Claims Denial

Insurance Claim Denial And Wine?

May 28, 2022 | Mark S. Humphreys

Here is an interesting claim denial. The case is a 2022, from the Southern District of Texas, Houston Division. It is styled, Sergio and Maria Weitzman v. Allstate Vehicle and Property Insurance Company.

The Weitzman’s bottle wine in Argentina and sell it, for money, to and through their Texas company, Serca Wines, LLC. In 2019, a fire destroyed 7,727 bottles stored in Argentina awaiting shipment to, and sale from, the United States. The Weitzman’s made a claim through their homeowners policy for the loss. The policy covered personal property located away from the residence, but with a business property coverage limit of $200.00. Allstate paid $200.00. The Weitzman’s, representing themselves sued Allstate alleging the wine business is a hobby and that the bottles were personal property. They sued for the policy limits of $303,000.00.

The undisputed facts in the record, which includes the tax returns for the relevant period and a few invoices, as well as responses to written discovery, show that as a matter of law, the $200.00 policy coverage limit for business property located away from the insureds’ residence applies. Allstate’s motion for summary judgment was granted.

Claims Denial Attorney – Watch For Limitations

May 7, 2022 | Mark S. Humphreys

Being aware of when the statute of limitations runs on a claim is vital so that the limitations period does not expire. This is illustrated in the 2022, opinion from the Western District of Texas, San Antonio Division. The opinion is styled, Tobin Endowment v. Great American Assurance Co.

Tobin Endowment is the insured and Great American is the insurer.

Tobin filed this lawsuit on August 23, 2020, claiming that Great American underpaid the claimed loss. Great American eventually filed this Motion For Summary Judgment stating to the Court that Tobin let too much time expire and that Tobin’s claim is barred by the statute of limitation stated in the policy.

Insurance Claims And Lawsuits

May 2, 2022 | Mark S. Humphreys

Most insurance claims will not end up in a lawsuit. However, for those claims that do end up in a lawsuit it is important for the insured to understand their responsibilities when in the lawsuit. The failure of a party to the lawsuit to cooperate in the litigation process can be fatal to the lawsuit.

The above is illustrated in a 2022, opinion from the Austin Court of Appeals. The opinion is styled, Michael V. Wright and Phyllis F. Wright v. State Farm Lloyds.

The Wrights were insured by State Farm with a homeowners policy. The Wright’s suffered losses stemming from two fires to their residence. One in 2013, and the other in 2015.

Insurance Claim Denial And Attorney Fees

April 23, 2022 | Mark S. Humphreys

An often asked question by insureds having a claim against their insurance company is, “Can I recover my attorney fees?” There is not a simple straight forward answer to this question. Many variables come into play. “Yes” is a simple answer but does not get into the variables.

A 2022, opinion from the Northern District of Texas, Dallas Division, discusses this issue as it relates to claims under Texas Insurance Code, Section 542A.003. The style of the opinion is, Betty Rahe v. Meridian Security Insurance Company D/B/A State Automobile Mutual Insurance Company and Larysa Santiago.

Plaintiff sued Defendant on a claim arising from wind and hail damage to her property.

Insurance Lawsuits Can Be A Lot Work For The Insured

April 18, 2022 | Mark S. Humphreys

There is lots of information available about actions to be taken before a lawsuit is filed. There is also a lot of information available about the potential wrongs of an insurance company, it’s agents and adjusters. What is rarely discussed is the work an insured has to do in a lawsuit. When we say”insured” we are speaking of the person, not the person’s lawyer.

This issue can be seen in a 2022 opinion from the Austin Court of Appeals. The style of the opinion is Michael V. Wright and Phyllis F. Wright v. State Farm Lloyds.

In this case, the Wrights sued State Farm for breach of contract and various violations of the Texas Insurance Code. The lawsuit arose out of the way the Wrights were treated after they made a claim for benefits after a fire loss.

Insurance Company Trying To Rescind Policy

February 26, 2022 | Mark S. Humphreys

Bad Faith Insurance Lawyers understand the law in Texas, at least as of the date of this post, requires that an insurer show that any misrepresentation made in an application for insurance be shown to have been made intentionally for the insurance company to be able to rescind the policy based on that misrepresentation.

This issue came up in a 2022, case from the Fort Worth Court of Appeals. The case is styled, Maria Robles, J.S. and Jose Almaguer Vazquez v. Cox Insurance Group, LLC and Old American County Mutual.

This is an appeal from a summary judgment granted in favor of the insurer by the trial court.

Insurance Claim Denial And Amount In Controversy

January 31, 2022 | Mark S. Humphreys

Insurance lawyers try to evaluate the value of a claim when talking with a prospective new client. Guess what? Federal Judges do the same with cases removed to their Court from the State and County Courts. This is seen in a 2021 opinion from the Southern District of Texas, McAllen Division. The opinion is styled, Macario Saenz v. State Farm Lloyds.

This is a dispute over the amount of damage resulting from a hurricane claim between Saenz and State Farm.

A lawsuit was filed in State Court and State Farm removed the case to Federal Court pursuant to 28 U.S.C., Section 1332, based on the amount in controversy exceeding $75,000. Saenz filed a motion to remand.

Insurance Claim Denial And Remand

December 27, 2021 | Mark S. Humphreys

Insurance lawyers need to understand every way possible for maintaining their case in State Court whenever possible. It is not possible too often, so when it is possible it needs to be done.

This 2021, opinion from the Northern District of Texas, Dallas Division, shows how one case was allowed to be in State Court. The opinion is styled, Richard Conrad and Brenda Conrad v. Cincinnati Insurance Company and John W. Schuster.

This is a property insurance coverage dispute. The Conrads sued Cincinnati and Schuster, an employee of Cincinnati who adjusted the claim, for various violations of the Texas Insurance Code and breach of contract after the Defendants concluded there was minimal damage to the property. Suit was filed in State Court and the Defendants had the case removed to Federal Court based on diversity jurisdiction and the assertion that Schuster was improperly joined in the lawsuit. The Conrads filed a Motion to Remand the case back to the State Court.

Insurance Company Denies Claim And Wins At Trial – Recourse?

December 13, 2021 | Mark S. Humphreys

The vast majority of insurance claims that get denied are settled. Less than 2% of these cases actually result in trial. When there is a trial, the odds are typically with the insurance company prevailing. That is what happened in this 2021, verdict in a case from the Southern District of Texas, Houston Division. The case is styled, Shane and Shannon Richardson v. Liberty Insurance Co.

The Richardson’s claimed damage to their roof and part of the interior of their home from a storm. Liberty inspected the damage and denied the claim based on their assertion that the covered damages were less than the deductible.

The case was tried to a jury and the jury found in favor of Liberty on the breach of contract damages but found that Liberty engaged in “false, misleading and deceptive acts or practices in the business of insurance in this case” and “misrepresented to the Richardsons the scope or cause of the damage from wind or hail,” in violation of the Texas Insurance Code, Section 541.001 et seq. The jury awarded no damages for any claim, but, based on finding that Liberty’s violation of the Insurance Code was “knowing,” the jury awarded the Richardson’s $7,082.54 in “additional” damages.

Suing Wrong Insurance Company – Removal

December 11, 2021 | Mark S. Humphreys

Here is an insurance law situation not seen very often. This is a 2021, opinion from the Western District of Texas, San Antonio Division. It is styled, Amali Obaya v. Allstate Vehicle & Property Insurance Company.

Obaya owned property in San Antonio that was insured by a policy of insurance, when the property was damaged in a wind/hailstorm. A claim was submitted. Obaya asserts that her claim was unreasonably investigated, improperly adjusted, and that the Defendant wrongfully denied the claim. Obaya sued Allstate Vehicle and Property Insurance Company for violations of the Texas Insurance Code, DTPA, breach of contract, and other causes of action. The lawsuit was filed in State Court. No claims were asserted against Allstate Texas Lloyd’s in State Court, nor did Allstate Texas Lloyd’s utilize procedural means to become an actual party to the lawsuit.

Allstate Texas Lloyd’s removed the case to this Federal Court. Plaintiff timely moved to remand, arguing that Allstate Texas Lloyd’s was not an actual party to the state court action and thus lacked the power to remove the case to federal court.