Claims Denial

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.

Sending Copies Of Lawsuit Papers To Insurance Company

February 27, 2014 | Mark S. Humphreys

Dallas insurance attorneys will advise a client to immediately turn over to the insurance company any lawsuit papers they receive. A 1978, Texas Supreme Court case illustrates why this should be done. The style of the case is, Weaver v. Hartford Accident and Indemnity Company. Here is some of the relevant information.

This is a suit by a judgment creditor against an insurer to recover under an automobile liability policy on the basis of a judgment secured against an omnibus insured. It is stipulated that the alleged omnibus insured failed to comply with the provision of the policy requiring him to forward to the insurer “every demand, notice, summons, or other process” he received. At issue is whether compliance with this policy provision by the named insured, in forwarding the citation which was served on him, should also be held to operate as compliance by the omnibus insured.

Thomas Enterprises is the named insured on a comprehensive automobile liability insurance policy issued by Hartford. The policy defines an “insured” under the policy to be the named insured and any other person using the vehicle with the permission of the named insured. Clyde Busch was an employee of Thomas Enterprises. While driving one of Thomas’ trucks in September 1969, Busch was involved in an accident with Weaver. Notice of the accident was given to Hartford who made an investigation.

Timely Notice Of Insurance Claim

February 25, 2014 | Mark S. Humphreys

Dallas insurance lawyers know to tell their clients to give timely notice of a claim to the insurance company. A 2006, Dallas Court of Appeals case discusses this issue. The style of the case is, Blanton v. Vesta Lloyds Insurance Company. Here is the relevant information.

This is a suit for declaratory judgment concerning insurance coverage. Don Blanton appeals the granting of Vesta Lloyds Insurance Company’s second motion for summary judgment, and Vesta appeals the denial of its initial motion for summary judgment. Because Vesta conclusively established that Blanton breached the “timely notice of occurrence” provision of the policy and that Vesta was prejudiced as a result this court ruled against Blanton.

In June 1997, Blanton leased certain property to Justin Burgess to operate a retail store of “one-of-a-kind restored art-deco furniture and related items.” On August 27, 1998, Vesta wrote a commercial general liability coverage policy for the property; the policy ran for a term of one year.

Total Disability

January 28, 2014 | Mark S. Humphreys

Aledo insurance attorneys need to know how the court interpret “total disability” in an insurance policy. The 1961, Texas Supreme Court case styled, Prudential Insurance Company of America v. Tate is a good case to read for understanding. Here is some of the relevant information.

This policy provided for certain benefits to be paid to Tate in the event he was disabled before reaching the age of 60 years. It was stipulated that Tate was under 60 years of age at the time he claimed he became totally and permanently disabled. Upon answer to special issues in favor of Tate by the trial jury, the trial court granted Tate’s motion for judgment on the verdict for the sum of $2,922, due under the terms of the policy, and $350.64 as 12% penalty provided by statute for failure of Prudential to pay upon demand by Tate.

This court held that the lower courts were in error in determining the amount due under the terms of the policy and reversed the judgments of both lower courts and remand the cause to the trial court.

Denials – Don’t Wait To File A Lawsuit

January 26, 2014 | Mark S. Humphreys

Arlington insurance lawyers know it is a mistake when a lawsuit is not filed asap after a claim is denied. A 1998, Corpus Christi Court of Appeals case illustrates this well. The style of the case is, Pena v. State Farm Lloyds.

This is an appeal from a summary judgment. Here is some relevant information.

The Penas purchased their home in July 1989. The single-story house was built in 1939 with a pier-and-beam foundation system, and a basement. The home’s hardwood floor was installed in 1939 without sub-flooring or a vapor barrier. In 1987, the then-owner, Ward Thomas, Jr., added a bathroom to the master bedroom at the rear of the house. The bathroom sits on a concrete slab foundation. Thomas never experienced any problems with the foundation or plumbing. After purchasing the home, the Penas obtained homeowner’s insurance coverage from State Farm.

What If You Make A Misrepresentation?

January 18, 2014 | Mark S. Humphreys

An experienced insurance law attorney will tell that insurance misrepresentations made by the insured do not always mean “no coverage.”

A 1956, Texas Supreme Court case is a good illustration of the above. The style of the case is, Womack v. Allstate. Here is the relevant information.

This is a summary judgment case. On January 4, 1952, Allstate issued a policy of public liability automobile insurance to Mrs. L. N. Coffee, the wife of William T. Coffee. Malcolm Womack and others, recovered judgment in the 99th District Court of Lubbock County against William T. Coffee for the damages which they sustained on July 20, 1952, when the automobiles in which they were riding collided with a vehicle operated by the latter. Womack instituted this suit to recover the amount of the judgment from Allstate, alleging that at the time of the accident William T. Coffee was driving, with the consent of the insured, the automobile covered by Allstate’s policy. The trial court entered summary judgment for Allstate, and the Court of Civil Appeals affirmed. This court reversed the summary judgment.

Renewing A Policy

December 24, 2013 | Mark S. Humphreys

Insurance attorneys in Dallas need to be able to advise a client when a policy had been properly renewed. An opinion from the Houston Court of Appeals [14th Dist.] helps in this advice. It is a 2009 case styled, Hartland v. Progressive County Mutual. Here is some information to know.

Hartland, obtained auto insurance through Progressive County Mutual Insurance. Policy number 37156966-1 began on November 9, 2003, at 12:01 a.m. and ended on May 9, 2004, at 12:01 a.m. Progressive sent Hartland a renewal bill on April 14, and a renewal reminder on April 23, stating the renewal policy period would run from May 9 to November 9. Hartland claimed he mailed a check in the amount of the renewal premium on May 8; Progressive attached a lockbox report to its counterclaim for declaratory judgment showing the postmark date was May 11. Joan Hartland was in a single-car accident on May 9, 2004 at approximately 8:00 a.m., damaging a car covered under the initial policy.

Progressive presented evidence that it received the check on May 16, and on May 18, sent Hartland a revised renewal declarations page. Policy number 37156966-2 listed coverage dates from May 12, 2004, at 12:01 a.m. to November 12, 2004, at 12:00 a.m., excluding coverage for the date of the accident. Progressive denied the claim, stating the policy was not in effect at the time of the loss.

Insurance Accepts Late Payment

December 22, 2013 | Mark S. Humphreys

Insurance lawyers in Dallas need to be aware of the law as it relates to an insurance company accepting a late premium payment. The Houston Court of Appeals [14th Dist.] issued an opinion in 2009, that dealt with this issue. The style of the case is, Hartland v. Progressive County Mutual Insurance Company. Here is some of the relevant information.

Charles Hartland, filed suit against Progressive, after the denial of an auto-insurance claim for a single-car accident. The jury found Hartland did not mail the premium to renew the policy until after the policy had expired; therefore, he did not have insurance when the accident occurred. On appeal, Hartland contended the parties formed a contract under the terms of the original renewal policy when Progressive accepted his premium payment, and therefore, the policy covered the accident.

Progressive sent Hartland a renewal bill on April 14, and a renewal reminder on April 23, stating the renewal policy period would run from May 9 to November 9. Hartland claimed he mailed a check in the amount of the renewal premium on May 8; Progressive attached a lockbox report to its counterclaim for declaratory judgment showing the postmark date was May 11. Joan Hartland, the wife, was in a single-car accident on May 9, 2004 at about 8:00 a.m., damaging a car covered under the initial policy.

Claim Denial Of Auto Policy Due To Cancellation

December 19, 2013 | Mark S. Humphreys

Fort Worth insurance attorneys will see situations where claims are denied due to policy cancellation. Here is a case that dealt with that situation. It is a Corpus Christi Court of Appeals opinion issued in 2001. The style of the case is, Jones v. Ray Insurance Agency. Here is some of the relevant information.

Jones purchased a new 1998 Pontiac automobile and purchased a State & County Mutual Fire Insurance Company (insurer) insurance policy from Ray and Harbor Insurance covering the automobile. Jones discussed with Ray that her sister lived with her, and was advised by him that would not be a problem, and as long as she paid the premiums on time she would have insurance. The policy excludes coverage for anyone residing with Ray age fourteen or over unless listed. Ray paid the November and December premium payments. The policy was effective from November 7, 1997 through May 7, 1998.

On December 28, 1977, Jone’s automobile was severely damaged when hit by another automobile driven by an uninsured drunk driver. Her vehicle was towed to Collision Clinic, Inc. The day after the accident, Jones was told by the insurer that she was in the computer and was fully covered by the insurance policy. Less than thirty minutes after she was told she was covered, Jones received a call from the insurer and was told she no longer was covered by the policy. At first appellant was told the policy was cancelled because she had not excluded her sister as a driver. Later she was told that the cancellation was because she had not provided a copy of her driver’s license. Ray alleged the notice of cancellation was sent by letter on November 25, 1997, to Jones at 9109 Fondren # 605, Houston, Texas 77074, but Jones denies receiving the letter and notice of cancellation. The letter allegedly advised Jones that her insurance policy would be cancelled on December 4, 1997. Ray has not returned Jones’s December 1997 premium payment or any part thereof.