Interpreting An Insurance Policy

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.

What Happens When Named Insured Dies

December 26, 2013 | Mark S. Humphreys

Dallas insurance attorneys need to be able to answer the above question. This was addressed in a 1990 opinion from the Houston Court of Appeals [14th Dist.]. The style of the case is, Nielson v. Allstate. Here is some relevant information.

This is an appeal from a summary judgment in favor of Allstate Insurance Company. For the reasons discussed here this court affirmed the trial court decision.

In November of 1978 Johanna Timm purchased an automobile insurance policy from Allstate. Timm was the sole named insured, and the insurance policy, by its terms, could not be assigned without Allstate’s written consent. Upon the death of the insured, however, coverage would extend to the legal representative of the deceased until the end of the policy period. Timm died in March of 1979. Allstate received renewal premiums for the policy and automatically renewed the policy in November of 1979 and 1980, but Allstate was not apprised of Timm’s death. In July of 1981 Charlotte Doyle died in a two-car automobile accident while driving the insured vehicle. Doyle was operating the automobile with the permission of the executor of Timm’s estate. Michael Shou Nielson, driver of the second auto, was severely injured in the accident. Nielson filed suit and received a default judgment against the administrator of Doyle’s estate. The administrator assigned any claim he might have against Allstate to Nielson. Nielson subsequently initiated this suit against Allstate.

Renewing A Policy

December 24, 2013 | Mark S. Humphreys

Insurance attorneys in Dallas need to be able to advise a client when a policy had been properly renewed. An opinion from the Houston Court of Appeals [14th Dist.] helps in this advice. It is a 2009 case styled, Hartland v. Progressive County Mutual. Here is some information to know.

Hartland, obtained auto insurance through Progressive County Mutual Insurance. Policy number 37156966-1 began on November 9, 2003, at 12:01 a.m. and ended on May 9, 2004, at 12:01 a.m. Progressive sent Hartland a renewal bill on April 14, and a renewal reminder on April 23, stating the renewal policy period would run from May 9 to November 9. Hartland claimed he mailed a check in the amount of the renewal premium on May 8; Progressive attached a lockbox report to its counterclaim for declaratory judgment showing the postmark date was May 11. Joan Hartland was in a single-car accident on May 9, 2004 at approximately 8:00 a.m., damaging a car covered under the initial policy.

Progressive presented evidence that it received the check on May 16, and on May 18, sent Hartland a revised renewal declarations page. Policy number 37156966-2 listed coverage dates from May 12, 2004, at 12:01 a.m. to November 12, 2004, at 12:00 a.m., excluding coverage for the date of the accident. Progressive denied the claim, stating the policy was not in effect at the time of the loss.

Insurance Accepts Late Payment

December 22, 2013 | Mark S. Humphreys

Insurance lawyers in Dallas need to be aware of the law as it relates to an insurance company accepting a late premium payment. The Houston Court of Appeals [14th Dist.] issued an opinion in 2009, that dealt with this issue. The style of the case is, Hartland v. Progressive County Mutual Insurance Company. Here is some of the relevant information.

Charles Hartland, filed suit against Progressive, after the denial of an auto-insurance claim for a single-car accident. The jury found Hartland did not mail the premium to renew the policy until after the policy had expired; therefore, he did not have insurance when the accident occurred. On appeal, Hartland contended the parties formed a contract under the terms of the original renewal policy when Progressive accepted his premium payment, and therefore, the policy covered the accident.

Progressive sent Hartland a renewal bill on April 14, and a renewal reminder on April 23, stating the renewal policy period would run from May 9 to November 9. Hartland claimed he mailed a check in the amount of the renewal premium on May 8; Progressive attached a lockbox report to its counterclaim for declaratory judgment showing the postmark date was May 11. Joan Hartland, the wife, was in a single-car accident on May 9, 2004 at about 8:00 a.m., damaging a car covered under the initial policy.

Geographic Limitation In Insurance Policy

December 21, 2013 | Mark S. Humphreys

Aledo insurance lawyers will not often run across what happened in this case, but it something to know about. The case is styled, McCallas v. State Farm Mutual. The opinion was issued by the Houston Court of Appeals [14th Dist.] in 1986.

The issue presented is whether the trial court was correct in holding that Personal Injury Protection (PIP) benefits can be denied on a geographic basis. This appeals court agreed with the decision of the trial court.

On March 3, 1984, McCalla was involved in an automobile accident on the island of Jamaica. He was hospitalized and treated. He has incurred expenses in excess of $2,500. Before the accident, McCalla was issued an insurance policy which was in effect at the time of the accident. This policy contained PIP coverage which was mandated by the Legislature. State Farm denied benefits because the policy applied only to accidents and losses which occurred in the United States and its territories or possessions, Puerto Rico or Canada. Thus, State Farm argued, the policy was not in effect when McCalla was driving in Jamaica.

When Is Property A Total Loss?

December 17, 2013 | Mark S. Humphreys

Dallas insurance lawyers will get a lot of calls wherein someone is asking the above question. This most often arises in the context of a motor vehicle accident. The Tyler Court of Appeals addressed this issue in a 2007 opinion styled, Canal Insurance v. Hopkins Towing. Here is some of the relevant information.

Henry Sweeney was operating a tractor-trailer rig hauling a load of peas when he lost control of the rig, which traveled off the road and into a deep ditch. The tractor-trailer struck several small trees and, eventually, rolled over onto its left side. Sweeney was the lessee and operator of the tractor, which was owned by Mullinax. Mullinax also owned the trailer. Both the tractor and trailer were insured against physical damage under an insurance policy issued by Canal. Mullinax was the named insured.

Trooper Faulkner ordered that a wrecker service be called in to tow the tractor and trailer. After two other wrecker services had refused the job because they “didn’t have the capabilities to do it,” Hopkins was called in to do the job. Because of the layout of the wreck site and the position of the tractor and trailer, Hopkins determined that they would have to use special air bags to return the trailer to an upright position. Hopkins recruited a subcontractor out of Tyler, Texas to supply the necessary air bags and operating personnel. In addition, Hopkins supplied three of his tow trucks and seven or eight employees who worked through the night, and in the rain, in order to remove the tractor and trailer from the ditch.

Policy Coverage In Mexico

December 14, 2013 | Mark S. Humphreys

Irving insurance attorneys will have many clients who travel to Mexico. The question then concerns auto coverage when traveling in Mexico. The first thing to do is to get with their agent and to read the policy. In order to understand how courts look at this issue, reading a 1999, El Paso Court of Appeals case may be helpful. The case is styled, Ruiz v. Geico. Here is some of the relevant information.

This is a summary judgement case wherein judgement was granted in favor of Geico.

Hermilinda Quesada de Ruiz was driving her 1996 Nissan Maxima in Ciudad Juarez, Chihuahua, Mexico, when she was involved in an automobile accident. The accident occurred within ten miles of the United States/Mexico border. As a result of the accident, Mrs. Ruiz incurred medical expenses arising from her injuries. The Ruizes contacted GEICO to advise of the accident and inquire as to coverage. GEICO responded that in accordance with the Ruizes’ policy, there was no coverage for the accident because it occurred in Mexico. The Ruizes received a letter from GEICO denying any and all liability. The Ruizes filed suit claiming that GEICO committed fraud because it negligently failed to disclose any limits of their coverage as it pertained to location. GEICO filed its motion for summary judgment which was granted by the trial court.

Coverage Outside The United States

December 12, 2013 | Mark S. Humphreys

Arlington insurance law lawyers will have clients who travel to foreign countries and as a result will get asked questions about coverage outside the United States. The simple answer to this question would be to read the policy. The Houston Court of Appeals [14th Dist.] issued an opinion in 1986 that partially addressed this issue. The style of the case is McGalla v. State Farm.

Here is some relevant information from that case.

On March 3, 1984, McCalla was involved in an automobile accident on the island of Jamaica. He was hospitalized and treated. He has incurred expenses in excess of $2,500. Before the accident, McGallas was issued an insurance policy which was in effect at the time of the accident. This policy contained PIP coverage which was mandated by the Legislature in the Texas Insurance Code. State Farm denied benefits because the policy applied only to accidents and losses which occurred in the United States and its territories or possessions, Puerto Rico or Canada. Thus, State Farm argues, the policy was not in effect when McCalla was driving in Jamaica.

Med-Pay And Subrogation

December 7, 2013 | Mark S. Humphreys

Fort Worth lawyers who handle car wreck cases need to be aware of the subrogation rights an insurance company has when a Med-Pay claim is made. The Dallas Court of Appeals dealt with this issue in 1970, in the case styled, Foundation Reserve Insurance Company v. Cody. Here is what happened.

Cody brought this action against Foundation seeking to recover the sum of $500, together with interest, penalty and attorney’s fees, alleged to be due him pursuant to the terms of ‘Medical Pay’ coverage of a family automobile policy issued to John D. McKee.

The facts were stipulated. On January 21, 1969 William Don Cody was riding in an automobile driven by John D. McKee in Dallas County, Texas when the car was involved in an accidental collision with another vehicle resulting in bodily injury to Cody. As a result of the accident Cody incurred reasonable medical expenses in excess of $500 within one year following the date of the accident. In due time Cody furnished proof of loss to Foundation in which he made demand for payment of the sum of $500, being the maximum amount of recovery provided for medical payments in the family automobile policy issued to McKee. In the meantime Cody made a claim against a third party for bodily injury and medical expenses arising from the collision and has heretofore settled his claim with such third party for a sum in excess of $500 by giving a general release to such third party. Foundation is a foreign insurance company and not qualified to write insurance in the State of Texas, such policy having been issued within the State of New Mexico to McKee who was then a resident of the State of New Mexico. The policy afforded various coverages including public liability, physical damage, uninsured motorist coverage, and expenses for medical services.

Named Driver Exclusion

December 5, 2013 | Mark S. Humphreys

Fort Worth insurance attorneys will have run across the type of situation that is presented in this 1996, opinion. This is a Corpus Christi Court of Appeals case styled, Zamora v. Dairyland County Mutual Insurance Company. Here is the relevant information.

Gracie Vela (wife of Jesus Toc) was operating Jesus Toc’s automobile when she was involved in an accident with Pete and Janie Zamora. At the time of the accident, Gracie Vela was named as an excluded driver in Mr. Toc’s automobile insurance policy with Dairyland. The Zamoras filed suit based on negligence, gross negligence, and negligent entrustment. Dairyland denied coverage on the basis of the named driver exclusion in the policy.

Thereafter, the Zamoras entered into an agreed judgment against Jesus Toc and Gracie Vela, and both parties filed suit against Dairyland on the basis that Dairyland wrongfully failed to provide coverage. Dairyland filed motion for a summary judgment asserting it had no duty to provide coverage because Gracie Vela was an excluded driver. The trial court granted the summary judgment in favor of Dairyland and this appeal ensued.