Articles Posted in General

Insurance payers in Grand Prairie, Arlington, Fort Worth, Dallas, Mansfield, De Soto, Cedar Hill, Duncanville, Irving, Cockrell Hill, and other places in Dallas County and Tarrant County do not like insurance fraud.

The Los Angeles Times published an article on May 20, 2011, dealing with insurance fraud in the state of California. The article is written by Marc Lifsher and the title to the article is, Quest Diagnostics Settles Medi-Cal Whistle-Blower Suit.

The article tells us that Quest Diagnostics, Inc., the biggest provider of medical lab services in California, has agreed to pay $241 million to settle a whistle-blower’s lawsuit that accused it of overcharging the state Medi-Cal program. The lawsuit also alleged that the Madison, N.J., company paid illegal kickbacks to doctors, hospitals, and clinics that sent patients their way.

An attorney in Weatherford, Mineral Wells, Aledo, Willow Park, Hudson Oaks, Azle, Peaster, Millsap, Brock, Poolville, Springtown, or anywhere else in Texas may be a good attorney to help someone with their case. When an insured gets sued he may want one of these attorneys to help him with his case and would expect their insurance company to pay the costs because that is one of the benefits of having insurance. Most of the time the insurance company pays for defense costs. Right?

The answer is no. The insurance company will pay for defense costs but they get to chose who the lawyers are going to be.

The Texas Supreme Court decided a case in 2004 styled, Northern County Mutual Insurance Co. v. Timoteo Davalos. Here is some background.

Someone in Grand Prairie, Arlington. Fort Worth, Keller, Hurst, Euless, Bedford, Richland Hills, Saginaw, Lake Worth, Benbrook, or anywhere else in the Tarrant County area would only be normal to think about sueing an insurance company someday. Particularly if they are doing you wrong.

Here is a case where a business that works with one insurance company got screwed around by apparently not sueing the insurance company correctly. One way to lessen the chances of this happening is to work with an experienced Insurance Law Attorney.

Here is some of the background of the case.

At least a few people in the Dallas – Fort Worth area and surrounding counties such as Parker County, Palo Pinto County, Johnson County, and others in Texas know that the insurance industry in the State of Texas is regulated by the Texas Department of Insurance.

Each state in the United States is able to enact its own rules and regulations for insurance companies. The New York Times published an article on May 8, 2011, that discusses how some states regulate insurance in such a way as to encourage insurance companies to come to their state to do business. There are pros and cons to this. The title of the article is, “Seeking Business, States Loosen Insurance Rules” and the authors are Mary Willams Walsh and Louise Story.

The first sentence in the article says, “Companies looking to do business in secret once had to travel to places like the Cayman Islands or Bermuda.”

If someone in Grand Prairie, Arlington, Fort Worth, Dallas, Irving, Hurst, Euless, Bedford, Dalworthington Gardens, Crowley, or some where else in Texas gets mis-led by an insurance company, can they sue them? The answer is a definite yes if the company is that person’s insurance company but is probably a no if it is the other person’s insurance company.

The 1989 case, Hermann Hospital v. National Standard Insurance Company and American Fire & Casualty Company, decided by the Houston Court of Appeals, 1st District, is a good case for an example where you can sue the other person’s insurance for a misrepresentation.

On June 17, 1978, Jose Carreon was stabbed by a fellow worker while working for his employer. He was taken to, and treated at, Memorial Hospital. In September 1978, Memorial sought to transfer Carreon to Hermann for further care and treatment. The insurance company paid Memorial. Three months after Carreon was injured, on September 18 and 20, 1978, and prior to accepting the transfer of Carreon, Hermann verified coverge with the insurers for its care and treatment of Carreon. On September 20, 1978, after verifying coverage, Hermann accepted the transfer of Carreon. Coverge was again verified on October 16, 1978. Thereafter, later in October 1978, the insurers denied that there was insurance coverage for the injury sustained by Carreon and refused to pay Hermann for the expenses incurred. Hermann asserted in the lawsuit it filed that it relied on the representation of coverage in accepting the transfer of Carreon and that it incurred expenses of $217,444.90 in its care and treatment of Carreon.

Anybody in Weatherford, Mineral Wells, Millsap, Aledo, Azle, Springtown, Peaster, Brock, Lipan, Hudson Oaks, Annetta, Poolville, Whitt, or other places in Texas would wonder if they can sue the insurance company. Especially when they feel as if though they are being jerked around and treated in a disrespectful or improper manner. Well the answer to the question is yes, you can sue them. The bigger question is, can you win. Here is a case to think about.

The Texas Supreme Court, in 1994, decided a case styled, Allstate Insurance Company v. Kathleen G. Watson. The issue in the case was whether the state legislature allowed a third party claimant to directly sue the other guy’s insurance company for violation of what is now Section 541.060 of the Texas Insurance Code. The holding by the court was no, it is not allowed in Texas.

Here are some facts in the case:

Many people in Grand Praire, Arlington, Irving, Mansfield, Garland, Mesquite, De Soto, Duncanville, Dallas, Fort Worth, Hurst, Euless, Bedford, and other places in Texas will wonder from time to time if they can sue the insurance company when something goes wrong.

Here is a short answer that does not necessarily apply to all situations.

When it is your own insurance company that commits a wrong then there is a procedure to be followed, but you can sue them.