” economy that policymakers like Gov. Rick Perry can’t quit talking about.

From the largest U.S. refinery in Port Arthur to the storied Permian Basin in West Texas, Big Oil is back. In formerly depressed South Texas, gas flares from the fracking boom can be seen from outer space.

Homeowners Policy And Fire

July 29, 2014 | Mark S. Humphreys

Insurance law attorneys will one day see a claim wherein the insurance company is denying a fire loss by asserting that the fire was the result of arson by the homeowner. The Houston Court of Appeals [14th Dist.] issued an opinion in a case wherein that denial occurred. The style of the case is, American Risk Insurance Company, Inc. v. Ahmad Abousway and Ibrahim Abousway. Here is the relevant information from that case.

Ahmad and Ibrahim Abousway had a homeowner insurance policy with American Risk Insurance Company, Inc., insuring a home the two brothers bought together in early 2008. The policy included coverage for fire loss. Following a 2010 fire that rendered the home uninhabitable, the Abousways submitted a claim for losses under the policy. American Risk hired a fire expert to investigate the fire. Based on his findings, American Risk refused payment of the claim until further investigation had concluded.

The Abousways sued American Risk, asserting claims for breach of contract and violations of chapters 541 and 542 of the Texas Insurance Code. American Risk answered the suit, asserting that the fire was an act of arson, thereby voiding the policy. The case was tried to the bench.

Who Can Sue For A 1st Party Claim?

June 24, 2014 | Mark S. Humphreys

Insurance lawyers in Grand Prairie can answer the above question for you. This issue was also discussed in the 1994, Texas Supreme Court case styled, Allstate Insurance Company v. Watson. Here is brief information relevant to the opinion.

Watson was injured in a car accident. Watson brought suit against the insured under an automobile liability policy issued by Allstate and also brought suit against Allstate alleging unfair claim settlement practices under Texas Insurance Code, Section 541.060, for failing to attempt in good faith to effectuate prompt settlement where liability had become reasonably clear. Watson also brought suit under the Texas Deceptive Trade Practices Act, breach of contract, and the common law duty of good faith and fair dealing. The trial court granted Allstate’s Motion for Summary Judgment against Watson. The Court of appeals reversed and remanded the trial court, holding that Watson, as a third-party beneficiary, could bring an action under Section 541.060 without first proceeding directly against the named insured of the policy.

The Texas Supreme Court held that Section 541.060 does not confer upon third-party claimants a direct cause of action against an insurer for unfair claim settlement practices. Under Section 541.060 is an exclusive list of statutory unfair or deceptive acts or practices. However, this section does not define unfair claim settlement practices as an unfair or deceptive act or practice. It provides a private cause of action for any practice defined by Section 17,46 of the DTPA as an unlawful deceptive trade practice. However, unfair claim settlement practices is not among the enumerated items defined by Section 17.46.

Life Insurance And Missed Payments

April 19, 2014 | Mark S. Humphreys

North Richland Hills Lawyers who handle life insurance claims can read this case and then tell potential clients they better hire an attorney. This case is from the United States District Court, Northern District, Fort Worth Division. The style is Doretha Hall v. Fidelity & Guaranty Life Insurance Company. Here is the relevant information.

Fidelity issued a term life insurance policy to Mr. Hall in the face amount of $75,000.00. In his application, Mr. Hall designated Doretha as the beneficiary of the policy, and no changes to that designation were ever made. Mr. Hall also requested the premium payments be drafted from his checking account. However, the payment due November 1, 2010, in the amount of $73.65, was rejected because Mr. Hall’s checking account was closed. On November 8, 2010, Fidelity sent a notice of the rejected payment to Mr. Hall’s home address. On December 3, 2010, Fidelity sent Mr. Hall a late payment notice informing him that his premium payment was past due and that the policy would lapse if the premium was not paid by the end of the grace period. When Fidelity still had not received any payment, it sent a second late payment notice on January 3, 2011, informing Mr. Hall again that his payment was past due and that his policy would lapse if the premium was not paid by the end of the grace period. On February 2, 2011, Fidelity mailed Mr. Hall a lapse notice indicating that Mr. Hall’s policy had lapsed and terminated on December 2, 2010, because Mr. Hall had failed to pay his premiums. The lapse notice expressly stated that to apply for reinstatement, Mr. Hall must complete the enclosed application for reinstatement and submit it with the past due premium amounts. On February 10, 2011, Fidelity received a check in regards to Mr. Hall’s policy in the amount of $73.65. Fidelity held the check in suspense and then refunded it to Mr. Hall on March 18, 2011, because Fidelity did not receive a reinstatement application or the remaining past-due premiums.

Doretha notified Fidelity of Mr. Hall’s death on April 17, 2011. However, Fidelity denied the claim for benefits under Mr. Hall’s policy because the policy had lapsed and terminated for nonpayment of premiums prior to Mr. Hall’s death.

Notice To Lien Holder Of Cancellation

March 27, 2014 | Mark S. Humphreys

Fort Worth insurance attorneys will come across situations where a claim is denied based on the policy having been cancelled for one reason or another. But what if there is a lien holder and the lien holder is not notified of the policy cancellation.

That was the issue in a February 2014, opinion by the United States Court of Appeals for the Fifth Circuit. The style of the case is Molly Properties, Incorporated v. The Cincinnati Insurance Company. Here is the relevant information.

The insurer, The Cincinnati Insurance Company (“Cincinnati Insurance”), issued a policy that covered a commercial property owned by the insured, Molly Properties, Incorporated (“Molly Properties”). After the policy lapsed for nonpayment of premiums, a fire damaged the covered property. Upon the denial of its claim for property damage, Molly Properties sued Cincinnati Insurance for breach of contract. The district court held that the policy was no longer in effect when the fire occurred, and granted summary judgement to the insurer. Molly Properties contended that the district court erred when it found that the policy had been cancelled at the time of the fire because Cincinnati Insurance failed to give notice to the mortgagee on the property before it cancelled the insurance, as required by the policy. This court affirmed that ruling.