Interpreting An Insurance Policy

Segregating Losses On Insurance Claim

May 13, 2014 | Mark S. Humphreys

Saginaw insurance lawyers need to know about this insurance case. The case is a 1999, San Antonio Court of Appeals case styled, Wallis v. United Services Automobile Association. Here is the relevant information.

In the spring of 1993, the Wallises noticed evidence of foundation damage in their home. Suspecting such damage was caused by a plumbing leak, the Wallises filed a claim under their homeowner’s policy. Through its investigation, USAA determined that the foundation damage was caused by a combination of several excluded perils under the Wallises’ policy, including settlement, poor surface drainage, the topography of the lot, and surrounding vegetation. Plumbing leaks, which are covered perils, were also detected; however, based on soil testing and continued earth settlement following repair of the Wallises’ plumbing system, USAA concluded that the leaks were negligible and had not caused or contributed to the complained-of damage. USAA believed improper compaction of the fill dirt upon which the Wallises’ foundation rests was the primary source of the problem. Elevation tests indicated that the Wallises’ home, which was built upon a sloping lot, had settled as much as fifteen inches on the low end of the hill where soil was placed to create a plane for the foundation. In short, USAA’s investigation revealed that the Wallises’ home was sliding down the lot. Experts for the Wallises did not refute USAA’s evidence regarding the excluded perils. They did, however, challenge the conclusion drawn regarding the effect of the plumbing leaks, and claimed instead that the leaks could not be excluded as a contributing cause of the damage.

At trial, the jury was asked to determine whether “earthquake, landslide, or earth movement,” perils excluded under exclusion k of the policy, caused the Wallises’ damage. The jury was also charged under question two of the charge with determining whether “accidental discharge, leakage, or overflow of water from within a plumbing system” contributed to the Wallises’ damage. The jury answered both questions affirmatively and, under question three, found that thirty-five percent of the Wallises’ damage was caused by plumbing leaks.

Assignment Of Insurance Claims

April 27, 2014 | Mark S. Humphreys

Arlington insurance attorneys will occasionally run across a situation where assigning an insurance claims seems like a good idea. Well it may be, but they need to be aware of this case from the United States Fifth Circuit Court of Appeals. It is styled, Nautilus Insurance Company v. Blanc Lila Villalta et al. Here is the relevant information.

Blanca Lila Villalta and Odis Armando Villalta, each individually and as the surviving parents of Odis Steven Villalta (the “Villaltas”), appealed the district court’s sua sponte grant of summary judgment for Nautilus Insurance Company (“Nautilus”). For the following reasons, the court decided to VACATE and REMAND with direction to ABATE or DISMISS the judgment for Nautilus.

Odis Villalta was shot to death by a security officer employed by Bellaire Security Patrol, Inc. (“Bellaire”). The Villaltas filed a lawsuit in Texas district court against Bellaire and others (the “Villalta case”). Nautilus provided general liability insurance to Bellaire and filed suit in federal district court against the Villaltas, seeking a declaration that the policy issued to Bellaire provides no coverage for damages sought in the Villalta case. The federal district court, sua sponte, issued summary judgment for Nautilus, holding that Nautilus had no duty to defend Bellaire as a matter of law because the “all assault or battery” policy exclusion clearly applied. On appeal, the Villaltas raised two primary issues: (1) whether the district court erred in granting summary judgment concerning Nautilus’s duty to defend; and (2) whether ruling on Nautilus’s duty to indemnify is premature based on the underlying Villalta case, which remains pending in state court.

Anti-Technicality Statute

April 22, 2014 | Mark S. Humphreys

Insurance lawyers need to know some of the more obscure areas of the Texas Insurance Code. A United States 5th Circuit of Appeals case dealt with the “Anti-Technically” Statute recently. The case is styled W.W. Rowland Trucking Company, Inc. v. Max America Insurance Company. Here is the relevant information.

Rowland transported a load of video game consoles valued at $354,000 from Marshall, Texas, to its Dallas, Texas terminal. Thieves stole the tractor/trailer loaded with the consoles while it was located at the Dallas terminal. At the time of the theft, Rowland had an insurance policy with Max America, also known as Alterra. The Policy’s section entitled “Coverage” provides for “Legal Liability Coverage,” which covers Rowland’s [L]egal liability for loss to covered property: a. while under [Rowland’s] care, custody, and control; [and] b. that [Rowland] become[s] legally obligated to pay as a common or contract carrier under a bill of lading, contract of carriage, or shipping receipt that is issued by [Rowland] or that is issued on [Rowland’s] behalf.

Under the “Property Covered” section, the Policy provides coverage for “Property in Vehicles,” defined as “direct physical loss caused by a covered peril to property of others described on the ‘schedule of coverages’ while in due course of ‘transit’ including loading and unloading.” The Policy also provides that all eight of Rowland’s terminals must be “100% fenced, gated, locked and lighted 24 hours per day, 7 days per week,” or else the “[c]overage is null and void.” The Policy had a limit of $300,000, and included a $2,500 deductible.

Policy Exclusions – Interpretations

April 17, 2014 | Mark S. Humphreys

Arlington insurance lawyers need to be able to know how the courts interpret insurance policy exclusions. A recent finding from a United States Magistrate Judge in the Northern District of Texas is helpful. The style of the case is, The Burlington Insurance Company v. Midlothian Chamber of Commerce, et al.

The Chamber sponsored a bike-a-thon in which John Shumaker participated. Shumaker was seriously injured and later sued the Chamber in Texas district court, claiming that his personal injuries resulted from various acts of negligence at the event. Shumaker alleges that the Chamber “organized and promoted” the bike-a-thon, which was a “scenic ride and tour of historic homes as well as newer neighborhood[s]” and was “not a race.” He asserts claims in the nature of negligence.

TBIC is paying the Chamber’s defense costs in the state case but initiated this declaratory judgment, requesting that the Court find that TBIC has no duty to defend the state suit or to indemnify the Chamber for the claims that Shumaker asserts.

Occupying A Vehicle

April 5, 2014 | Mark S. Humphreys

Insurance lawyers in Dallas need to be able to tell a new client whether or not they have a claim worth pursuing. In 1963, the Waco Court of Appeals issued an opinion that insurance lawyers should know about. The style of the case is, Ferguson v. Aetna Casualty & Surety Company. Here is the relevant information from that case.

Ferguson sued Aetna Casualty upon the ‘medical payments provision‘ of a policy issued upon her automobile. Such policy provided medical payments for the named insured who sustains ‘bodily injury, caused by accident, while occupying or through being struck by an automobile.’ The term ‘occupying’ is defined in the policy as meaning ‘in or upon or entering into or alighting from an automobile.’

Ferguson had been to the beauty parlor. She left the beauty parlor, came out onto the parking lot where she had left her automobile. In front of the beauty shop was a board that went out into the parking area. Parked alongside of this board at the end of it was ‘an automobile’. Ferguson walked to the end of the board and reached out and grabbed the door handle of the car to support herself. While holding onto the handle for support, she stepped off the board and went down into the mud, breaking both legs and suffering other injuries. The car Ferguson had hold of was not her own, and she was not in the act of entering such car; she was merely holding onto the handle for support as she walked around the car on her way to her own car, which was parked further down on the parking lot. However, if Ferguson was ‘in or upon, or entering or alighting from’ this particular car, she would be covered by the policies..

Courts Interpreting Insurance Law

March 23, 2014 | Mark S. Humphreys

Attorneys handling insurance cases need to keep up with developments in the law. The Insurance Journal published an article worth reading on February 3, 2014. Here is what it tells us.

On Jan. 17, 2014, the Texas Supreme Court in Ewing Construction Company v. Amerisure Insurance Co. issued another surprising and controversial decision in a construction defect coverage case.

For many years the Texas Supreme Courts had largely been a model of restrained and plain-meaning interpreter of insurance policies. While there were anomalies, such as the broadly criticized Mid-Continent v. Liberty Mutual, where the longstanding practices of carrier contribution were undermined, the Court still steered a generally reasonable course in protecting the rights of policyholders and carriers.

What Is An Accident

March 18, 2014 | Mark S. Humphreys

Dallas insurance attorneys need to be able to answer the above question in the context of an insurance policy. A 1997, Texas Supreme Court case provides some guidance for the question. The style of the case is, Farmers Texas County Mutual Insurance Company v. Griffin. Here is some of the relevant information.

This is a declaratory judgment action. Farmers sought a declaration that it had no duty to defend or indemnify its insured, James Royal III, in a suit brought by Robert Griffin. The trial court granted summary judgment for Farmers. This Court affirmed the judgment for Farmers.

Gunshots from a passing vehicle hit and injured Robert Griffin as he walked down the street in Beaumont, Texas. Griffin sued the driver of the vehicle, James Royal III, and others for negligence and gross negligence resulting in injury to his right leg. Griffin alleged that Royal drove the vehicle while his two passengers fired the shots. Royal invoked Farmers’ duty to defend him under his personal automobile liability insurance policy. Farmers defended Royal subject to a reservation of rights and then filed this declaratory judgment action to challenge its duty to defend and indemnify Royal.

Who Does A Policy Cover

March 16, 2014 | Mark S. Humphreys

Grand Prairie insurance lawyers need to be able to look at an insurance policy and determined who is insured by the policy. A 1997, Texas Supreme Court case provides some guidance for an answer. The style of the case is, Grain Dealers Mutual Insurance Company v. McKee. Here is some of the relevant information.

In this case the court must determine whether the Business Auto Policy that Grain Dealers issued to Future Investments, Inc. (“Future Investments”), a corporation of which Gerald McKee is the president and sole shareholder, provides coverage for McKee’s daughter. The court concluded that it does not.

McKee’s eleven-year-old daughter, Kelly, was injured in a one-car accident while riding as a passenger in a car driven by her adult step-sister, Delane Aranda. Delane’s husband owned the car. The parties stipulated that neither Delane nor the car involved in the accident was covered under the Grain Dealers policy and that the accident occurred during an outing unrelated to any business purpose of Future Investments. Kelly resided with McKee when the accident occurred; Delane did not.

Co-Operating With Your Insurance Company

March 4, 2014 | Mark S. Humphreys

Insurance attorneys will tell a client that they have a responsibility, under their insurance policy, to co-operate with their insurance company. If they refuse to co-operate they may lose coverage. A 2006, San Antonio Court of Appeals case illustrates this. The style of the case is, Progressive v. Trevino. Here is some info on that case.

This appeal concerns a personal injury lawsuit brought in by Hector Raul Trevino and Mario Moyeda against Alejandro Alvarado, a driver covered by automobile insurance issued by Progressive. In this lawsuit, Trevino and Moyeda obtained a post-answer default judgment against Alvarado. Although Alvarado had timely notified Progressive that he had been served with a negligence suit brought by Trevino and Moyeda, according to Progressive, he later refused to cooperate with his defense. Because Alvarado refused to cooperate, on October 16, 2003, the lawyers hired by Progressive to represent Alvarado withdrew from their representation of Alvarado. However, before withdrawing, the lawyers filed a motion to continue the trial set for October 20, 2003. On October 20th, the district court called the case, and Trevino and Moyeda announced ready. Alvarado, however, did not appear for trial. The district court proceeded to hear evidence and argument from Trevino and Moyeda. It later entered a judgment awarding $45,000 to Trevino and $25,000 to Moyeda.

After obtaining the default judgment against Alvarado, Trevino and Moyeda filed this action against Progressive, arguing that by virtue of the judgment against Alvarado, they had become judgment creditors of Alvarado and thus, had standing to bring a claim directly against Progressive as third-party beneficiaries of the insurance policy. In their petition, Trevino and Moyeda pled that all conditions precedent to bringing the suit had been satisfied. Progressive, however, in its answer, denied that all conditions precedent had been satisfied: “Alejandro Alvarado and Plaintiffs, as judgment creditors, have failed to comply with the cooperation clause contained in the policy of insurance.”

Insurance Company Choosing Liability Attorney

March 2, 2014 | Mark S. Humphreys

Choosing an insurance attorney is usually the choice of the person being sued. However, if a person is being sued under an insurance policy, it is the insurance company who gets to choose the attorney. A 2004, Texas Supreme Court case illustrates this. The case is styled, Northern County Mutual Insurance Co v. Davalos. Here are some of the relevant facts of the case.

The automobile liability policy in this case obligated the insurer to provide a defense for covered claims and granted the insurer the right to conduct that defense. The insured, however, refused the insurer’s tendered defense because of a disagreement about where the case should be defended.

Davalos, a resident of Matagorda County, was injured in an automobile accident in Dallas County. Davalos sued the driver of the other car in Matagorda County. The other driver and his wife then sued Davalos and a third driver involved in the accident, but in a separate action in Dallas County. Although Davalos was insured by Northern, he turned the Dallas litigation over to the attorneys representing him as a plaintiff in Matagorda County. These attorneys answered the Dallas suit and moved to transfer venue to Matagorda County. The attorneys then notified Northern of the Dallas litigation.