Dallas Fort Worth Insurance Lawyer Blog

Does Uninsured Motorist Coverage Apply?

May 7, 2016 | Mark S. Humphreys

Insurance lawyers in Dallas and Fort Worth areas will often deal with uninsured motorist situations. Some of the situations are strange and the question becomes whether or not the uninsured motorist statutes in the Texas Insurance Code and actual provisions of policies apply to the fact situation being confronted. A 1999, Texas Supreme Court case deals with one strange situation. The style of the case is State Farm Mutual Automobile Insurance Company v. Whitehead.

In this case the Court considered whether an uninsured motorist policy provision covers damages sustained by the insured’s survivors when a passenger in another vehicle shot and killed the insured while he was driving his vehicle. After a bench trial, the trial court held that the policy provided uninsured motorist benefits. The court of appeals affirmed. This Court reversed and rendered judgment that the plaintiffs take nothing.

The underlying facts are largely undisputed. Kevin Hawkins was riding in a van driven by his brother, Howard Hawkins, Jr., when he saw a passenger in a pickup truck with whom he believed he had quarreled earlier in the evening. As the van pulled alongside the pickup, Kevin pointed a pistol at the pickup and fired several shots. Brent Taylor, the driver of the pickup, was shot and killed. The pickup then went out of control and struck a bridge stanchion. Starlette Whitehead, a passenger in the pickup, was injured in the crash.

Insurance Company Apology

May 5, 2016 | Mark S. Humphreys

Insurance attorneys rarely see an insurance company apologize. What might happen if they did?

In a society that highly values a genuine apology, it is shocking that most in-house counsel and most trial lawyers never even consider whether an apology might be appropriate to resolve a claim or lawsuit. We teach our children to apologize at a very young age. As adults, we are well-versed in giving and receiving apologies with our spouses, coworkers, friends, and families. It seems one week cannot pass without a high-profile celebrity, sports figure, or politician issuing a public apology for some transgression. It seems, however, that the concept of even considering an apology rarely enters the thought process of claim professionals and trial lawyers when evaluating strategic options for dealing with the claims and lawsuits that cross their desks. The absence of any academic discussions within the field of insurance is certainly not because of the lack of psychological and legal work regarding the science of apology. Apology research is as old as the study of rhetoric and it has gained widespread popularity in other disciplines in the last two decades.

Regardless of the relationship or magnitude of the transgression, the first step towards evaluating whether an apology is owed is always self-assessment. As for apologies within a personal relationship, for some people this seems to be very easy and for others very hard. In businesses, it seems to be exceptionally hard.Initially, the group-think of some organizations seems to create a presumption of righteous perfection. It’s exceptionally rare for group assessment to conclude that some kind of wrongdoing occurred and that an apology may be owed. While among some individuals this eemingly arrogant group-think is the result of pride, the greater driving force seems to be fear. Most business leaders fear the implications of an apology. Fundamentally, however, those who both lead companies and the trial bar must be challenged to have a more candid, transparent, and accurate assessment of the shortcomings of any organization, its claim handling, and its litigation decision making. An organization can’t accurately contemplate whether an apology is owed unless it can accurately assess whether something went wrong for which an apology might be owed. As simplistic as this sounds, it is mind boggling how hard it is for many business organizations to make an accurate self-assessment. Needless to say, far more work is needed in our industry to accurately assess when and how to apologize.

Hail Claim And Communicating With Insurance Company

May 3, 2016 | Mark S. Humphreys

Lawyers who handle hail claims know that the quicker a claim is made, the better. Communication with the insurance company is also important. Both these points are made in Southern District of Texas, McAllen Division opinion styled, Juan Sanchez Fregoso, et al v. State Farm Lloyds, et al.

In this case, the court granted State Farm’s motion for summary judgment.

Plaintiffs’ claims arise from damage sustained to their property as a result of a hailstorm event occurring in March / April 2012. The property is insured under a State Farm policy providing replacement cost benefits. Shortly after the storm, Plaintiffs reported an insurance claim to State Farm for the damages sustained to their property. Thereafter, State Farm inspected the property on May 6, 2012, estimating the loss to the property to be $6,910.44. On that same day, State Farm issued to Plaintiffs an actual cash value payment of $3,160.27, the amount remaining after deducting the recoverable depreciation ($1,796.17), and the deductible ($1,954), from the replacement cost value ($6,910.44).

Insurance Companies Will Prosecute Fraud Cases

May 1, 2016 | Mark S. Humphreys

Insurance lawyers know that some cases they see involve fraud. The trick for them is to distinguish good cases from bad cases. The Insurance Journal published an article that some would find surprising. The title of the article is, Former Iowa Firefighter Again Pleads Guilty To Insurance Fraud.

A former Iowa firefighter pleaded guilty to insurance fraud related to a string of cases spanning Buchanan, Clayton and Delaware counties, the Iowa Department of Insurance reported.

Terry Russell Groth, a former Strawberry Point firefighter, entered the plea on Feb. 16, 2016. It’s third conviction for Groth related to these cases.

When Your Own Insurance Finds You At Fault

April 30, 2016 | Mark S. Humphreys

Farmers Branch insurance lawyers will have a client walk in and say that their own insurance company has found them at fault for an accident and paid the other party. What can be done? A Dallas Court of Appeals case gives some insight. The style of the case is, Van K. Martin v. State Farm Mutual Automobile Insurance Company.

This is an appeal from a declaratory judgment action and an appeal from an adverse finding in a summary judgment.

Martin’s son was involved in an auto accident with another State Farm insured, Jeffery Lonsdale. No one was injured in the accident, but Lonsdale filed a claim for property damage, which was submitted to State Farm under Part A of Martin’s liability policy. Martin filed a claim for property damage to his vehicle under Part D of the policy. State Farm settled Lonsdale’s claim and provided coverage for the property damage to Martin’s vehicle. Martin alleges that State Farm unreasonably concluded his son was primarily responsible for the accident without interviewing Martin’s son or other witnesses in the car. Martin alleges he paid the deductible to have his vehicle repaired and paid “incremental semi-annual premiums” related to the accident.

ERISA Or Not

April 28, 2016 | Mark S. Humphreys

ERISA lawyers will tell you that sometimes determining whether or not a plan is an ERISA plan or not can be confusing. The U.S. Southern District, Houston Division, issued an opinion that needs to be read on this issue. The style of the case is, Williams v. United Healthcare of Texas, Inc.

Williams had medical coverage under her employer plan for Retirees and Other Eligible Individuals (“the Plan”) with United Healthcare of Texas, Inc. and administered through UMR, Inc. Williams suffered from serious acid reflux pain and was diagnosed with esophageal diverticulum and hiatal hernia. Williams’s doctors determined that her condition would require surgery. On September 8, 2014, Williams entered the hospital and was released the following day. Five days later, Williams suffered complications from surgery and returned to the hospital. Williams remained under doctor’s care from September 13, 2014, to October 13, 2014. On September 17, 2014, and October 3, 2014, Williams received confirmation from Defendants that additional surgery was medically necessary. Williams was later transferred to the hospital. On November 3, 2014, Williams received correspondence from Defendants authorizing the additional medical procedures in Houston. Williams alleges that Defendants later denied her coverage under the Plan despite authorizing the treatment on multiple occasions.

Williams filed a lawsuit. Defendants removed the case to Federal Court based on Williams claims being pre-empted by ERISA.

Hail Damage Claim

April 26, 2016 | Mark S. Humphreys

Lawyers handling hail damage claims should read this Northern District, San Angelo Division opinion. It is styled, April Munoz v. Safeco Insurance Company of Indiana, et al.

This is a homeowners hail damage claim filed by April against Safeco and the adjuster assigned to handle the claim. Munoz sued for breach of contract, violation of the Texas Insurance Code, and violations of the Texas Deceptive Trade Practices Act.

This is a summary judgment action filed by Safeco which was granted by the court.

Duty To Defend

April 24, 2016 | Mark S. Humphreys

An Arlington insurance attorney will have someone come into their office and show the attorney lawsuit papers that have been filed against them and then will show a copy of an insurance policy that is suppose to defend against the lawsuit. The problem will be that the insurance company is refusing to honor the policy. This is the situation in a recent 5th Circuit opinion. The style of the case is, Castle Point National Insurance Company v. Everado Chuca Lalo, Jr.

Castle Point National Insurance Co. is obligated to defend a trucking company in connection with an accident because there is no evidence the person injured in the incident was an employee and would therefore fall under its policy’s exclusions, says the 5th Circuit Court of Appeals in New Orleans, in reversing a lower court ruling.

New York-based Castle Point had issued a commercial auto liability policy with a $1 million limit to El Paso, Texas, based B.S. Trucking that covered the period Aug. 29, 2009, to Aug. 29, 2010, according to court papers in Thursday’s ruling.

Trying To Stay Out Of Federal Court

April 23, 2016 | Mark S. Humphreys

Commercial insurance attorneys in Dallas need to read this opinion from the Northern District, Dallas Division. The case is styled, Meritt Buffalo Events Center, LLC v. Central Mutual Insurance Company, et al.

In this case, the carrier, Central, and the adjuster were sued in State Court and Central and the adjuster removed the case to Federal Court, where this motion to remand was filed by Meritt.

According to Meritt Central initially assigned Massey to investigate and adjust the claim, and later reassigned the claim to Cagle. Meritt alleges that Massey failed to reasonably investigate the claim, incorrectly calculated the loss, and represented that Meritt was covered for business income and extra expenses, but delayed full and prompt payment; Cagle continued adjusting the claim but failed to conduct a reasonable investigation, neglected to follow the Policy and Texas law, and did not pay for the property damage; and, although Meritt’s representatives provided documentation to support the claim, some of which Massey approved, Meritt has been underpaid by more than $900,000, causing Meritt to suffer additional business loss.

Federal Court And Home Owners Claim

April 21, 2016 | Mark S. Humphreys

Irving insurance attorneys want to be aware of the proper ways of avoiding Federal Court to best help their clients. This is illustrated in a 2016, Southern District, Houston Division opinion styled, Hector Puente and Teresa Rivera v. Pillar Insurance Company and Matthew Greenhouse.

This case was removed from State Court by Pillar.

Plaintiffs had a homeowners policy with Pillar. They allege that Greenhouse is an independent licensed adjuster who mishandled their claim in various ways, including “failed to properly adjust the claim and summarily improperly denied the claim with obvious knowledge and evidence of serious cosmetic and structural damage.