Claims Handling Process

Gripes About Insurance Arbitration Requirements

December 2, 2012 | Mark S. Humphreys

Grand Prairie insurance attorneys and those in Duncanville, De Soto, Cedar Hill, Lancaster, Irving, Mesquite, Garland, and other places in Dallas County need to know changes that are being contemplated by the Texas Department of Insurance.

One change currently being contemplated is good news for insurance policy holders. Here is an excerpt from a bulletin put out recently.

“The Texas Department of Insurance is considering a rule to prohibit pre-dispute mandatory binding arbitration provisions in insurance products.

Agent Responsibility For Informing Of Policy Expiration

November 8, 2012 | Mark S. Humphreys

Fort Worth Insurance Law attorneys need to know the responsibilities of agents in order to know when an agent has violated duties it owes to its insureds.

A 1992, opinion issued by the Amarillo Court of Appeals is noteworthy for the guidance its gives on this matter. The style of the case is, Horn v. Hedgecoke Insurance Agency. Here is some of the relevant information.

This appeal presents the novel question whether an insurance agency, through which an insurance policy was issued naming a mortgagee to whom a loss was payable and who paid the premium, has a duty of reasonably informing the mortgagee of the expiration and non-renewal of the policy by the named insured.

Agent Did Not Inform Insured Of Policy ExpIration

November 6, 2012 | Mark S. Humphreys

Parker County Attorneys who handle insurance cases need to know case law that will help clients. So, what does case law tell an attorney about agent responsibilities about keeping customers informed as to when a policy is fixing to expire?

In 1985, the Texas Supreme Court issued an opinion in the case styled, Woodie Kitching et ux. v. Pete O. Zamora. Here is what this case tells us.

This is an appeal that arises from a negligence lawsuit brought by Woodie and Sandra Kitching against their flood insurance agent, Pete O. Zamora. At issue is whether an insurance agent can be held liable for failing to keep a customer informed about the expiration date of the customer’s insurance policy. The trial court rendered judgment for the Kitchings. This Court upheld that judgment.

Insurance Attorneys And Reading The Policy

October 23, 2012 | Mark S. Humphreys

Fort Worth insurance attorneys and those in Benbrook, Burleson, Crowley, and other parts of Tarrant County need to keep up with recent cases.

Here is one that was decided on September 2012. The style of the case is, Wendy Rutherford Branham v. State Farm Lloyds. The opinion was issued by the San Antonio Court of Appeals.

Branham sued State Farm Lloyds for failing to provide a defense and indemnity with regard to a lawsuit filed against her by Patrick and Melissa McCullough. The McCulloughs’ lawsuit was based on a contract they entered into with Branham to purchase a home from her. In their petition, the McCulloughs alleged that Branham “falsely represented that there was no (1) previous flooding into the home, (2) water penetration into the home, (3) active infestation of termites or other wood destroying insects, (4) previous termite or wood destroying insect damage repaired, and (5) termite or wood destroying insect damage needing repair.” The McCulloughs further alleged that Branham “failed to disclose to Plaintiffs the previous problems with water penetration and damage to the home and that Ms. Branham had filed a homeowners’ insurance claim for water damages sustained in the home.” The McCulloughs also claimed that although Branham “was paid on these water damage claims by her homeowners’ insurance carrier,” she “did not make proper repairs to the home or if she did, only made cosmetic repairs to conceal the damages.” The McCulloughs asserted numerous causes of action against Branham based on these allegations including: (1) fraudulent concealment for making affirmative false representations or omitting to disclose material facts, alleging the representations and concealments were “made with knowledge of the real facts;” (2) breach of contract for “failing to disclose the home’s previous water penetration problems and damages, thereby, fraudulently inducing Plaintiffs into entering the contract;” (3) negligence for failing to properly disclose the condition of the home; (4) DTPA violations; (5) negligent misrepresentations by supplying false information and not exercising reasonable care or competence in communicating the information; (6) common-law fraud and fraud by non-disclosure; and (7) violation of section 27.01 of the Texas Business and Commerce Code for making misrepresentations in a transaction involving real estate that Branham knew were false.

Declaratory Judgments For Insurance Cases

September 25, 2012 | Mark S. Humphreys

Weatherford insurance lawyers and those in Aledo, Azle, Springtown, Hudson Oaks, Cool, Millsap, Brock, and other places in Parker County need to have a good understanding of declaratory judgment actions.

The Austin Court of Appeals issued an opinion in 1998, that was a declaratory judgment action. The style of the case is, Calderon v. Mid-Century Insurance Company of Texas.

Here is the relevant information:

Notifying Insurance Company About A Claim

September 9, 2012 | Mark S. Humphreys

Weatherford Insurance Lawyers and those in Aledo, Azle, Mineral Wells, Willow Park, Hudson Oaks, Springtown, Millsap, Brock, and other places in Parker County need to make sure their clients promptly turn claims in to their insurance company.

The United States Court of Appeals for the 5th Circuit issued an opinion in August that illustrates the need for doing this. The style of the case is, Berkley Regional Insurance Company, as Subrogee of Venus Rouhani and as Assignedd/Subrogee of the Tower of Town Lake Condominium Association, Inc. v. Philadelphia Indemnity Insurance Company. Here is some relevant background and facts:

This is an appeal from a summary judgment granted in favor of Berkley.

Who Are Permissive Drivers

July 28, 2012 | Mark S. Humphreys

Fort Worth Insurance Lawyers and those in Grand Prairie, Saginaw, Benbrook, Lake Worth, Grapevine, and other places in Tarrant County need to understand who gets covered by an auto insurance policy and who doesn’t. Here is a case that helps with part of that question.

It is a 1989, Dallas Court of Appeals case. The style is United States Fire Insurance Company v. United Service Automobile Association. Here are some facts.

This is an appeal involving a dispute between insurance companies over which one has a duty to defend Anna Milliken, a passenger in an auto, who allegedly caused an accident by grabbing the steering wheel of a moving vehicle.

Residents Of The Same Household Issue

July 3, 2012 | Mark S. Humphreys

Grand Prairie lawyers and those in Arlington, Fort Worth, Dallas, Grapevine, Richardson, Farmers Branch, Carrollton, Mesquite, and other places in the DFW area need to understand this part of an insurance policy.

It is the part dealing with defining “residents of a household.” This is usually a fact question for a judge or jury to decide.

A 1958, El Paso Court of Appeals case, Afredo Arellano v. Maryland Casualty Company issued an opinion that is still good guidance today.

How Insurance Companies Adjust Claims

July 1, 2012 | Mark S. Humphreys

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:

Turning In Claim to Insurance Company

June 26, 2012 | Mark S. Humphreys

Insurance lawyers in Grand Prairie, Fort Worth, Dallas, Richardson, Mesquite, Garland, and other places in the Dallas and Fort Worth area need to know and understand this case. It discusses one of the responsibilities of an insured under an insurance policy relating to claims made and notifying the insurance company.

The case opinion was issued by the Fort Worth Court of Appeals in 1969, and is still good law. The style of the case is, National Union Fire Insurance Company et al. v. Joe Bourn, Jr. Here is some relevant information.

The facts are longs and rather detailed. What is relevant is that on October 5, 1965, Bourn was involved as a victim in an assault and resulting injuries. Bourn sued the attackers and won a judgment against them. National Union defended in the resulting lawsuit but refused to pay any damages rendered against their insureds.