Interpreting An Insurance Policy

Hail Claims And Appraisal

November 14, 2015 | Mark S. Humphreys

Forth Worth lawyers handling hail damage claims need to read a recent opinion from the Amarillo Court of Appeals. The case is styled, In Re GuideOne National Insurance Company.

The case involves two insurance claims: one for fire damage and another for wind or hail damage to property. The insurer is GuideOne who sought appraisal in this case. A lawsuit had been filed and the property owners requested that the Court not allow the appraisal. This request was sought long after the law suit had been filed and the property owners had incurred substantial costs. The Court denied the appraisal request and this mandamus action followed. This Court upheld the trial Court decision.

Appraisal clauses provide a means to resolve disputes about the amount of loss for a covered claim. As the Texas Supreme Court has explained: “In every property damage claim, someone must determine the ‘amount of loss,’ as that is what the insurer must pay. An appraisal clause ‘binds the parties to have the extent or amount of the loss determined in a particular way.'”

Promptly Reporting Hail Damage

October 27, 2015 | Mark S. Humphreys

Fort Worth insurance attorneys tell their clients to report all claims immediately. A 2015, 5th Circuit Court of Appeals case is a good illustration of why. The opinion is styled, Carlos Alaniz v. Sirius International Insurance Corporation.

This is a summary judgment case granted in favor of Sirius.

Alaniz owns four rental properties. Each property contains four apartment units.

Crime Protection Insurance Policy

September 19, 2015 | Mark S. Humphreys

Fort Worth insurance lawyers will not see this situation very often. But it does happen. This is a case from the U. S District Court, Houston Division. The style of the case is Apache Corporation v. Great American Insurance Company.

Apache purchased a Crime Protection Policy from Great American. The Policy was an insurance policy meant to insure against several types of risk. One such category of risks the policy covered was “computer fraud.” The Computer Fraud section, or Section B.5 of the Policy read as follows:

5. Computer Fraud

Statutes Of Limitations

September 17, 2015 | Mark S. Humphreys

Dallas insurance attorneys know about limitations. As a reminder, a 2015 case from the U.S. District Court, Southern District of Texas, Houston Division, is worth reading. It is styled, Charles Van Tassel v. State Farm Lloyds, et al. Their are a number of issues in this case but this focus will be on the limitations imposed contractually by State Farm.

In this case, State Farm filed a motion for summary judgment based on the defense of limitations. The Court stated that the party asserting an affirmative defense, such as the statute of limitations or estoppel, bears the burden of proof on it.

In Texas, pursuant to Texas Civil Practices & Remedies Code, Section 16.051, the statute of limitations for a breach of insurance contract action is four years from the day the cause of action accrues. Under the “legal injury rule,” a cause of action accrues when a wrongful act causes the legal injury, even if the injury is not discovered until later.

HomeOwners Policy And Judgment

September 12, 2015 | Mark S. Humphreys

Fort Worth insurance lawyers will be interested in this opinion from their own backyard. It is a Fort Worth Court of Appeals opinion issued in 2015, styled, Texas Farmers Insurance Company and Farmers Insurance Exchange v. Frank Kurosky and Pamela Rust.

Kurosky lives at 4325 Fossil Drive. He also owns a home at 4333 Fossil Drive, which he rents to his daughter, Rust. Kurosky has homeowners insurance on his home at 4325 Fossil Drive with Texas Farmers on which he is listed as the sole insured. Texas Farmers also issued an insurance policy for 4333 Fossil Drive that names both Rust and Kurosky as the insureds. Kurosky also has a personal umbrella policy with Farmers Exchange.

In June 2008, Rust was injured while riding a lawnmower in her backyard. She sued Texas Farmers in the 153rd District Court for medical benefits under both Fossil Drive insurance policies. Rust later added a negligence cause of action against Kurosky in her second amended petition, filed October 23, 2009. On November 25, 2009, Texas Farmers sent a reservation-of-rights letter to Kurosky to 4325 Fossil Drive, Fort Worth, Texas, as his address was listed on the policy. Kurosky claimed never to have received the letter because his address is in Haltom City. It is undisputed that he was represented by the attorney whom Texas Farmers retained and paid.

ERISA And Life Insurance And Accidental Death Coverage

August 27, 2015 | Mark S. Humphreys

Fort Worth lawyers who handle ERISA claims will need to read this opinion out of the U.S. District Court for the Southern District of Texas, Houston Division. It is styled, Sandra James v. Life Insurance Company of North America and Geico.

This is an appeal of a Magistrates ruling on a summary judgment in favor of Life Insurance Company of North America and Geico (Geico).

Sandra’s husband was killed in a one vehicle accident with a tree and subsequent fire. The medical examiner stated Robert’s cause of death was “inhalation of combustion products and thermal injury.” The listed manner of death was an “accident.”

Exclusions In Policy – How To Interpret

August 25, 2015 | Mark S. Humphreys

Duncanville insurance lawyers have to be able to read an insurance policy and understand how the courts will interpret the language found in the policy. The Amarillo Court of Appeals issued an opinion in July of 2015, that deals with this issue. The opinion is styled, Doe #1, Doe #2 and Doe #3, v. National Union Fire Insurance.

The trial court granted summary judgment in favor of National Union and this appeal followed.

National Union issued a CGL policy to Watchtower Bible and Tract Society Et al. Watchtower sought coverage for coverage from conduct of a sexual nature, including the sexual abuse of minors.

Coverage Extensions In Insurance Policies

August 8, 2015 | Mark S. Humphreys

Fort Worth insurance lawyers who handle commercial case need to read a 2015, Austin Court of Appeals opinion. It is styled, 3109 Props, L.L.C.; Detour, Inc.; and Richard Linklater v. Truck Insurance Exchange.

Linklater appealed a summary judgement in the trial court in favor of TIE on their claims for breach of contract, unfair insurance practices, and violation of the prompt payment statute. This appeals court upheld the summary judgment.

3109 Props and Linklater, a filmmaker, were the named insureds on a commercial property insurance policy issued by TIE. A property owned by Linklater located at Cardinal Drive in Paige, Texas was destroyed by fire. Stored in the building and also destroyed in the fire was Linklater’s archive of materials from his various film projects. The archive had been appraised and was estimated to be worth at least $500,000. According to Linklater, the archive had been stored at 171 Cardinal Drive since at least 2010 in a building erected for that purpose and owned by Linklater.

Health Insurance And Intoxication Exclusions

August 2, 2015 | Mark S. Humphreys

Insurance attorneys in Dallas County need to be able to know how the courts interpret exclusions in policies when the exclusions rule out coverage for injury resulting from intoxication of narcotics. The United States Western District Court in Austin issued an opinion in June of 2015, dealing with this issue. It is styled, Eleanor Crose v. Humana Insurance.

This is an adverse ruling to Crose involving a summary judgment.

Crose is insured under a health insurance policy issued by Humana. Crose suffered a stroke which left him mentally and physically impaired. He filed a claim which Humana rejected citing a policy exclusion rendering benefits non-payable when the insured’s injury is “due to being intoxicated or under the influence of any narcotic unless administered on the advice of a health care practitioner.” Crose sued for violations of the Texas Insurance Code Sections under 541.060 and 542.051.

Prompt Pay And Auto Insurance

July 28, 2015 | Mark S. Humphreys

Mansfield insurance lawyers need to read the Houston Court of Appeals [14th Dist.] opinion styled, Daugherty v. American Motorists Insurance Company. It was issued in 1998.

Daugherty filed suit against American for refusing to pay his claim. The trial court ruled in favor of American. Daugherty appealed.

The record reflects that Daugherty purchased a BMW on January 12, 1994. The sales price of the vehicle was $58,148.88. With the addition of taxes and fees, Daugherty paid a total of $64,678.97 for the automobile. The car was stolen on February 15, 1994. Daugherty promptly reported the theft to American. On February 25, 1994, Daugherty submitted an affidavit of vehicle theft to American in which he claimed a loss of $68,895.42.