Dallas Fort Worth Insurance Lawyer Blog

Insurance Agent Cheating People

June 28, 2016 | Mark S. Humphreys

The Insurance Journal published an article in May 2016, that insurance lawyers and consumers will find interesting. The article is titled, Fraud Lead to 20 Year Prison Sentence for Houston Insurance Agent.

Harris County District Attorney Devon Anderson that a Houston-based insurance agent has been sentenced to 20 years in prison after a Texas Department of Insurance investigation uncovered an annuity scam, in which she bilked almost a dozen elderly clients out of more than $3 million.

TDI investigators built their case against Celia Castillo after getting complaints about the legitimacy of the investment products she was selling.

Prompt Pay Act – Insurance Company Duties

June 26, 2016 | Mark S. Humphreys

Texas insurance lawyers need to be able to tell their clients the responsibility the insurance company has under the Texas Prompt Pay Act.

To start with, no deadlines are triggered until the insurance company receives all items, statements, and forms reasonably required by the insurance company. Once the insurance company receives this information, seven new duties arise that were not mentioned in the previous post.

(5) Accept or reject the claim. – By the 15th “business day,” the insurer, pursuant to Section 542.056(a), must notify the claimant that it accepts or rejects the claim. This deadline extends to 30 “days” if the insurance company reasonably expects arson. Also, the insurance company can get a 45 day extension of these deadlines.

Prompt Payment Act – Duties Of Insurance Company

June 25, 2016 | Mark S. Humphreys

Texas lawyers handling insurance claims need to know the following.

Once an insurance company receives notice of a claim, four duties are triggered:

(1) Acknowledge the claim. Texas Insurance Code, Section 542.055(a)(1) says the insurer must acknowledge receipt of the claim.

Insurance lawyers need to be aware of the Prompt Payment of Claims Act

June 23, 2016 | Mark S. Humphreys

Insurance lawyers need to be aware of the Prompt Payment of Claims Act found in Texas Insurance Code, Section 542.051. When suing for violation of this Act, an attorney must know that at the same time, he must sue for breach of contract. This is illustrated in the 2005, Waco Court of Appeals opinion styled, United States Fire insurance Company v. Tammy Fugate.

Fugate and her family were injured in a motor vehicle collision with a vehicle operated by William Heintz. After filing suit against Heintz, Fugate settled with him for his remaining policy limits of $15,200.

Fugate had an automobile insurance policy with US Fire, and that policy provided underinsured and uninsured motorist (UIM) coverage for her.

Dog Bite Insurance

June 21, 2016 | Mark S. Humphreys

Texas insurance attorneys should find this article from the Insurance Journal interesting. It is titled, F.I.D.O.’S Dog Bite Liability Insurance Fills Coverage Gap.

When commercial lines insurance agent and dog owner Debbie Turner began to look into help for her difficult dog back in 2000, she had no idea that her journey would end up leading to a new personal lines insurance option.

Now, she believes her new Covered Canine policy could take a bite out of the dog liability insurance marketplace.

Insurance And Dog Bites

June 19, 2016 | Mark S. Humphreys

Attorneys who handle insurance cases will eventually have a dog bite case they are involved in helping someone with. The Insurance Journal published a story titled, Number of Dog Bite Insurance Claims Falls But Average Claim Rises to $37K. This story is worth reading to keep informed with what is going on in the world of insurance.

The cost of dog-bite claims for U.S. insurers climbed 16 percent last year on higher medical expenses and larger settlements to resolve court disputes.

The average claim increased to $37,214 in 2015 from $32,072 a year earlier, according to the Insurance Information Institute, an industry group. The average in Arizona was $56,654, the highest figure among the 10 states with the most claims. California has the second highest average cost per dog bite claim at $44,983 while New Yok, at $44,320, comes in third.

Tornado Damage And Appraisal Award

June 18, 2016 | Mark S. Humphreys

Dallas County insurance attorneys see tornado claims. Here is a case resulting from a tornado claim. It is from the Dallas Court of Appeals. It is styled, Halton v. American Risk Insurance Company, et al.

This is an appeal from an adverse summary judgment granted in favor or American. The parties dispute whether American properly and fully paid an appraisal award to repair damage to Halton’s home that was damaged by a tornado. This Court reversed the summary judgment.

The Halton’s home was damaged and American paid damages totaling $42,083.87. After the lawsuit was filed an umpire was hired to appraise the loss. The lose was determined to be $180,273.92 in replacement cost and $163,613.92 in actual cash value. The Halton’s deductible was $1,631.89. American issued additional checks totaling $102,548.04.

Attempting To Sue The Adjuster

June 16, 2016 | Mark S. Humphreys

Most insurance lawyers will attempt to keep any case they are involved with, out of Federal Court. One way of doing this is to sue the local adjuster who handled the claim. The Laredo Division, of the Southern District was inclined to agree with that method except the problem was showing that the adjuster the insured sued, did anything wrong. The style of the case is, Maria Rudolph v. Nationwide General Insurance Company, et al.

This is an insurance coverage dispute arising out of hail and storm damage to Rudolph’s property. Nationwide is an out of state insurer but adjuster Catherine Brown is the adjuster and a Texas resident. Brown’s Texas residency defeats the diversity jurisdiction to stay out of Federal Court. Rudolph filed a motion to remand.

The lawsuit was filed in State Court and Nationwide removed the case to Federal Court saying that Brown was fraudulently sued in order to defeat the diversity requirements of Federal Court removal.

ERISA Versus State Law

June 14, 2016 | Mark S. Humphreys

ERISA lawyers in the Dallas / Fort Worth can tell you how powerful ERISA is and that the rules governing ERISA plans pre-empt State rules governing insurance. This is argued in a Northern District, Dallas Division case styled, Curtis v. Metropolitan Life Insurance Company.

This case concerns a three-party contractual relationship between Curtis (Plaintiff), his employer (EFH), and MetLife. The contractual relationship is governed by ERISA.

Three documents encapsulate the terms of this relationship: the EFH Master Plan Document, the EFH Summary Plan Description (SPD), and the MetLife Certificate of Insurance (COI).

Hail Damage – Amount In Controversy

June 12, 2016 | Mark S. Humphreys

Lawyers who handle hail claims need to ready a McAllen Division opinion from the Southern District of Texas. The case is styled, Mirosalva Cantu v. Allstate Vehicle and Property Insurance Company.

Cantu filed suit in State Court and Allstate timely removed the case to Federal Court arguing that the amount in controversy exceeds $75,000. Cantu filed a motion to remand stating that the amount in controversy did not exceed $75,000. The Court denied the motion.

The removing party bears the burden of establishing whether federal jurisdiction exists, and the Court must resolve all doubts regarding whether removal jurisdiction is proper in favor of remand. The Court does not have subject matter jurisdiction under 28 U.S.C. § 1332 unless the parties are completely diverse and the amount in controversy exceeds $75,000. Generally, “the sum demanded in good faith in the initial pleading shall be deemed to be the amount in controversy.” However, when the state practice does not permit a demand for a specific sum, removal is proper if the removing party proves by a preponderance of the evidence that the amount in ontroversy exceeds $75,000. Defendant can satisfy this burden by (1) showing it is “apparent from the face of the petition that the claims are likely to exceed $75,000” or (2) setting forth “summary judgment-type evidence of facts in controversy that support a finding of the requisite amount.”