Interpreting An Insurance Policy

Timely Notice Of Insurance Claim

February 25, 2014 | Mark S. Humphreys

Dallas insurance lawyers know to tell their clients to give timely notice of a claim to the insurance company. A 2006, Dallas Court of Appeals case discusses this issue. The style of the case is, Blanton v. Vesta Lloyds Insurance Company. Here is the relevant information.

This is a suit for declaratory judgment concerning insurance coverage. Don Blanton appeals the granting of Vesta Lloyds Insurance Company’s second motion for summary judgment, and Vesta appeals the denial of its initial motion for summary judgment. Because Vesta conclusively established that Blanton breached the “timely notice of occurrence” provision of the policy and that Vesta was prejudiced as a result this court ruled against Blanton.

In June 1997, Blanton leased certain property to Justin Burgess to operate a retail store of “one-of-a-kind restored art-deco furniture and related items.” On August 27, 1998, Vesta wrote a commercial general liability coverage policy for the property; the policy ran for a term of one year.

Loading Or Unloading A Vehicle

February 15, 2014 | Mark S. Humphreys

Insurance attorneys need to be able to read and interpret insurance policies in light of how the courts in Texas interpret the policies.

A 1970, Texas Supreme Court case styled, Commercial Standard Insurance Company v. American General Insurance Company is worth reading.

American brought this suit against Commercial and Berry Contracting, Inc., and its employees, Eugene J. Adams and J. W. Rosson, seeking a judgment declaring that its automobile liability policy (issued to Harris Concrete Co.) did not provide coverage to Berry and its employees against claims asserted against them by employees of the general contractor, Fuller Construction Company.

Insurance Policy Language

February 11, 2014 | Mark S. Humphreys

Arlington insurance attorneys know how important the language in a policy is and how that language relates to the facts in a claim. The Houston Court of Appeals issued an opinion in 1996, in the case styled, “Schulz v. State Farm Mutual Auto.” Here is some the relevant information in this summary judgment case.

The summary judgment evidence shows that Gunar Fulk, Schulz’s son, was driving a pickup truck owned by Schulz’s husband and insured by State Farm. Fulk, accompanied by a friend, gave a ride to Lonnie Earl Johnson. Some time thereafter, Johnson shot three fatal rounds into Fulk’s face and chest as Fulk was standing outside the truck. Johnson then killed Fulk’s friend with a shot to his back.

Schulz sued State Farm seeking to recover benefits under the personal injury protection (PIP) and auto death indemnity (ADI) coverages provided under a State Farm insurance policy that covered the vehicle. In her original petition, Schulz claimed Johnson pulled the gun in an apparent attempt to hijack the truck. She also claimed that, at the time the shots were fired, Fulk was either seated in the truck or, in the alternative, had been ordered at gunpoint to get out and was kneeling next to the truck. However, there is nothing in the record, other than Schulz’s assertions in her original petition, to support the allegations that Fulk’s truck was hijacked, that Fulk was ordered out of the truck or that Fulk was kneeling next to the truck when shot.

Life Insurance Claim Denial

February 9, 2014 | Mark S. Humphreys

Life insurance attorneys will tell you that the language used in the insurance policy is important to determining coverage. An experienced Insurance Law Attorney will also tell you there are many ways of getting around some of the language in a policy.

Here is a case where the facts were bad but the case still serves as an example of how the courts interpret policy language. The style of the case is Douglas v. Southwestern Life Ins. Co. It is a Tyler Court of Appeals opinion that was issued in 1964.

Here is some of the relevant information.

When Is A Person “Totally Disabled”

February 6, 2014 | Mark S. Humphreys

Aledo insurance law lawyers need to be able to discuss how insurance companies interpret their policies that provide coverage for “total disability.” An old 1932 case from what was then called the Court of Commission of Appeals of Texas, Section A, is a good place to start reading. The style of the case is Kemper v. Police & Firemen’s Ins. Ass’n. Here is some information from that case.

The Kemper sued the insurer to recover $2,000 alleged to be due as insurance on the life of William H. Kemper, deceased husband, on a contract of insurance issued by the insurer to the deceased during his lifetime, in which certificate Kemper was named beneficiary. Trial in the district court with a jury resulted in a verdict and judgment for Kemper for the full amount of the policy. The policy of insurance made the basis of this suit contains, among others, the following provisions:

“Any and all such payments or liability to pay shall be and is in accordance with, subject to, each and all of the provisions of the by-laws of said association and of the provisions of any and all amendments, alterations and new issues of said by-laws, which said by-laws are hereby referred to and made a part hereof as fully as if they were recited at length over the signatures hereto affixed as soon as such amendments, alterations or new issues of said by-laws respectively are or may be duly adopted, and the said William H. Kemper hereby and by the acceptance hereof agrees to abide and be bound by said by-laws and each of them and by any and all lawful amendments, alterations and new issues thereof or of any of them.”

Death Benefits In An Insurance Policy

February 4, 2014 | Mark S. Humphreys

Tarrant County insurance attorneys need to be able to interpret policies when discussing possible cases with clients. The Texarkana Court of Appeals issued an opinion in a 1967 case, styled Willeford v. Home Indemnity Company that is helpful to read. Here is some of the relevant information.

Lewis Willeford, as plaintiff, sued defendant insurance company for $10,000.00 on an insurance policy covering defendant’s deceased wife, Cordia Willeford, allegedly due as a death indemnity benefit under said policy. Plaintiff and defendant both filed motions for summary judgment and the trial court entered summary judgment for defendant and denied plaintiff’s motion for summary judgment. However it appears that there was no dispute that plaintiff was entitled to recover $3,500.00 for the loss of sight of one eye sustained by Mrs. Willeford and the summary judgment awarded this amount to plaintiff. Plaintiff appealed, contending that he is entitled to judgment for $10,000.00, rather than $3,500.00.

Defendant issued its Family Automobile Policy to Lewis Willeford effective August 15, 1964, with endorsement 157 M. Under such endorsement, Willeford contends that he is entitled to the principal sum of $10,000.00 as a result of the death of his wife, Cordia Willeford, which occurred more than 90 days after the hereinafter referred to accident. The policy of insurance and endorsement provided in part as follows:

Auto Policy Definitions

February 2, 2014 | Mark S. Humphreys

Parker County insurance lawyers need to be able to read and discuss policy terms from a legal standpoint with prospective clients. A 1978, Dallas Court of Appeals case styled Republic Insurance Company v. Bolton may help in this regard.

M. Dean Bolton sued Republic Insurance Company, his insurer, for medical expenses and lost wages under the Personal Injury Protection (PIP) endorsement to his family automobile insurance policy. The injuries which formed the basis of Bolton’s claim resulted from an accident which occurred while he was driving a modified Volkswagen, referred to as a “dune buggy,” in an off-road race in Oklahoma. The sole disputed issue at trial was whether the dune buggy was a “motor vehicle” under the terms of the policy. This issue was submitted to a jury, which found that the dune buggy was a motor vehicle within the meaning of the policy. The trial court rendered judgment upon the verdict, and Republic appealed. This Court affirmed.

Republic’s initial argument was that the issue of whether the dune buggy was a motor vehicle under the policy was a question of law which should not have been submitted for jury determination, and hence, that the jury’s finding should be disregarded and judgment rendered against Bolton’s claim. Alternatively, Republic urges that the jury’s finding is against the great weight and preponderance of the evidence.

Policy Exclusions – Automobile

February 1, 2014 | Mark S. Humphreys

Mineral Wells lawyers need to be able to give advice regarding insurance policy exclusions. The 1966, Texas Supreme Court case styled, Williams v. Cimarron Insurance Co. is a good place to start. Here is some information about this case.

This is an action to recover medical, hospital and funeral expenses under the medical payments provision of an automobile insurance policy issued by Cimarron Insurance Co., Inc. The facts are stipulated and the controlling question is whether the stock car racer here involved is comprehended by the definition of ‘automobile’ contained in coverage C of the policy. The trial court held that it was not and rendered judgment that Williams, take nothing against the insurance company. The Court of Civil Appeals at Amarillo affirmed. This court ruled that the judgment of the Court of Civil Appeals was correct.

Jimmy Ray Williams, his wife and their minor son, James Richard Williams, were spectators at a race track located on private property when one of the stock car racers careened through the fence and struck all the members of the Williams family. Mr. and Mrs. Williams sustained serious personal injuries and James Richard was killed. The racer which struck them was a stripped-down 1947 Ford sedan with a 1954 Mercury motor owned by Carl Osborn and Robert R. Riddle. The vehicle had been originally manufactured by the Ford Motor Company, but it had been modified by Robert R. Riddle about a year prior to the accident and converted into a stock car racer and after modification, the vehicle had no tail lights, headlights or window glass. A screen wire served as a species of windshield. In front the car had a safety bar and two angle irons coming to a point about two and one-half (2 1/2) feet in front of the radiator, but it had no fenders, bumpers or horn. It was equipped with heavy-duty tie rods and spindles and oversized tires. The speedmeter cable was not connected and it was either towed or carried on a trailer to and from the race track. The vehicle was not licensed by the State of Oklahoma or any other state for operation upon the public roads and highways.

Total Disability

January 28, 2014 | Mark S. Humphreys

Aledo insurance attorneys need to know how the court interpret “total disability” in an insurance policy. The 1961, Texas Supreme Court case styled, Prudential Insurance Company of America v. Tate is a good case to read for understanding. Here is some of the relevant information.

This policy provided for certain benefits to be paid to Tate in the event he was disabled before reaching the age of 60 years. It was stipulated that Tate was under 60 years of age at the time he claimed he became totally and permanently disabled. Upon answer to special issues in favor of Tate by the trial jury, the trial court granted Tate’s motion for judgment on the verdict for the sum of $2,922, due under the terms of the policy, and $350.64 as 12% penalty provided by statute for failure of Prudential to pay upon demand by Tate.

This court held that the lower courts were in error in determining the amount due under the terms of the policy and reversed the judgments of both lower courts and remand the cause to the trial court.

Read The Policy

January 23, 2014 | Mark S. Humphreys

Saginaw insurance attorneys and their clients need to read and understand the insurance policies they are presented with by the insurance company. The United States 5th Circuit issued an opinion in November 2013, that illustrates why. The style of the case is Willoughby v. Metropolitan Lloyds. Here is the relevant information.

This appeal involves the timeliness of a homeowner’s lawsuit against her insurer. The district court determined the lawsuit was untimely and granted summary judgment. This appeals court affirmed.

Willoughby contracted with Metropolitan Lloyds for a homeowner’s insurance policy. The policy included a shortened limitations period, stating that “[a]ction brought against [Metropolitan] must be started within two years and one day after the cause of action accrues.” In November 2007, Willoughby reported to Metropolitan that a fire had damaged her home in Blooming Grove, Texas. Metropolitan subsequently investigated Willoughby’s insurance claim and examined her under oath regarding the circumstances of the fire. During the course of this examination, Willoughby provided her mailing address and stated that her and her husband’s attorney was Paul Lewallen. Nine months later, in a letter dated September 25, 2008, Metropolitan denied Willoughby’s claim, explaining that it believed “the fire was set by or at the direction of one or more of the named insureds.” The letter further explained that Willoughby had not complied with her insurance policy’s reporting obligations, one of which required her to provide a signed “proof of loss” statement. Metropolitan sent this letter to the mailing address provided by Willoughby. Willoughby denies ever receiving it.