Claims Refusal

Where Appraisal Does Not Apply

November 12, 2011 | Mark S. Humphreys

If someone in Grand Prairie, Arlington, Crowley, Mansfield, Benbrook, Burleson, Keene, or anywhere else the metroplex area reads their homeowners insurance policy, they will probably find an appraisal clause. This clause usually, is for the benefit of the insurance company. As a result, getting around that clause is a good thing.

The United States District Court for the Southern District of Texas, Houston Division, issued an opinion on October 13, 2011, that is insightful for understanding at least one way of beating the appraisal clause. The style of the case is, Sidney Sam, et al. v. National Lloyds Insurance Company.

Sam and others (Plaintiffs) were insured under a Standard Flood Insurance Policy (SFIP) issued by Lloyds pursuant to the National Flood Insurance Program (NFIP). Plaintiffs’ apartment building was damaged by flood waters following Hurricane Ike. Plaintiffs submitted their claim to Lloyds, which determined that the flood damage to the building and its contents would require repairs in the amount of $100,622.67. Plaintiffs submitted a request for supplemental payment in the total amount of $249,000, or an additional amount of $148,377.33 beyond the amount offered by Lloyds. The additional payment included $39,000 for the presence of a “Commercial Superintendent on the site for 3 months for commercial restoration.” On April 21, 2010, Plaintiffs demanded an appraisal. On May 3, 2010, Lloyds denied the request. Plaintiffs filed a Motion to Compel Appraisal on September 15, 2011.

Insurance Claim Denial

October 29, 2011 | Mark S. Humphreys

Insureds in Weatherford, Mineral Wells, Aledo, Azle, Hudson Oaks, Willow Park, Brock, Millsap, Cool, Springtown, and other places in Parker County and Texas do not always understand what is covered by their policy and what is not. Here is a case that helps understand a little bit about coverage as it relates to auto policies.

In 2003, the Houston Court of Appeals, 14th Dist. issued an opinion in the case, Alejandro Armendariz and Alma Armendairz v. Progressive County Mutual Insurance Company. This case is an appeal from a Declaratory Judgment lawsuit where in Progressive won after filing a motion for Summary Judgment. Here is some background.

The Progressive automobile insurance policy in the case covered two cars, one owed by Alejandro and the other owned by his sister, Alma. Alejandro was the named insured on the policy. Additionally, Alejandro’s parents, who lived with him, and Alma were named as “listed drivers” on the policy. When Alejandro first purchased insurance from Progressive, the policy covered his parents’ van. However, Alejandro deleted the van from the policy because his parents wanted to sell it. Four months later, while driving her parents’ then uninsured van, Alma, by accident, backed over and killed her father. Alma’s mother then sued Alma for the father’s wrongful death.

Insurable Interest

October 13, 2011 | Mark S. Humphreys

What if someone in Weatherford, Mineral Wells, Aledo, Willow Park, Azle, Hudson Oaks, Millsap, Brock, Springtown, Cool, or anywhere else in Parker County has insurance on a house and the house burns down – do they automatically get paid the insurance on the house? The answer is – It depends.

To be able to recover on an insurance policy, the person suffering the loss must have an insurable interest in the property that is insured. The Dallas Court of Appeals issued an opinion in 1993, that is still good law. The style of the case is, William T. & Elaine Jones v. Texas Pacific Indemnity Company.

It is a summary judgment case. The Jones sued Texas Pacific on an insurance policy. The summary judgment was granted in favor of Texas Pacific because the court said the Joneses could not recover insurance proceeds on property which they did not have an insurable interest to.

When Does The Policy Go Into Effect?

September 10, 2011 | Mark S. Humphreys

The above is a reasonable question for someone in Grand Prairie, Weatherford, Arlington, Fort Worth, Dallas, or anywhere else in Texas to ask. When does a policy go into effect? Sometimes a claim arises immediately.

The Corpus Christi Court of Appeals had this issue come up in the case styled, Mark A. Becerra v. Maria Elena Ball A/K/A Nena Ball D/B/A Ball Insurance Agency, National Lloyds Insurance Company, and Ruth Cantu. This opinion was issued in August 2011.

This appeal involves National Lloyds denial of Becerra’s insurance claim. Becerra asserted that Rudy Cantu , an employee of Ball Insurance Agency was allegedly negligent in obtaining an insurance policy on Becerra’s behalf. The trial court granted summary judgment on National Lloyds behalf as it relates to the breach of contract claim and negligence claim. We will discuss the breach of contract claim only.

Rental House Fire

September 3, 2011 | Mark S. Humphreys

Lots of people in Weatherford, Mineral Wells, Aledo, Springtown, Millsap, Brock, Hudson Oaks, Willow Park, Cool, Peaster, Poolville, and other towns in Parker County own rental property. There will be times when that property is vacant. What if a fire occurs when the property is vacant?

The Fort Worth Court of Appeals issued an opinion in 2002, that dealt with the above scenario. The style of the case is, Charles J. Walch v. United Services Automobile Association Property and Casualty Insurance Co. The trial court had granted a summary judgement in favor of United and Walch appealed. There were several issues in this case but the relevant part to this writing, is where the appeals court overruled the trial court as it relates to the question as to whether the property was “vacant” at the time the fire loss occurred.

Here are relevant facts to know. Walch owed a small rental house that was insured by United under a policy of insurance. The tenants of the house moved out on May 15, 1999, and left it in a damaged condition. About ten days later, Walch began renovations. On September 2, 1999, Walch discovered the house had been damaged by fire and in October filed a claim for the fire losses.

Suspicion Of Arson

August 28, 2011 | Mark S. Humphreys

Arson happens in places like Fort Worth, Dallas, Garland, Irving, Mesquite, Richardson, Plano, Duncanville, De Soto, and all other places in Texas at one time or another. But to be accused of arson and have your insurance claim denied because you are suspected by the insurance company is something else. Is there a typical case or situation where this comes about? The answer is no. Every situation has to be scrutinized based on the facts of that particular situation.

The Texarkana Court of Appeals issued an opinion in a 1990 case that discusses the way these arson cases are evaluated. The style of the case is, The St. Paul Guardian Insurance Company v. Teri Lynn Luker and Paul Kimbel Luker. In the case, a jury found in favor of the Lukers and compensated the Lukers for contractual damages of $27,000 and tort damages of $50,000 and mental anguish of $15,000. The court reversed all but the contractual damages of $27,000.

Here are some of the facts of this case.

Fire Insurance Claims

August 13, 2011 | Mark S. Humphreys

No one in Grand Prairie, Weatherford, Arlington, Aledo, Fort Worth, Mansfield, Dallas, Irving, Garland, Mesquite, or any other place in Texas likes the though that they will be involved in a fire claim. But for some people it happens. So, what should you expect from the insurance company if it does happen? Here is one example of what can happen when a fire claim is made.

This case was decided in 1991, by the Corpus Christ Court of Appeals. The style of the case is, Automobile Insurance Company of Hartford Connecticut v. David Davila and Donna Davila. David and Donna sued Automobile Insurance Company of Hartford Connecticut (Hartford) for bad faith after a denial of insurance benefits following a fire loss. A jury found in David and Donna’s favor and Hartford appealed. This court modified the judgment in favor of David and Donna. Here is some background.

The Davilla’s house burned in November, 1985. The police were at the house at the time the fire was discovered. Hartford conducted an investigation and denied the claim.

Arson And Insurance

August 7, 2011 | Mark S. Humphreys

Anyone living in Weatherford, Mineral Wells, Aledo, Azle, Hudson Oaks, Willow Park, Millsap, Brock, Cool, Springtown, or other areas in Parker County, or the State of Texas know what arson means. The question to be wondered about is, what happens if your home burns as the result of an arson fire?

The Waco Court of Appeals issued an opinion in 1998, in the case styled, State Farm Fire and Casualty Insurance Company v. Sandra Sue Vandiver.

In this case Vandiver had sued State Farm seeking to recover damages which resulted from the destruction of her home by a fire. The trial court made many ruling in favor of Vandiver, the result of which, she won her case. One of these ruling was a directed verdict against State Farm on its arson defense. State Farm appealed and this court reversed the verdict and set the case for a new trial. Here is some relevant information.

Insurance Company Denies Claim

June 23, 2011 | Mark S. Humphreys

Someone in Grand Prairie, Arlington, Grapevine, Colleyville, Hurst, Euless, Bedford, Keller, Flower Mound, Roanoke, Haslet, Saginaw, and other places in the state of Texas would naturally be upset if their claim were denied. But next, they would want to hire an experienced Insurance Law Attorney and pursue a lawsuit against their insurance company to make them pay.

Here is a case where an attorney tried to get the insurance company to pay but most of the lawsuit was almost thrown out of court. The style of the case is, Rosa Garcia and Augustin Garcia v. Nationwide Property and Casualty Insurance Company. The opinion in this case was issued on May 16, 2011, by the United States District Court, S. D. Texas, Houston Division.

Here is what is going on in this situation:

Examination Under Oath Compliance

May 1, 2011 | Mark S. Humphreys

Most insureds living in Grand Prairie, Fort Worth, Dallas, Arlington, Pantego, Hurst, Euless, Bedford, Keller, Colleyville, Saginaw, and other places in Texas would not be sure what it means to submit to an “examination under oath” (EUO).

An EUO is where a person is asked questions, usually by an attorney or insurance investigator, after the person has taken an oath to tell the truth, and the testimony is taken by a certified court reporter.

The United States District Court, Southern District, Houston Division, issued an opinion on April 11, 2011, where part of the case dealt with the requirements of an EUO. The style of the case is, Rossco Holdings, Inc. v. Lexington Insurance Company.