Dallas Fort Worth Insurance Lawyer Blog

Late Payment Of Claims – How To Make A Claim

July 3, 2023 | Mark S. Humphreys

When making a claim, what is required of the claimant? Here is some guidance.

Pursuant to Texas Insurance Code, Section 542.051(4), there is no particular content required, as long as the claim “reasonably apprises the insurer of the facts relating to the claim.”

The statute requires that the claim be in writing. The statute provides that “notice of claim” means “any written notification provided by a claimant to an insurer that reasonably apprises the insurer of the facts relating to the claim. A 2005, Austin Court of Appeals, in an opinion styled, McMillin v. State Farm Lloyds, has strictly applied the requirement of written notice, holding that a phone call was not sufficient.

Life Insurance = Misrepresentation – 3

July 1, 2023 | Mark S. Humphreys

Life Insurance claims denial attorney are well aware of this 2023 opinion from the Texas Supreme Court. The opinion is styled, Arce v. American National Insurance Company.

In the opinion the Texas Supreme Court discussed “intent.”

American National argued that, because the Texas Legislature included the word “intent” in other provisions of the Texas Insurance Code, the absence of such a phrase in Section 705.051 indicated the Legislature’s intent Not to require “intent.”

Life Insurance Denial – Misrepresentation – 2

June 26, 2023 | Mark S. Humphreys

Life Insurance claims denial attorney are well aware of this 2023 opinion from the Texas Supreme Court. The opinion is styled, Arce v. American National Insurance Company.

The Court discussed the plain text of Texas Insurance Code, Section 705.051 wherein it states: “a misrepresentation in an application for a life, accident, or health insurance policy does not defeat recovery under the policy unless the misrepresentation:

(1) is of a material fact; and

Life Insurance Denial – Misrepresentation – 1

June 24, 2023 | Mark S. Humphreys

Life Insurance claims denial attorney are well aware of this 2023 opinion from the Texas Supreme Court. The opinion is styled, Arce v. American National Insurance Company.

On April 28, 2023, the Texas Supreme Court held that a life insurer seeking to avoid a life insurance policy via a Texas Insurance Code statutory misrepresentation defense must, just like under a common-law misrepresentation defense, prove the insured had “intent to deceive” when it made a misrepresentation in a life, accident, or health insurance application.

In making this ruling, the Texas Supreme Court rejected American’s argument that Texas Insurance Code, Section 705.051 did not require intent to deceive just because the statute was silent on whether intent to deceive was required.

Credit Life Insurance – Date Of Termination

June 19, 2023 | Mark S. Humphreys

Credit Life Insurance policies always list specific termination times. Here is a 1985, San Antonio Court of Appeals opinion that deals with credit life insurance and the issue of when the policy terminated. The opinion is styled, Eagle Life Insurance v. G.I.C. Insurance Co.

This lawsuit was tried before the Judge and the judgment was in favor of G.I.C. Eagle filed this appeal. This Court reversed the trial Court and stated as follows:

The agreed undisputed facts are as follows. G.I.C. and Eagle Life, entered into a reinsurance treaty. Under the terms of this treaty, G.I.C. wrote credit life insurance policies which were re-insured with Eagle Life. Eagle was given most of the insurance premiums and in turn agreed to reimburse G.I.C. “for all losses arising under the specific terms and provisions of the policies and certificates of insurance re-insured hereunder.” Under the terms of the reinsurance treaty, G.I.C. retained the first $5,000.00 of each policy written, so Eagle Life’s obligation to reimburse G.I.C. was limited to amounts above $5,000.00 which G.I.C. properly paid out on valid claims.

Life Insurance – Date Of Termination – Claims Denial Attorney

June 17, 2023 | Mark S. Humphreys

Credit Life Insurance is the type of policy at issue in this 1979 opinion from the Fort Worth Court of Appeals. The opinion is styled, Leach v. Eureka Life Insurance Company of America.

Tommy Leach took out a loan from a bank and as part of the loan agreement, Tommy was required to purchase credit life insurance. The credit life insurance was for six months which began on March 13, 1977, and ended on September 13, 1977. Tragically, Tommy was reported killed in an auto accident that is showed a time of death as 12:45 a.m., September 14, 1977, Central Daylight Time.

Tommy’s widow, Mary Leach, made a demand on Eureka to pay the loan balance to the bank. Eureka refused payment, stating that the policy had terminated on September 13, 1977. This lawsuit resulted and the trial resulted in a ruling in favor of Eureka.

Force Placed Insurance Policies

June 12, 2023 | Mark S. Humphreys

Force Placed Insurance Policies are unique. The biggest thing to know about these policies is that their purpose is to protect the lender, not the homeowner. This is illustrated in a 2023 opinion from the Southern District of Texas, Houston Division. The opinion is styled, Peter Garcia v. Great American Assurance Company.

Peter Garcia (“Plaintiff”) filed this action against Great American Assurance Company (“Defendant”) alleging that Defendant failed to pay for covered damage to his home under an insurance policy purchased by his mortgagee, Carrington Mortgage Services LLC (“Carrington”). Pending before the court is Defendant’s Motion for Summary Judgment. The Court granted the motion.

Plaintiff’s home is mortgaged in favor of Carrington. Lenders often require borrower-mortgagors to purchase insurance on their home. When the borrower does not do so, the lender might purchase a “force-placed” policy and include the cost in the borrower’s mortgage payments. Carrington purchased a force-placed insurance policy (“the Policy”) covering its interest in Plaintiff’s home. Plaintiff is not a party to the Policy, and all payment for loss is
to be made to Carrington.

Life Insurance And More Than One Beneficiary – Life Insurance Claim Denial Attorney

June 10, 2023 | Mark S. Humphreys

Here is an unusual life insurance situation. It is an opinion from 1992. The opinion is from the Amarillo Court of Appeals and is styled, Ester Belle Medlin, Appellant v. Earnest G. Medlin, Floyd W. Medlin, Brenda E. Burford and Carolyn E. Medlin, Appellees.

The question to be determined in this matter is whether appellant Esther or appellees are entitled to one-half of insurance proceeds which had become payable due to the death of Jessie F. Medlin, Jr. (Jessie), the insured. Appellant is the insured’s mother and appellees are the insured’s children by a previous marriage. From a trial court judgment awarding those proceeds to appellees, appellant brings this appeal. For reasons hereinafter expressed, we reverse the judgment of the trial court and render judgment awarding the proceeds in question to appellant.

The beneficiary clause of the insurance policy provides in pertinent part:

Bad Faith Lawyers – Was There A Settlement Agreement

June 5, 2023 | Mark S. Humphreys

Here is a 2023 opinion from the Northern District of Texas, Dallas Division worth reading when it comes to determining whether the insurer and the insured have reached a settlement agreement. The opinion is styled, Brenda Kirby and Gary Kirby v. State Farm Lloyds’, Evan Kingery, and Kimberly Scholes. The opinion deals with other issues and the facts make a good read along with the legal history. We will focus on whether or not there was a settlement agreement.

After the lawsuit was filed, Defendant’s filed a motion to enforce a settlement agreement. For support, State Farm submitted copies of the above referenced e-mail correspondence exchanged by counsel for the parties on January 18, 21, 24, and February 2, 2022. Defendant contends that this correspondence clearly establishes the formation of a binding agreement to settle the claims asserted in this lawsuit under Texas law.

A district court has inherent power to recognize, encourage, and when necessary enforce settlement agreements reached by the parties. That one party to a suit initially agrees to a settlement but later refuses to execute a formal agreement that recites the terms of the settlement does not preclude a district court from exercising such discretion to enforce a settlement agreement. Further, the issue of whether such withdrawal by one party is allowed under Texas law is irrelevant to whether a settlement is enforceable. Unless the party seeking to withdraw can demonstrate that the agreement is invalid under state law at the time it was made or differs materially from any judgment entered enforcing the agreement, a federal court may hold them to their word by incorporating the terms of their agreement into a final judgment.

Bad Faith Insurance And Claims Expert

June 3, 2023 | Mark S. Humphreys

Here is a case discussing bad faith insurance and a claims expert. This is an 2023 opinion from the Western District of Texas, San Antonio Division. The opinion is styled, PMJ Bleu Terre Management, LLC v. AmTrust Insurance Company of Kansas, Inc.

AmTrust filed a Motion to Strike Expert, PMJ’s claims handling expert, Mark Earle. The Court has authority in this matter pursuant to 28 U.S.C., Section 636(b)(1)(A).

This is a claim arising out of alleged property damage that resulted from a storm causing wind and hailstorm damage.