Disability Policies

Disability Claim Denied

January 29, 2011 | Mark S. Humphreys

If someone in Dallas, Fort Worth, Grand Prairie, Arlington, Irving, Mesquite, Garland, Richardson, Plano, Coppell, Mansfield, Cedar Hill, or anywhere else in Texas has a claim under their disability insurance policy denied, what can be done?

Start with the legal reality that an insurance policy is a contract. When a party to a contract is obligated by the contract to another, absolutely repudiates the obligation without justification, the obligee is “entitled to maintain his action in damages at once for the entire breach, and is entitled in one suit to receive in damages the present value of all that he would have received if the contract had been performed, and he is not compelled to resort to repeated suits to recover the monthly payments.” This was stated in the 1937, Texas Supreme Court case, Universal Life & Accident Insurance Company v. Sanders.

Here are some of the facts of the Sanders case:

Disability Policies – Illness Versus Accident

January 18, 2011 | Mark S. Humphreys

Someone is Burleson, Granbury, Cleburne, Bembrook, Crowley, Dallas, Fort Worth, Grand Prairie, Arlington, or any other place in Texas who has a disability insurance policy probably is not sure exactly how the policy works. Most people who have these types of policies get them through their job. When obtained through work the person usually gets a pamplet explaining some of the benefits but rarely is much attention paid to it. A few people will purchase them through an independent insurance agent who explains the coverage but even then, the explanation is quickly forgotten or not completely understood.

The Beaumont Court of Appeals decided a case in 1978, dealing with an insurance policy. The policy had different periods of disability that applied depending on whether the disability resulted from an accident or an illness. The style of the case is, Lone Star Life Insurance Company v. Joseph B. Griffin.

At the trial level, Griffin obtained a judgment against Lone Star Life Insurance Company (Lone Star). Lone Star appealed.

Total Disability Coverage

January 16, 2011 | Mark S. Humphreys

Disability income insurance coverage for someone in Grand Prairie, Dallas, Fort Worth, Arlington, Bedford, Euless, Hurst, Lake Worth, Aledo, or anywhere else in Texas is usually expensive. In addition to being expensive, the policy language is sometimes difficult to interpret.

Disability income policies typically specify an amount that will be paid in the event of a disability (as defined in the policy) and a maximum length of a disability (as defined in the policy) and a maximum lenght of time for which such benefits will be paid (e.g., “$200 per month for up to 60 months”).

A beginning place to look to see how Texas regulates disability income insurance policies is the Texas Administrative Code. Title 28, Part 1, Chapter 3, Subchapter S, Rule Section 3.3005 deals with the definitions in policies. It reads:

Total Disability Claim

January 4, 2011 | Mark S. Humphreys

Lots of people in Arlington, Grand Prairie, Fort Worth, Dallas, Mesquite, Garland, Richardson, Burleson, Benbrook, Crowley, and other places in the Dallas-Fort Worth metroplex area have purchased insurance policies that provide payment to them in the event they become disabled and are unable to work. A natural question would be: What happens if the insurance company denies a claim for disability benefits because of total disability and the case goes to trial?

This is what happened in the case styled, Occidental Life Insurance Company of California v. Robert L. Duncan. This case was decided by the San Antonio Court of Appeals in 1966.

The record in this case shows that Duncan was engaged in the selling of labels as an independent contractor for Louis Roesch Company on a commission basis. Louis Roesch Company manufactures labels and Duncan sells them, generally to canners. He has been in the label selling business for some twenty years. He was in an airplane accident on October 25, 1957, and was rather severly injured, Occidental Life Insurance Company of California, (Occidental) paid him for total disability from the time of the accident until September, 1963, when it stopped payment. Duncan sued.