Life Insurance

Life Insurance Denial

September 22, 2015 | Mark S. Humphreys

Dallas life insurance lawyers keep up with court decisions related to life insurance claims. The most recent from the date of the post is from the U.S. 5th Circuit Court of Appeals. It is styled, Lila McWhirter v. AAA Life Insurance Company.

Eugene McWhirter purchased a life-insurance policy from AAA covering accidents that occurred while “exiting from any private passenger automobile . . . .” In December, McWhirter attended a party with his daughter Karen and wife Lila. After the party, Karen drove the family home and backed into the driveway. Shortly thereafter, McWhirter fell. Neither Lila nor Karen witnessed the incident. They discovered McWhirter lying in the grass near the car. McWhirter died as a result of the head injury he sustained during the fall.

Lila filed a claim with AAA seeking death benefits. In the claim forms, she described the accident as follows: “While exiting the vehicle and entering the home hit the entry step and fell backwards into the yard hitting the back of his head to the ground.” She also submitted McWhirter’s death certificate, an EMS report, an affidavit from a neighbor who observed the scene, and a drawing and photograph in which the neighbor showed that McWhirter was found lying parallel to the car on his back. AAA concluded that these documents, as well as Lila’s description of the accident and statements made by Karen in letters to the company, indicated that McWhirter fell after exiting the car. As a result, it determined that the fall was not covered under McWhirter’s policy and denied Lila’s claim.

Insurance Company Trying To Rescind A Policy

September 1, 2015 | Mark S. Humphreys

Life insurance lawyers need to know the facts in a 1980, Texas Supreme Court case. It is styled, Mayes v. Massachusetts Mutual Life Insurance Co. This case is important because a life insurance company often times to rescind a policy based on misrepresentations made in the policy application.

In Mayes, Massachusetts tried to rescind three policies of insurance on the life of Albert Hayes after he died. Mayes did not disclose that certain answers which were correct when made became false by the time the policies were delivered.

On May 6, 1976, Albert Mayes signed and delivered to an agent of Massachusetts Part 1 of two applications for life insurance. These applications had been filled out by the agent and his secretary from information secured from a previous policy issued to Mayes through this agent. The applications are identical except for the amount of insurance requested by each application. On page three of each application is the following paragraph:

Life Insurance – Homicide

August 29, 2015 | Mark S. Humphreys

Life Insurance attorneys will eventually have a case where the benefits of a life insurance policy are being denied for the stated reason that the beneficiary of the life insurance policy willfully brought about the death of the insured. The United States District Court, Western District of Texas, San Antonio Division, had this issue in a case. It is a 2015 case styled, Garrett Bean and Aneilia Bean v. Minerva Alcorta.

Gary Bean was the father of Garrett and Aneilia Bean (plaintiffs). Gary was killed by a gunshot wound. Gary had life insurance and the insurance company inter-pled the life insurance benefits into the registry of the court.

Minerva was the primary beneficiary under the policy. Minerva was the boyfriend of Gary and at the scene of the homicide, Minerva hysterically told policy that she had shot her boyfriend. Due to the circumstances, plaintiffs made claim to the policy benefits stating the Minerva had forfeited her rights to the policy benefits by intentionally causing the death of Gary and that plaintiffs were, as a result, the proper claimants to the life insurance benefits.

ERISA And Life Insurance And Accidental Death Coverage

August 27, 2015 | Mark S. Humphreys

Fort Worth lawyers who handle ERISA claims will need to read this opinion out of the U.S. District Court for the Southern District of Texas, Houston Division. It is styled, Sandra James v. Life Insurance Company of North America and Geico.

This is an appeal of a Magistrates ruling on a summary judgment in favor of Life Insurance Company of North America and Geico (Geico).

Sandra’s husband was killed in a one vehicle accident with a tree and subsequent fire. The medical examiner stated Robert’s cause of death was “inhalation of combustion products and thermal injury.” The listed manner of death was an “accident.”

Life Insurance And ERISA

June 28, 2015 | Mark S. Humphreys

Forest Hill insurance lawyers who handle ERISA claims can tell you horror stories about the rulings and statutes that govern ERISA. The Washington Post published an article not long ago giving reasons and examples about some of the issues with ERISA life insurance claims.

Life insurance companies want employers with life insurance plans governed by ERISA. So eager are the largest insurers to get ERISA contracts that they sometimes cross a line, according to prosecutors in California and New York.

MetLife and Prudential have made improper undisclosed payments to brokers to win business, according to settlements. Each company paid $19 million to settle accusations by the New York Attorney General’s Office in 2006 that they had illegally paid brokers to get new corporate clients. In a similar case, MetLife paid $500,000 and Prudential spent $350,000 to settle with three California counties in 2008. The insurance companies did not admit to any wrongdoing in the cases.

ERISA And Life Insurance

June 27, 2015 | Mark S. Humphreys

Haltom City life insurance attorneys who handle ERISA claims should already know this, but here goes anyway.

Insurance companies can make erroneous arguments with near impunity when it comes to life and accidental death policies provided by companies with ERISA plans. That is because of loopholes in the ERISA laws intended to protect worker benefits.

Under ERISA – the Employee Retirement Income Security Act, insurers can even win when they lose because they can keep and invest claims money while cases are pending.

Life Insurance Lawyers Know This Already

June 25, 2015 | Mark S. Humphreys

Life insurance lawyers in Dallas already know what was published in the Washington Post. It is an article about the death of a loved one being the beginning of a hard fight with the life insurance company.

The article tells us of an experience by a Jane Pierce. Jane spent nine years struggling beside her husband, Todd, as he fought cancer in his sinus cavity. The treatments were working. Then in July 2009, Todd died in a fiery car crash at the age of 46. Todd’s death ended a fight with cancer but began a long fight with Todd’s insurance company, MetLife, for life insurance benefits.

A state medical examiner and a sheriff investigating the case concluded that Todd’s death was an accident. The accident was caused when Todd lost control of his silver GMC pickup after passing a car on a two-lane road. Sounds simple enough, right!?

Life Insurance And Interpleaders

May 21, 2015 | Mark S. Humphreys

Dallas life insurance attorneys will encounter situations where the funds to be recovered from a life insurance policy are “inter-plead” into a court. A Texas Supreme Court opinion issued in 2007, is a must read for lawyers handling interpleader cases. The style of the case is, State Farm Life Insurance Company v. Toni Wasson Martinez.

It has long been the rule in Texas that if an insurer promptly interpleads policy proceeds, it cannot be subjected to statutory penalties for delayed payment even if it missed the statutory deadlines.

After 13 years of marriage, Ed and Linda Martinez divorced in 1994. In their Agreement Incident to Divorce, Ed agreed to pay Linda contractual alimony of $5,000 per month for ten years, with his estate to continue paying if he died earlier. Ed also agreed to name Linda as irrevocable beneficiary on three life insurance policies, providing that he could drop those policies or change beneficiaries so long as the unpaid alimony amount was covered.

Statement In Insurance Application

May 16, 2015 | Mark S. Humphreys

Dallas life insurance lawyers need to read this 1979, Amarillo Court of Appeals opinion. It is styled, Allied Bankers Life Insurance Company v. Mary De La Cerda.

On December 27, 1976, Paul A. De La Cerda secured a $9,000 group credit life insurance certificate from Allied. The certificate contained a statement that the insured had not been, nor was being, treated for certain diseases and that he was in good health.

On February 3, 1977, insured died. The cause of death was diagnosed as acute myocardial infarction superimposed upon a previous anterolateral infarction. The bank filed its claim under the certificate, which was denied by Allied. Thereafter, the bank assigned its interest to Mrs. De La Cerda.

Life Insurance

May 12, 2015 | Mark S. Humphreys

Palo Pinto County insurance lawyers need to understand life insurance.

Life insurance pays a stated amount of benefits to the beneficiary upon the insured’s death. Typically, the policy has a “face amount” that is, a stated value that is payable. Some policies may offer increased benefits if the insured dies from certain causes. For example, some policies pay “double indemnity” benefits if the insured dies in an accident.

“Term” policies pay a fixed amount stated in the policy. Whole life policies accumulate cash value. On the other hand, if the policy allows the insured to borrow against the policy, the death benefit may be reduced by the amount of any outstanding loans.