Interpreting An Insurance Policy

Notice Of Claim To Insurance Company

March 3, 2012 | Mark S. Humphreys

Sometimes an insured in Weatherford, Aledo, Mineral Wells, Brock, Willow Park, Hudson Oaks, Springtown, Azle, or somewhere else in Parker County will have a claim they can make against their insurance company and not realize it. Well, what happens if they make that claim a long time after the loss occurs?

Here is a case that looked at that question. The style of the case is Prodigy Communications Corporation v. Agricultural Excess and Surplus Insurance Company. The case was decided in 2009, by the Texas Supreme Court.

Here are some of the facts in the case.

Reservation Of Rights Letter – Get An Attorney

March 1, 2012 | Mark S. Humphreys

If someone in Grand Prairie, Fort Worth, Saginaw, Keller, Roanoke, Haslet, Rhome, Justin, Boyd, or anywhere els gets a “reservation of rights” letter from their insurance company, there is one thing they need to do right away. See an experienced Insurance Law Attorney and have him go over the facts and policy in your situation.

The Texas Court of Appeals, Houston, 1st District, issued an opinion in 1999, that deals with a “reservation of rights” situation. The style of the case is Pecan Grove Association v. John L. Wortham & Sons. Here are some facts.

From 1982 to 1988, Pecan Grove purchased general liability insurance from Lloyds through its agent, Wortham. After June 1988, Pecan Grove purchased its general liability insurance from St. Paul through Wortham, which was also an agent for St. Paul. Wortham was an agent for both carriers. In February, 1988, Pecan Grove was sued by homeowners alleging that the property sold to them was not fit for construction. In October 1990, the Plaintiffs in the underlying suit amended their claims to add more than 70 additional plaintiffs. On December 6, 1990, Pecan Grove sent a letter to St. Paul with a copy to St. Paul through Wortham. On December 13, 1990, St. Paul issued a general reservation of rights letter. On December 17, 1992, St. Paul denied a defense and indemnity based on the policy’s real estate operations exclusion. On December 30, 1993, Pecan Grove settled the underlying lawsuit for $2,500,000.

Interpreting An Insurance Policy / Get A Lawyer To Help

February 28, 2012 | Mark S. Humphreys

Regular people in Weatherford, Aledo, Millsap, Willow Park, Hudson Oaks, Azle, Springtown, Mineral Wells, Brock, and other places in Parker County are going to have a hard time reading and understanding the wording in an insurance policy. It is also safe to say that experienced Insurance Law Attorneys will sometimes differ over the proper interpretation of the words in a policy.

The United States Fifth Circuit issued an opinion in a case in 1999, where the parties were arguing over the correct interpretation of a portion of an insurance policy. The style of the case is, Matador Petroleum Corp. v. St. Paul Surplus Lines Insurance Company. Here are some of the facts.

St. Paul provided Matador with insurance coverage pursuant to an oil and gas commercial general liability policy. The policy contained an absolute pollution exclusion clause. However, an endorsement provided a narrow exception stating that the pollution exclusion would not apply in the event of a “covered pollution incident.” A covered incident was a discharge, release, etc., that begins and ends within 72 hours, does not result from a well out-of-control, is known to you (Matador) or your operating partner within 7 days of its beginning and is reported to the company within 30 days of its beginning. In March 1994, a drilling bit collapsed in a well owned in part by Matador. The collapse caused a discharge of pollutants that fed onto adjacent property and waterways. Matador reported the incident to St. Paul’s agent 38 days after the incident occurred and requested coverage under the policy for damages claimed by landowners. After investigating the claim, St. Paul declined the request for coverage and informed Matador that St. Paul would not provide a defense or indemnity.

Lawyers And Home Owners Claim Denial Based On Lateness Of Claim

February 18, 2012 | Mark S. Humphreys

When someone in Grand Prairie, Weatherford, Fort Worth, or anywhere else in the north Texas area suffers an insured loss, how long do they have to report the claim to their insurance company? The answer is a lawyers answer: It Depends.

The Fifth Circuit Court of Appeals dealt with this issue in an opinion it issued in 2005. The style of the case is Ridglea Estate Condominium Association v. Lexington Insurance Company. Here are some of the facts.

In July 2001, after receiving notice from a roofing inspector that its building in Fort Worth, Texas has suffered hail damage, Ridglea filed an insurance claim with its carrier Chubb Custom Insurance. Upon its inspection, however, Chubb informed Ridglea that the damage was not caused by the more recent storm but rather by a storm that occurred on May 5, 1995. Ridglea did so and filed the claim with the 1995 carrier, Lexington Insurance Company. Lexington’s inspection revealed that the damage did not exceed the deductible and that there was not sufficient evidence that the damage occurred in 1995 and denied the claim. After about a year’s worth of negotiations involving Ridglea and all its insurers, Ridglea made a final demand. Lexington again denied the claim and brought a declaratory judgment action seeking a ruling that it was not liable for the damage. Both parties moved for summary judgment and the trial court granted summary judgment in favor of Lexington holding that Ridglea had failed to comply with the notice requirements contained in the policy. Ridglea appealed to the U.S. Court of Appeals for the Fifth Circuit.

Insurance Law Attorney Arguing Policy Interpretation

February 11, 2012 | Mark S. Humphreys

Business owners in Weatherford, Mineral Wells, Aledo, Azle, Springtown, Millsap, Brock, Hudson Oaks, Willow Park, and other areas of Parker County need to have a good understanding of the coverage provided in their policies.

The United States District Court, Southern District, Houston Division, issued an opinion on December 20, 2011, that dealt with the interpretation of a commercial insurance policy. The style of the case is, H & H Hospitality LLC v. Discover Specialty Insurance Company. The attorney for the business owner had to argue with the attorney for the insurance company as to the correct interpretation of the policy language related to the “business cessation” clause in the policy.

Here is some background.

Insurance Claims For Emotional Distress

February 9, 2012 | Mark S. Humphreys

Someone in Weatherford, Mineral Wells, Aledo, Hudson Oaks, Springtown, Azle, Brock, Millsap, Cool, Willow Park, or anywhere else in Parker County would have a hard time understanding the coverages in their insurance policy. Most policies cover an insured when they are sued but that is not always the case.

The United States Court of Appeals for the 5th Circuit issued an opinion in a case in 1994, that says the insurance company did not have to defend a case where the insured was sued for “emotional distress.” The style of the case is Travelers Indemnity Company v. Holloway. Here is some background and facts.

This was a declaratory judgment action wherein the insurance carrier, Travelers Indemnity Company of Rhode Island, contended that it had no duty to defend its insured, Wanda Holloway, against a lawsuit for intentional infliction of emotional distress, since this claim was not covered by the policy. Holloway, the mother of a junior high school student competing for a cheerleader position, allegedly plotted to kill Heath, the mother of one of her daughter’s competitors. The mother of the competitor brought suit against Holloway alleging “outrageous conduct causing severe emotional distress” or “intentional infliction of emotional distress.” Holloway sought a defense from Travelers. Travelers argued that Holloway was not entitled to a defense and that there was no coverage, since (1) the conduct did not constitute an “occurrence” under the policy, (2) the conduct was excluded from coverage as intentional conduct, and (3) the conduct was not alleged to have caused “bodily injury” as defined by the policy.

Title Insurance Case

January 29, 2012 | Mark S. Humphreys

Grand Prairie and Fort Worth holders of a title insurance policy might find this recent case of interest.

The Court of Appeals, Tyler, issued an opinion recently in the case styled, Howard L Straily and Tommie J. Straily v. Lawyers Title Insurance Corporation. Here is some background information:

The Strailys own a home built on a pier and beam foundation. Upon noticing that water had pooled beneath their home and believing the source of the pooling to be a water leak, they hired a plumber to investigate the problem. The plumber pumped water from beneath the home and conducted a visual inspection of the area and discovered an uncapped sewer line that was depositing a large quantity of sewage and water onto the property.

Like Kind And Quality

January 22, 2012 | Mark S. Humphreys

Persons who are insured in Grand Prairie, Arlington, Mansfield, Fort Worth, Dallas, De Soto, Duncanville, Cedar Hill, and other places in Texas are probably unsure what the phrase “like kind and quality” means in an insurance contract. Here is a case that may help to understand.

This is a Texas Supreme Court case that was decided in 2004. The style of the case is, Republic Underwriters Insurance Company v. Mex-Tex, Inc. Here are some relevant background facts in the case:

The roof atop a shopping mall was damaged by a hail storm. Before the insurance company agreed to pay for the replacement, the insured, owner of the mall, retained a roofer on a priority basis to replace the roof in order to avoid further injury to the tenants from future rains at a total cost of $179,000. Republic estimated the cost of replacing the roof with an identical make to be $145,460 and tendered that amount. The new roof was substantially similar in kind and quality to the old one, but the additional cost was due to the method of the roof’s attachment to the building and the high priority of the job. Republic refused to pay the balance of the claim and the insured sued. Tex-Mex sought to recover the balance of the amount owed plus a statutory 18% penalty on the entire claim. Republic argued that the penalty, if any, should be assessed only on the disputed amount, rather than on the entire claim. The trial court entered the judgment in favor of Tex-Mex and Republic appealed. The Amarillo Court of Appeals affirmed, holding that the policy did not require the replacement roof to be identical and that an insurer’s tender of the amount it believed was owed on a claim did not stop the accrual of Texas Insurance Code 542.060 penalties, or prejudgment interest, on what was later judicially determined to be the full amount of the claim. This Texas Supreme Court granted review of the case.

Life Insurance Claims

January 14, 2012 | Mark S. Humphreys

Residents of Grand Prairie, Arlington, Fort Worth, Dallas, and other areas in the State of Texas would want to understand what happens when a policy payment is missed. The following case is one where the policy ended up lapsing. An experienced Insurance Law Attorney may have been able to get a different result.

The case is State Farm Life Insurance Company v. Beaston. The case decided in 1995, by the Texas Supreme Court. Here is some background.

Beaston purchased a graded premium whole life policy from State Farm. The premium on the policy was due on 12/28/93. The thirty-one day grace period expired on 1/28/94. Three days after the expiration of the grace period, Beaston died in an automobile accident. State Farm refused to pay benefits because coverage had expired. Beaston’s wife, the beneficiary, brought suit alleging that the policy remained in force because of its dividend-at-death provision. The trial court found the policy ambiguous and instructed a verdict in favor of Beaston with respect to coverage.

Insurance Policy Interpretation

January 8, 2012 | Mark S. Humphreys

Customers in Grand Prairie, Arlington, Mansfield, Fort Worth, Hurst, Euless, Bedford, Saginaw, Haslet, Rhome, and other places in Texas would have a hard time trying to read and interpret an insurance policy. This is when the advice of an experienced Insurance Law Attorney is most helpful.

The United States District Court, Southern District of Texas, Houston Division, issued an opinion on October 5, 2011. This opinion deals with policy interpretation. The case arises from a declaratory judgement lawsuit filed by the insurance company, RLI Insurance Company, and the partial motion for summary judgment filed by the insured, Willbros Construction (U.S.) LLC, et al.

The court ruled in favor of the insureds. Her is some factual background.