Claims Refusal

Life Insurance – ERISA And Misrepresentation

April 30, 2011 | Mark S. Humphreys

Here is a case for insureds in Grand Prairie, Weatherford, Mineral Wells, Arlington, Dallas, Fort Worth, and other places in Texas to think about.

This case was decided by the United States Court of Appeals for the Fifth Circuit, on April 13, 2011. The style of the case is, Araceli Medina Garcia v. American United Life Insurance Company. Here is some background.

In January 2006, Salvador DeReza Garcia died in a car accident. At the time of this death, Salvador was covered under a group life and accidental death insurance policy issued by American United Life Insurance Company (AUL) and subject to the Employee Retirement Income Security Act (ERISA), 29 U.S.C. Sections 1001-46. Salvador’s wife, Araceli Medina Garcia, submitted a claim under this policy following his death. AUL denied her claim because Salvador was living illegally in the United States and made material misrepresentations regarding his identity during the application process. A lawsuit was filed, the district court ruled in AUL’s favor. This appeal followed. This appeals court affirmed the ruling of the trial court.

Uninsured / Underinsured Coverage And Limitations

April 10, 2011 | Mark S. Humphreys

Someone with uninsured and underinsured coverage in Grand Prairie, Arlington, Dallas, Fort Worth, Mansfield, Irving, Pantego, Dalworthington Gardens, or anywhere else in Texas would probably have a hard time understanding when it becomes too late to file a claim for benefits under these coverages. Maybe this will help.

A Texas Supreme Court case decided in 1974, is still good law and a reference point for answering this question. The case is styled, “Raul C. Franco et us. v. Allstate Insurance Company.

In this case, Franco and his wife sought to recover from Allstate Insurance Company, under the uninsured motorist provision of their insurance policy, for the death of their daughter and personal injuries to Franco, arising out of an accident alleged to have been caused by the negligence of an uninsured motorist. Their suit was filed approximately three years after the date of the accident and death. The question is whether the two or four year statute of limitations is applicable to either or both of the claims asserted.

Life Insurance Denials

March 20, 2011 | Mark S. Humphreys

When someone in Grand Prairie, Arlington, Dallas, Fort Worth, Mansfield, De Soto, Duncanville, Ennis, Weatherford, Aledo, or any other place in Texas, buys life insurance they expect that when they die, the life insurance company will pay the benefits of the policy to their named beneficiary. However that is not always what happens.

The Washington Post published an article on March 5, 2011, titled “Death of a loved one can be beginning of hard fight with life insurer.” The article is written by David Evans of Bloomberg News.

The article tells of a lady named Jane Pierce who spent nine years struggling alongside her husband, Todd, as he fought cancer in his sinus cavity. The treatments were working. Then in July 2009, Todd died in a fiery car crash. He was 46. That was the beginning of a whole new battle for Jane, this time with Todd’s life insurance company, MetLife.

Potential Recovery In Insurance Breach Of Contract Claims

February 12, 2011 | Mark S. Humphreys

A fair question for someone in Grand Prairie, Arlington, Mansfield, Alvarado, Keene, Joshua, Cleburne, Granbury, Aledo, Hudson Oaks, or anywhere else in Texas might be; What is the potential recovery against an insurance company that breaks their agreement with me?

Of course, the answer would depend on many things. The harm caused by breaking the agreement, the intent of the insurance company in breaking the agreement, was a lawsuit filed or was there just some phone calls and correspondence back and forth, did the insured have to hire an experienced Insurance Law Attorney to protect their rights, etc. Many factors come into play but as it relates to just the breaking of the contract here is some food for thought.

Policy benefits are the basic recovery allowed for the insurance company’s breaking of its contractual obligations. An insurance company’s refusal to pay the insured’s claim causes damages in at least the amount of the policy benefits wrongfully withheld. This was stated by the Texas Supreme Court in the case, Vail v. Texas Farm Bureau Mutual Insurance Company, a case decided in 1988. Another Texas Supreme Court case, which was decided in 1994, styled Transportation Insurance Company v. Moriel, said breaking of the insurance contract allows recovery of benefit of the bargain damages.

Life Insurance – Denial Of Benefits

November 30, 2010 | Mark S. Humphreys

Someone in Dallas, Fort Worth, Grand Prairie, Mesquite, Arlington, Cleburne, Aledo, Weatherford, or anywhere else in Texas, purchases a life insurance policy. They expect the policy benefits to be paid when the insured passes away. But that does not always happen.

The Los Angeles Times ran an article on November 21, 2010, titled “Flaws Can Cancel Life Insurance – After Death.” The article is written by Lisa Girion and Sandra Poindexter.

This article has tells of three examples where someone takes out a life insurance policy and then when a claim for benefits is turned in to the insurance company the company cancels the policy without paying the benefits.

Duty Of Good Faith And Fair Dealing

November 21, 2010 | Mark S. Humphreys

What if someone in Dallas, Fort Worth, Grand Prairie, Arlington, Irving, Richardson, Hurst, Euless, Bedford, or somewhere else in Texas, thinks the insurance company is denying their claim for insurance benefits for the wrong reason? Can anything be done? As with so many legal answers – it depends.

The Texas Supreme Court issued an opinion in 1993, in the case styled, Golda A. Lyons v. The Millers Casualty Insurance Company of Texas, that helps with the above question. As the court stated, “This case presents us with the opportunity to clarify the method by which Texas courts should conduct legal sufficiency review of factfindings of bad faith against an insurer.”

Here are the facts:

Insurance Policy – Excluded Driver

October 1, 2010 | Mark S. Humphreys

“Excluded Driver”? Someone in Grand Prairie, Dallas, Arlington, Fort Worth, Garland, Mansfield, Crowley, Benbrook, Cleburne, or anywhere else in Texas may ask what does that means.

An “excluded driver” is someone who not covered on an automobile insurance policy while that person is driving or operating an insured vehicle. In an automobile insurance policy this is usually referred to as a “515A endorsement” or a “515A exclusion”. The Texas Department of Insurance allows insurance companies to exclude drivers from a policy but does require that anybody who is excluded to be named as an “excluded driver” and for there to be a signature by the person taking out the policy, to acknowledge the exclusion with their signature.

The most common situation where this occurs is when a child becomes sixteen and it is time to add them to the policy. The parents get a bill that is substantially higher than what they are use to paying and when they discover the reason for the increased rate is their teenage son or daughter they complain to the insurance agent. The agent then lets the parents know that they can keep their older / cheaper rates by not having the teenager on the policy. But because the teenager lives in the same house as the parents, there is a belief that the child will have access to the insured vehicles. Since the teenager usually exposes the insurance company to a greater risk and the child has access to the family vehicles the insurance agent will inform the parents that the only way they can not include the teenager in the rates being charged is to have the parents sign the “excluded driver” document. This document says there is not coverage for any damage the “excluded driver” does to the insured vehicle nor will there be coverage for any damage the “excluded driver” does to others.

Cancellation Of Insurance Policy

September 28, 2010 | Mark S. Humphreys

Insured persons in Grand Prairie, Frisco, Arlington, Aledo, Fort Worth, Dallas, Mesquite, Garland, and other places in the state may be adversely affected when an insurance company cancels a policy. If no claim is being made, or in the process of being made, then it may be a case of “no harm, no foul.” But what if the cancellation is first brought up when a claim is made?

This is what happened in a 2001, case styled, Lois Jones v. Ray Insurance Gency a/k/a Azteca Insurance and / or Alamo Insurance, and Collision Clinic, Inc., State & County Mutual Fire Insurance Company and Harbor Insurance Managers. This is a Corpus Christi, Court of Appeals case that was affirmed in 2002 by the Texas Supreme Court.

Here are the facts:

Automobile Insurance Policy

September 11, 2010 | Mark S. Humphreys

Oops! That’s what someone from Aledo, Hurst, Euless, Bedford, De Soto, Dallas, Fort Worth, Grand Prairie, Arlington, and other cities might say when they wait too long to consult with an experienced Insurance Law Attorney. When a claim is denied it is vital that the person who has that claim denied contact an attorney asap.

The Court of Appeals of Texas, El Paso, rendered a decision on August 24, 2010, where it appears the claimant waited too long to make their claim. The style of this case is, Sonia Caballero de Rangel and Eliazar Rangel v. Progressive County Mutual Insurance Company. The opinion is written by Justice, Ann Crawford McClure.

Here are some facts. On October 20, 2001, the Rangels purchased a vehicle. On the same day they obtained insurance coverage from Progressive for the vehicle. On June 3, 2006, the Rangels drove the vehicle to Juarez, Mexico, and it was stolen. Ms Rangel told a claims adjuster that she drove the vehicle to Juarez on a daily basis because her mother cared for her children. When the adjuster asked if she had driven it thirty times to Juarez in the month, Ms Rangel stated, “No, approximately 20 times per month … I would estimate.” Progressive denied the Rangels theft claim based on a provision in the policy excluding coverage if the vehicle was driven into Mexico more than ten times in the thirty day period leading up to the actual date of loss.

Home Owners Claims Being Denied

August 29, 2010 | Mark S. Humphreys

Home owners in Benbrook, Arlington, Grand Prairie, Mansfield, Dallas, Fort Worth, Azle, Aledo, and other places in Texas need to know about what is happening with home owner insurance claims across the nation. Being informed helps you keep your “guard up” when dealing with a home owners claim.

The Washington Post ran an article on August 17, 2010, dealing with policyholders having their home damage claims being denied. The author of the article is Greg Risling and the title of the article is “Suit: Farmers Hasn’t Paid California Wildfire Claims.”

The lawsuit that this article is about was filed in Los Angeles. In the lawsuit it is alleged that Farmers Group Inc. is refusing to pay claims to policyholders whose homes were damaged in last summer’s massive Station Fire.