General

Life Insurance Claims And Payments

August 26, 2010 | Mark S. Humphreys

Life insurance is something most people in Arlington, Dallas, Fort Worth, Grand Prairie, Mansfield, Weatherford, and other places in Texas pay for each month. Of course, the reason it is purchased is to help in a financial way those left behind. Those left behind are spouses and children nine times out of ten.

The amount of money tied up in life insurance policies nationwide is staggering. Insurance companies make lots of money on the premiums paid to them for the policies and most people understand and accept that. What bothers people is when the life insurance companies continue making money after a claim is made and that money is made at the expense of the beneficiaries of the life insurance policies.

Bloomberg ran an article on this topic on August 16, 2010. The authors are David Evans and Hui-yong Yu. The title of the article is, “U.S. Insurance Regulators Issue Consumer Alert on Death Benefits.”The article tells us that State insurance regulators, under pressure to improve disclosure of death benefit payment options, issued a consumer alert about the industry practice of retaining funds rather than paying them in a lump sum.

Loss Of Use / Rental

August 21, 2010 | Mark S. Humphreys

If you live in Grand Prairie, Arlington, Mansfield, Dallas, Fort Worth, Burleson, Southlake, Hurst, Euless, Bedford, Lake Worth, or anywhere else in Texas, you might wonder what happens if your car is involved in a wreck and it is the other person who is at fault, then the other person’s insurance refuses to fix the car. What happens?

That is kind of what happened in the 1997 case, Cirilo Mondragon v. Morris Austin. This case was decided by the Austin, Court of Appeals.

To begin with, this case is not that uncommon. When something like this happens, it would be prudent to seek the advice of an experienced Insurance Law Attorney.

Deceptive Trade Practices / Loss Of Use

August 19, 2010 | Mark S. Humphreys

Someone in Aledo, Azle, Haslet, Saginaw, Cedar Hill, Grand Prairie, Arlington, Dallas, Fort Worth, Hurst, Bedford, or anywhere else in Texas might ask: What happens when I lose the use of my car because of the actions of another person?

This usually happens in a car wreck situation but also happens in situations where engine repairs are not properly completed. Other insurance situations might be when a car is lost or destroyed due to fire, flood, or theft, and the owner is trying to get their own insurance company to take care of the matter.

As it relates to the Texas Deceptive Trade Practices Act (DTPA) the issue of compensation for “loss of use” came up in a case decided in 1984. The style of the case is “Yolanda Luna v. North Star Dodge Sales, Inc. and was decided by the Texas Supreme Court.

Insurance Companies Playing Games?

August 8, 2010 | Mark S. Humphreys

An insured in Dallas, Fort Worth, Grand Prairie, Arlington, Colleyville, Burleson, Benbrook, Grapevine, Irving, or anywhere else in Texas probably thinks they pay too much in health insurance rates. Well, the reality is they probably are paying too much.

The above is addressed in a USA Today article published on July 22, 2010. The author is Alison Young and the title of the article is, “Consumer group: Insurers kept surplus while hiking premiums.” The article focused on Blue Cross and Blue Shield health plans because the company covers one in three Americans with private insurance.

The article tells us that non-profit Blue Cross and Blue Shield health plans stockpiled billions of dollars during the past decade, yet continued to hit consumers with double digit premium increases. This was discovered by Consumers Union in an anaylsis of 10 of the plans’ finances.

Accused Of Cheating The Insurance Company

August 5, 2010 | Mark S. Humphreys

Insurance companies often times accuse policyholders of trying to cheat them. No matter if you are in Dallas, Fort Worth, Arlington, Grand Prairie, or somewhere else, if you make a claim the insurance company will assign an adjuster to investigate the claim. The adjusters job is to evaluate and settle the claim. Sometimes the adjuster finds things that make him suspicious of how legit the claim is. If the adjuster is ever questioning your honesty you should immediately get an experienced Insurance Law Attorney involved.

A big reason adjusters question the honesty of a claim is that occassionally they find something that is just not right. This is illustrated by an article that was published on July 19, 2010, in the Fresno Bee, a newspaper in California. The article is written by Barbara Anderson and is titled, “Valley doctors, chiropractors accused of fraud.”

The article tells us that Allstate Insurance Company is suing San Joaquin Valley doctors and several chiropractors in a multimillion-dollar lawsuit, alleging they falsely operated chiropractic clinics as medical groups to get insurance payments.

First Party Insurance Claims

August 1, 2010 | Mark S. Humphreys

Someone in Dallas, Fort Worth, Grand Prairie, Arlington, Mansfield, De Soto, Aledo, Weatherford, Azle, Burleson, or anywhere else in Texas may ask, What is a “First Party” Insurance Claim?

“First party” insurance claims are claims that an insured makes against their own insurance policy. Most of the time a person making a claim against someone else’s insurance policy is considered a “third party” claimant. However, sometimes a person making a claim against someone else’s policy is still considered a “first party” claimant when the person making the claim is a beneficiary of the insurance policy.

A “first party” policy typically involves insurance that provides policy benefits directly to the insured or beneficiary in the event of a loss. This is further set out in the Texas Insurance Code, Section 542.051(2). In that section, “first party claim” is defined as a claim “by an insured or a policyholder under an insurance policy or contract or by a beneficiary named in the policy or contract that must be paid by the insurer directly to the insured or beneficiary.” These types of policies generally include health insurance, life insurance, disability insurance, workers’ compensation insurance, auto property insurance, homeowner’s property insurance, and commercial property insurance. The Texas Supreme Court, in 1997, described the difference between first party and third party insurance in the case styled, Universal Life Insurance Company v. Giles.

Uninsured Drivers In Dallas And Fort Worth

July 27, 2010 | Mark S. Humphreys

It just makes you mad! Most drivers in Dallas, Fort Worth, Grand Prairie, Arlington, Mansfield, De Soto, Duncanville, Weatherford, Azle, Aledo, and throughout Texas do the right thing by maintaining liability coverage on their automobiles. But, way too many drivers are on the road without insurance.

The Dallas Morning News ran an article on Saturday, July 17, 2010, addressing this subject. The article is written by Terrence Stutz. The title of the article is, TexasSure program finds about 25 percent of vehicles uninsured in Dallas County.

This article points to a scary statistic. This stastistic is that 25 percent of all vehicles in Dallas County, according to records, 429,478 cars and trucks, remain without liability insurance. This statistic comes from the Texas Department of Insurance.

Cheating Insurance Company

July 22, 2010 | Mark S. Humphreys

Am I paying too much for my insurance? Whether you live in Cedar Hill, Mansfield, Benbrook, Saginaw, Keller, Fort Worth, Dallas, Grand Prairie, Arlington, or some other place in Texas, that would be a question most people would ask at one time or another when thinking about their finances.

For a California woman, the answer to the above question seems to be, yes. She has sued Blue Shield of California, accusing the nonprofit health plan of overcharging thousands of policyholders who bought safety net insurance for peole who were sick or jobless.

This was reported by the Los Angeles Times in an article written by Duke Hefland and published on July 8, 2010.

2 Other Subrogation Concerns – Veterans Administration And Child Support Liens

July 20, 2010 | Mark S. Humphreys

What is common to a lot of residents of Dallas, Fort Worth, Grand Prairie, Arlington, Mansfield, Benbrook, Burleson, Aledo, and other areas of Texas? One, there are a lot of veterans living in the state and two, there are a lot of people who are behind on their child support payments.

First of all, there is no correlation between the two, except they are easy and short discussions. Let’s talk about VA subrogation first.

When someone is injured as the result of a third person’s negligent activity and the Veterans Administration has paid benefits to the injured person, the VA is entitled to be repaid for the amount of money they spent on the veteran’s behalf. The reimbursement rights of the VA are written into law and are set out in the 1990 case, United States v. Maryland. This is a United States 4th Circuit case and in part says:

Hospital Liens In Texas And Insurance

July 14, 2010 | Mark S. Humphreys

What if someone in Fort Worth, Arlington, Mansfield, Mesquite, Garland, Irving, Grand Prairie, Dallas, or anywhere else in Texas, is involved in an accident and goes to the hospital for treatment? Are there any special laws that apply?

The answer is yes. It depends on the circumstances, but often times, what is called a “hospital lien” comes into play. If this hospital lien is not properly dealt with it could cost a lot of money and heartache.

Texas public policy strongly supports hospital liens, and it is important to understand that these liens are not just applicable to hospitals; they may also operate for the benefit of EMS providers and doctors at teaching hospitals whose bills are not already included in the bill. The rights of hospitals and certain other medical providers to be paid from settlement proceeds or a judgment begins with the Hospital Lien Statute. This is found in the Texas Property Code, Chapter 55. It says, in relevent part, that a lien attaches to “any cause of action, judgment, or settlement” received as a result of an accident for which the person was admitted to a hospital within 72 hours of the injury, as well as any hospital to which the injured person is subsequently transferred for the same injuries. This is found in Texas Property Code, Section 55.002. These hopital liens must be filed prior to settlement in order to be valid, and hospital liens are limited to “reasonable and regular” charges within the first 100 days following the injury. Even the attorney representing the injured person may have to wrestle with the hospital for first priority, as seen in the Texas Supreme Court case styled, Bashara v. Baptist Memorial Hospital System, decided in 1985.