Dallas Fort Worth Insurance Lawyer Blog

Life Insurance And Illegal Drug Use Exclusions

July 10, 2016 | Mark S. Humphreys

Life insurance lawyers will have clients approach after a claim for life insurance benefits has been denied because of a denial based on an exclusion for use of illegal drugs. A 2016, 5th Circuit opinion is a good read for how the courts look at these situations. The style of the opinion is, Eleanor Crose v. Humana Insurance Company.

The facts in the case show Ronald Crose died after ingesting ecstasy. Humana denied the claim for life insurance benefits by Eleanor citing the following exclusion in the policy:

“Causation Exclusions . . . Loss due to being intoxicated or under the influence of any narcotic unless administered on the advice of a health care practitioner.”

Allegations In A Lawsuit

July 9, 2016 | Mark S. Humphreys

Weatherford insurance lawyers need to understand how to properly make allegations when filing a lawsuit. The Fort Worth Division, Northern District of Texas issued an opinion wherein it is pointed out allegations were not properly made. The opinion is styled, Mark Buettner, et al., v. USA Gymnastics, et al.

Bailey was a competitor at an event run by Gymnastics when she landed wrong upon a dismount from uneven parallel bars and suffered a torn ACL, which required surgical repair. Bailey was insured under a policy of insurance issued by Mutual to Gymnastics as policyholder. Specialty administered claims made under the policy and corresponded with plaintiff regarding Bailey’s injury and his claim for payment under the policy.

Bailey sued Mutual and Gymnastics for breach of contract, Insurance Code violations, and DTPA violations. Suit was filed in State Court and removed to Federal Court by Mutual and Gymnastics.

Disability Policies And Lawsuits

July 7, 2016 | Mark S. Humphreys

Attorneys who litigate disability claims need to read this case from the Southern District of Texas, Houston Division. It is styled, Larry Frederick v. American Heritage Life Insurance Company. This case will help an attorney understand some of the burdens put on the insurance company.

In October 2012, Frederick was severely injured in a vehicular accident. One month later, he submitted a claim for benefits under an accident insurance policy he purchased from AHLIC several months earlier. AHLIC initially denied payment under the policy, but later paid the claim after reversal on administrative appeal. Frederick now sues claiming that AHLIC violated the Texas Insurance Code by unreasonably delaying payment of the benefits.

In its answer to Frederick’s first amended complaint, AHLIC raises several affirmative defenses, including a pre-existing condition exclusion in the policy, ratification by Frederick, nonpayment of the policy premium, and failure to prove loss.

Is Your Child Covered Under Your Policy?

July 5, 2016 | Mark S. Humphreys

Insurance attorneys in Dallas and Fort Worth need to be able to give advise on the above question. An Austin Division, Western District case is a good read for attorneys. The style of the case is, State Farm Fire and Casualty Company v. Clayton J. Neuman.

Clayton Neuman was the driver of a car that crashed on November 11, 2011. A passenger in the car, Ellis McClane was killed. Neuman sought coverage under the umbrella policy that Neuman’s parents had with State Farm. State Farm filed this Declaratory Judgment action to determine whether or not they had any responsibility under the policy.

The policy had been issued to Grover and Laura Neuman in September of 2009. The policy provides coverage for to “insureds” and defines “insureds” as “you or your relatives whose primary residence is your household.”

Insurance Companies Push For Arbitration

July 3, 2016 | Mark S. Humphreys

Insurance law lawyers can tell you to be aware of arbitration clauses in your insurance contract. These usually favor the insurance company. The Austin-American Statesman published an article titled, Consumer Groups Oppose Insurance Company’s Push For Arbitration.

Government and private sector consumer advocates are calling on a state regulator to reject a proposal by Texas Farm Bureau’s insurance division to allow the company to require customers to go to arbitration over policy disputes.

Deeia Beck, head of the state’s Office of Public Insurance Counsel, wrote this week to David Mattax, the state commissioner of insurance, to tell him that arbitration endorsements on homeowner insurance policies can be harmful to Texans, and the Texas Department of Insurance should not approve a proposal by Texas Farm Bureau Insurance Companies.

Hail Claim And A Jury Trial

July 2, 2016 | Mark S. Humphreys

The Insurance Journal published a good article in 2014 that gives a perspective on a jury trial. It is worthwhile reading for hail claims lawyers. The article is titled, Juror Witnesses Firsthand What the Hail Is Going on in Texas.

Alejandro Stolarski is a United States citizen who emigrated from Mexico. Stolarski resides in Dallas County. Like hundreds of other Dallas County residents each week, Stolarski received a notice in the mail for jury duty. But unlike most Dallas County residents, he was excited about being called to jury duty. Even better, Stolarksi was thrilled when he was selected to actually serve on a jury and, in his words, be an integral part of his adopted country’s legal system. Unfortunately, Stolarski was selected to serve as a juror in a Texas hail damage lawsuit.

The trial was representative of thousands of hail damage lawsuits presently pending in courts across Texas. The homeowner alleged that her roof was damaged in an April 2011 hail storm. Three months later, on June 23, 2011, she submitted a claim to State Farm. One week later, on June 29, 2011, State Farm inspected the reported damage. Shortly thereafter, State Farm issued payment for the cost to repair minor damage to the roof and other building components. The homeowner accepted the payment. It appeared to State Farm that the claim had been amicably resolved.

Hail Claims And Insurance Companies

June 30, 2016 | Mark S. Humphreys

Lawyers who handle hail damage claims will want to read this article. It was published by the Insurance Journal in February 2015. It is titled, Attorneys, Insurers Facing Off Over Hail Litigation In Texas.

The vestiges of twin hailstorms that ravaged the south Texas coast in 2012 are now blowing through the halls of the Capitol in Austin.

Two of the state’s most-powerful lobbies, the insurance industry and trial lawyers, are gearing up for a fight over a push to ease penalties against companies that deny homeowners their hail-damage claims.

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.