Articles Posted in Claims Denial

Weatherford lawyers and those in Mineral Wells, Aledo, Azle, Brock, Willow Park, Graford, Millsap and other places in Parker County need to know about this insurance case and the exception that often can apply.

The style of the case is, Ulico Casualty Company v. Allied Pilots Association. This is a Texas Supreme Court case and the opinion was issued in 2008.

Here is some background:

Grand Prairie lawyers and those in Fort Worth, Dallas, Arlington, Hurst, Euless, Bedford, and other places in North Texas who handle insurance claims would want to know about this article.

The Consumer Federation of America has published an article titled “Low Ball: An Insider’s Look At How Some Insurers Can Manipulate Computerized Systems To Broadly Underpay Injury Claims.”

Here is some information about the article:

Life Insurance Attorneys in Weatherford, Mineral Wells, Peaster, Springtown, Aledo, Azle, Brock, Millsap, Cool, Hudson Oaks, Willow Park, and other places in Parker County would want to read this case.

The case is an appeal in the Corpus Christ Court of Appeals that was issued in 1988. The style of the case is, Lilly Sharp v. Lincoln American Life Insurance Company. Here is some easily understood background.

Lincoln defended the case on the grounds of there being misrepresentations in the policy application. The trial was to the Judge without a jury. A take nothing judgment was entered in favor of Lincoln. Findings of fact and conclusions of law were properly requested and filed.

Insureds in Grand Prairie, Fort Worth, Saginaw, Southlake, Roanoke, Keller, North Richland Hills, and other places in Tarrant County need to understand what their life insurance policy says.

The United States 5th Circuit Court of Appeals issued an opinion in 2008, that is on point. The style of the case is, Quihong Liu v. Fidelity and Guaranty Life Insurance Company.

Here is some of the factual and procedural background.

Policy holders in Grand Prairie, Fort Worth, Dallas, Arlington, Irving, Grapevine, Colleyville, Roanoke, Saginaw, Carrollton, and other places in Dallas and Tarrant Counties would need to know the ways a life insurance claim can be denied.

One common reason for denial of a life insurance claim is that the insurance company says there was a misrepresentation made in the application.

The San Antonio Court of Appeals issued an opinion in 1993, that dealt with this issue. The style of the case is, Carmen L. Garcia v. John Hancock Variable Life Insurance Company. Here are some of the facts.

A person in Weatherford, Mineral Wells, Aledo, Azle, Springtown, Peaster, Willow Park, Millsap, Brock, Hudson Oaks. or anywhere else in Parker County who has a life insurance policy might want to know about the following case.

The case was decided by the El Paso Court of Appeals in 1989. The style of the case is Southwestern Life Insurance Company v. Doris L. Green.

Here is some background.

Someone in Grand Prairie, Fort Worth, Arlington, Irving, Dallas, Mansfield, or anywhere else in Texas may find themselves in a situation where an insurance company is denying a claim based on the insured making a misrepresentation in an application for insurance coverage. Does that mean the insurance company wins? Here is a case that might help with the answer.

The case is styled Union Bankers Insurance Company v. Thomas D. Shelton and Ann Shelton. It is a Texas Supreme Court case decided in 1994.

The Sheltons sued Union Bankers and its agent Donny Stone after Union Banker cancelled Mr. Shelton’s health insurance policy on the basis of an alleged misrepresentation in his application. The Sheltons alleged Union Banker breached the contract and the duty of good faith and fair dealing dealing with improperly canceling the policy.

People in Weatherford, Mineral Wells, Aledo, Azle, Springtown, Peaster, Cool, Millsap, Brock, Willow Park, Hudson Oaks, and other places in Parker County will make mistakes in insurance applications. It just happens. So what if you have a claim denied due to the mistake? Let’s see.

The Houston Court of Appeals, 14th District, issued an opinion in 1991, that is still good law and cited by today’s courts. The style of the case is, Betty Flowers v. United Insurance Company of America.

The basic facts of the case are not in dispute. In November 1987, Betty and her husband, Edward, applied for and were issued a joint life insurance policy with United. In the application for the policy Mr. Flowers was asked a series of questions regarding his health history. In pertinent part, the question asked:

If someone in Grand Prairie, Fort Worth, Arlington, Hurst, Euless, Bedford, Grapevine, Mansfield, or anywhere else in Texas is slow or really late in reporting a claim to their insurance company, can the insurance company get away with denying the claim based on the slow or late reporting?

The answer to the question is short: It depends!

So the follow up is: Depends on what?

Policy holders in Grand Prairie, Fort Worth, Benbrook, Hurst, Euless, Bedford, Saginaw, Newark, Roanoke, Keller, Grapevine, and other places in Texas might wonder about how premium payments affect coverage. Here are two cases dealing with premium payments and both might seem kind of strange but for these folks they were real and had to be dealt with.

The first case is a Dallas Court of Appeals case decided in 2004. The style of the case is Royal Maccabees Life Insurance Company v. James. Here are some of the facts.

Royal Maccabees Life Insurance Company was sued by the surviving spouse of a police officer seeking an additional $50,000 in life insurance proceeds after the insurer paid the basic $50,000 upon the officer’s death. It was undisputed that the insured applied for the additional $50,000 in coverage. It was also undisputed, however, that the insurer never sent a letter to the insured approving the disputed benefits as required by the insurance policy. The insurer denied the additional $50,000 in coverage and refunded the premiums paid for this coverage. The trial court entered judgment on the jury finding that the insurer breached the contract, committed fraud, and violated the Deceptive Trade Practices Act, the Texas Insurance Code and the duty of good faith and fair dealing. The judgment included mental anguish damages, punitive damages, attorney’s fees and pre-judgment interest. An appeal was filed.

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