Dallas Fort Worth Insurance Lawyer Blog

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.”

Co-operating With Insurance Investigation

June 11, 2016 | Mark S. Humphreys

Texas insurance attorneys will tell you that one of your obligations under your insurance policy is to co-operate with the insurance company investigation of your claim. A Houston Division, Southern District case illustrates how difficult matters can be when the co-operation is questionable. The case is styled, Resie’s Chicken & Waffles Restaurant, et al. v. Acceptance Indemnity Company, et al.

This case went to trial and the jury found in favor of Resie’s and against AIC. However, AIC argued that the jury finding in favor of Resie’s should be disregarded due to the jury making findings against Resie’s as it relates to Resie’s turning over financial records that were sought from Resie’s by AIC.

This declaratory judgement action was for breach of contract, violations of Chapters 541 and 542 of the Texas Insurance Code and DTPA violations.

Insurance And Hospital Liens

June 9, 2016 | Mark S. Humphreys

One of the issues Arlington insurance lawyers have to deal with is hospital liens.

Texas public policy strongly supports hospital liens, and it is important to understand that these liens aren’t just applicable to hospitals; they also operate in the benefit of EMS providers and doctors at teaching hospitals whose bills are not already included in the hospital bill. The right of hospitals and certain other medical providers to be paid from settlement proceeds or a judgment begins with the Hospital Lien Statute, found in Chapter 55 of the Texas Property Code. It olds, in pertinent part, that a lien attaches to “any cause of action, judgment or settlement” received as a result of an accident for which the person was admitted to a hospital within 72 hours of the injury, as well as any hospital to which the injured party subsequently transferred for the same injuries. This is found in at Section 55.002(a),(b). These liens must be filed prior to settlement in order to be valid, and hospital liens are limited to “reasonable and regular” charges within the first 100 days following the injury. Even the attorney representing the injured party may have to wrestle with the hospital for first priority, according to the 1985, Texas Supreme Court case styled, Bashara v. Baptist Memorial Hospital System.

The intent of the Hospital Lien statute was to save lives, by “…inducing hospitals to receive a patient, injured by the negligence of others, by giving the hospital a lien on the claims, suit or settlement of the patient.” This is cited in the 1979, Dallas Court of Appeals opinion styled, Baylor University Medical Center v. Travelers.

Life Insurance And Committing A Crime

June 7, 2016 | Mark S. Humphreys

Dallas area life insurance attorneys will occasionally see a situations like this 1997, Dallas Court of Appeals case. The case is styled, Grant v. Group Life & Health Insurance Co.

Grant used a pry bar to break into the residence of Stokes. When Grant entered the residence Stokes shot him five times, killing him. Grant’s wife sued Group Life to recover benefits under an accident policy for the death of her husband. Group Life moved for summary judgement on the basis that Grant died while committing a burglary and, therefore, his death was not accidental. The trial court granted the summary judgment and Grant appealed.

In it’s ruling, the Court said that because Grant’s death was not accidental, the trial court correctly granted Group Life’s motion for summary judgement. Grant argues that because Group Life id not furnish her with a certificate of insurance, it is estopped from relying on undisclosed exclusions. Because the policy in question does not provide coverage for Grant’s death the policy exclusions are irrelevant.