Interpreting An Insurance Policy

Business Owners Insurance In Texas

April 7, 2010 | Mark S. Humphreys

What if you are a business owner in Arlington, Grand Prairie, Weatherford, Fort Worth, Dallas, or somewhere else in Texas, and your business is shut down for a while? How does your commercial policy help you with lost income?

This was the question in the case, Catlin Syndicate Limited v. Imperial Palace of Mississippi, Inc; Imperial Palace of Mississippi, LLC. This case was decided by the United States District Court for the Southern District of Mississippi. The date of its decision is March 15, 2010.

Catlin Syndicate Limited (Catlin) is an insurer. They insured the casino operator Imperial Palace of Mississippi (Imperial). As the result of damage caused by hurricane Katrina, Imperial suffered a business interruption. Imperial was shut down for several months. When Imperial reopened it made much greater revenue than before the hurricane because many of the nearby casinos remained closed, and people had fewer gambling choices. Catlin agreed to pay Imperial’s claim but there was a dispute as to how the business interruption loss should be calculated.

Misrepresentations In Texas Insurance

March 26, 2010 | Mark S. Humphreys

Grand Prairie residents and residents of Arlington, Dallas, Fort Worth, Mansfield, Weatherford, and any other town or city in Texas have a right to have their insurance company and agent be honest with them. Misrepresentation of an insurance policy in Texas is illegal under the Texas Insurance Code and Texas Deceptive Trade Practices Act.

The Texas Insurance Code, Section 541.061, states that misrepresentation of an insurance policy in Texas is an unfair method of competition or an unfair or deceptive act or practice in the business of insurance. The title of Section 541.061 is “Misrepresentation of Insurance Policy”.

A violation of this section of the Texas Insurance Code is also a violation of the Texas Deceptive Trade Practices Act. As it relates to insurance misrepresentation, this section of the Insurance Code states that it is illegal to misrepresent features of an insurance policy by:

Commercial Insurance Policy and Interpretation

March 21, 2010 | Mark S. Humphreys

How an insurance policy is interpreted by Texas Courts is important. This is true whether you live in Grand Prairie, Arlington, Weatherford, Fort Worth, Mansfield, Dallas, or anywhere else in Texas.

A commercial insurance policy was recently interpreted by the United States District Court, Southern District of Texas, Houston Division. The style of this case is National Casualty Insurance Company v. Orion Transport, Inc. and Silvia Brune, Individually and as Representative of the Estate of James Brune, Deceased and Cody Brune and Cory Brune. The case was decided on February 22, 2010.

The undisputed facts in this case are that on February 4, 2009, Orion Transport, Inc. (Orion) hired welder, James Brune, to perform maintenance on its 1977 Heil Tanker Trailer. While Brune was performing the requested maintenance the trailer exploded injuring Brune, who later died of his injuries. The Brune estate and his survivors sued Orion and ETOCO. L.P., and ETOCO Management, LLC. in State District Court. National Casualty Insurance Company (National) brought this instant case in Federal District Court asking the court to rule that National had no duty or obligation under its policy of insurance with Orion to defend Orion or to pay any claims against Orion.

Coverage Or No Coverage?

March 19, 2010 | Mark S. Humphreys

The first thing a person wants to know who has insurance is; Does my policy protect me? This is true no matter if you are living in Grand Prairie, Fort Worth, Arlington, Mansfield, Dallas, or out in Weatherford, Texas.

The United States District Court, Southern District, Corpus Christi Division, had that decision to make in a case styled, National Fire Insurance Company of Hartford, et, al. v. Radiology Associates, LLP, et al., and issued an opinion on March 3, 2010. In this case, a couple sued Radiology Associates, LLP. (Radiology) and one of their employees, Brian K. Riley. Radiology had three insurance companies providing policies for them and Radiology presented the lawsuit to all three companies to provide a legal defense and settle any potential claims.

The facts in the case were that, Mrs. Pecore, a patient of Radiology, was to have a trans-vaginal ultrasound. It was alleged that during this exam, Riley inserted a finger into Mrs. Pecore’s vagina without permission and that Radiology should have informed Mrs. Pecore she had a right to have a chaparone present during the exam and that if a chaparone had been present the “assault” to Mrs. Pecore would not have occurred. There was nothing about the precedure involving the trans-vaginal exam that would have called for Riley to have committed the act he is accused of commiting.

Underinsured And Liability On Same Policy – How Does It Work

March 15, 2010 | Mark S. Humphreys

Whether you live in Weatherford, Texas, Grand Prairie, Arlington, Mansfield, Dallas, or Fort Worth, the answer to the above would be the same. Texas insurance law is going to apply to all residents of Texas, no matter where in the state they live.

Of course there is no one answer to the above title. The answer depends on the policy and the fact situation. A case decided in 1992, gives some insight into a scenario that is fairly common across the state.

The case, Margot Bergensen v. Hartford Insurance Company of the Midwest and Harry Bergensen, was decided by the 1st Court of Appeals in Houston, Texas. Here are the relevant facts.

An Understanding Of How Exclusions Work In An Insurance Policy

March 6, 2010 | Mark S. Humphreys

Insurance policy holders in Arlington, Grand Praire, Fort Worth, Weatherford, or Dallas, will all notice something called “Exclusions” in their policies. Maybe most people don’t look at their insurance policy’s until they have a reason to make a claim, but when they do they may read something they do not like. This something will usually be in the section of the policy titled “Exclusions.”

When Courts in Texas are called upon to read and interpret an insurance policy, the rule is, they are going to look at and interpret exclusions very narrowly. Their construction of the policy provisions are going to be very liberal with the aim being to favor coverage for the insured policy holder.

The Texas Supreme Court case, Puckett v. United States Fire Insurance Company, was decided in 1984, and states that insurance policies are strictly construed in favor of the insured to avoid excluding coverage. A historically long line of cases says that exceptions or limitations (exclusions) on liability are strictly construed against the insurer and liberally in favor of the insured. Here are a few of those Texas Supreme Court cases, National Union Fire Insurance Company v. Hudson Energy Company, decided in 1991. Barnett v. Aetna Life Insurance Company, decided in 1987. A 1982 case, Blaylock v. American Guarantee Bank Liability Insurance Company. Glover v. National Insurance Underwriter, was decided in 1977. And here is one, Brown v. Palatine Insurance Company, decided in 1896.

Interpreting An Insurance Policy In Texas

March 5, 2010 | Mark S. Humphreys

When a Court in Texas makes a ruling on an insurance issue in Texas, that ruling has the same effect on Texas residents regardless of where they live in the State. Living in Grand Prairie, Arlington, Dallas, Fort Worth, or out in Weatherford or anywhere else in the State, would all be the same.

What happens if an insurance contract is ambiguous? Ambiguous is when an insurance policy is subject to more than one reasonable interpretation. When an insurance policy is ambiguous the Courts in Texas have ruled that the interpretation of the policy that is most favorable to providing coverage will be adopted, as a matter of law. The reasoning for this is discussed in a line of Texas Supreme Court cases. A few of these cases are: (1) Grain Dealers Mutual Insurance Company v. McKee, decided in 1997, (2) State Farm Fire & Casualty Company v. Vaughan, decided in 1998, (3) Kelly Associates., Ltd. v. Aetna Casualty & Surity Company, decided in 1984.

The above cases say that it is for the Judge of the Court to decide if a reading of the insurance policy is ambiguous. If the policy is found to be subject to more than one interpretation, then the Court “must” rule in favor of coverage being provided under the policy. The intention of the insurance company in drafting the policy does not matter.

Excluded Drivers In Texas

February 26, 2010 | Mark S. Humphreys

There are lots of people in the Fort Worth, Dallas, Grand Prairie, Arlington, and Weatherford, areas of Texas who have problems getting affordable insurance. The reasons can be many, examples are, they are young, too many tickets, too many wrecks, a DWI conviction, license suspension issues, and medical conditions.

What happens if you have insurance on your car but when you bought the insurance you signed a document called a “named driver exclusion” on your spouse because the insurance company would not cover her because she suffered from epileptic seizures. That is what happened in the case, Janie Zamora, Pete Zamora, Jesus Toe, and Gracie Vela v. Dairyland County Mutual Insurance Company. This case was decided by the Court of Appeals in Corpus Christi, Texas.

The facts are, on December 2, 1993, Gracie Vela (wife of Jesus Toe) was operating Jesus’ automobile when she was involved in an accident with Pete and Janie Zamora. At the time of the accident, Gracie was named as an excluded driver in Toe’s policy with Dairyland County Mutual Insurance Company. The Zamora’s sued Gracie for her negligence and Jesus for negligently entrusting his car to Gracie. Dairyland denied coverage to Gracie and Jesus based on the named driver exclusion in the policy.

Permission? To Operate The Vehicle

February 25, 2010 | Mark S. Humphreys

A Dallas Appeals Court upheld a lower Court ruling in an interesting case. The ruling applies to the same facts anywhere in Texas, including, Fort Worth, Arlington, Grand Prairie, or Weatherford.

This case is valid law today but was decided in 1989. The fact pattern is unique. The style of the case is United States Fire Insurance Company v. United Service Automobile Association.

The underlying liability lawsuit arose out of an accident that occurred when an Anna Milliken was riding as a passenger, with a Douglas Martin, being the driver. The car Douglas was driving was owned by his father and was covered by the United States Fire Insurance Company (U.S. Fire) policy. Anna’s insurance was United Service Automobile Association. Douglas testified about some swerving and horseplay prior to the accident. Anna testified that Douglas was zigzagging the wheel back and forth and that she grabbed the wheel on two occasions prior to the accident. She was doing this to play back with Douglas. The first time she did this, Douglas did not object, and the second time was when the accident occurred causing serious injury to Douglas. Douglas sued Anna for his injuries.

Cooperating With Your Own Insurance Company

February 24, 2010 | Mark S. Humphreys

A case decided in Fort Worth, Texas on June 11, 2009, is important to understand. The result of this case is the same in Weatherford, Grand Prairie, Arlington, or Dallas.

The style of this case is Garry Jenkins v. State and County Mutual Fire Insurance Company. The facts in this case are undisputed. Garry Jenkins foot was crushed when a tank skid fell off a truck driven by Mark Lemmon. The accident happened when Mark applied the brakes too quickly, causing the skid to break free and fall on Garry’s foot. Both Garry and Mark were working as independent contractors for L & G Pipe. L & G Pipe was owned by two people, Deborah Grisamer and Richard Lemmon.

At the time of the accident, State and County Mutual Fire Insurance Company had a policy of insurance with Deborah as the named insured. The policy was in effect on the date of the accident and the policy listed the truck as a “covered auto.” The wording in the policy is important in this case and provided as follows: