Dallas Fort Worth Insurance Lawyer Blog

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.

What Will A Homeowners Policy Cover?

April 19, 2016 | Mark S. Humphreys

When someone gets sued, they need to find out if they have coverage to protect them. So the issue for most people becomes, will my homeowners policy cover me? Courthouse News Service published an article on March 10, 2016, that shows how far a homeowners policy can go to provide liability coverage. The title of the article is, Home Insurers Cornered On Woman’s Overdose.

A man who says his daughter overdosed after someone drugged and date-raped her can sue the insurers of the home where she died, an Illinois appeals court ruled.

Haley Johnson, 21, was out with friends in May 2012 when they met Joshua Skolnik, who bought them all drinks, according to the ruling, which merely summarizes the allegations put forward by Johnson’s father. There is no indication that Skolnik faced criminal charges over Johnson’s death.

Intentional Acts And Insurance Coverage And Sports

April 17, 2016 | Mark S. Humphreys

Insurance lawyers can tell you that most intentional acts are not covered by an insurance policy. What if the act occurs in the context of a sports event? A 1998, Fort Worth Court of Appeals case talks about this. The style of the case is, Monk v. Phillips.

Factual background – Michael, Phillips, Gary Duffek (“Duffek”), and Gary Watson (“Watson”) were playing a recreational game of golf as a foursome when the incident occurred. Phillips’s first tee shot on the second hole traveled off to the right side of the fairway into the trees. Phillips then shot a mulligan, a second tee shot, which also traveled off to the right and landed near the first ball. Because only the second ball was visible from the cart path, Michael and Duffek attempted to retrieve the missing first ball.

Phillips decided to play the second ball and proceeded to its location in the rough to the right of the fairway. At this point, Michael and Duffek, riding in the golf cart, passed in front of Phillips and then to Phillips’s right. Phillips heard Duffek say “look out, he’s fixing to hit.” No one told Phillips to wait. Phillips then hit the ball off the toe of his golf club, shanking the ball to the right at an approximately ninety-degree angle from where he intended the ball to go. The ball struck Michael, leaving him blind in his right eye.

Beneficiary Of Life Insurance

April 16, 2016 | Mark S. Humphreys

Can the person causing the death of the insured still recover it they are the named beneficiary under the policy? This is a reasonable question to ask and this issue is discussed in the1969, Fort Worth Court of Appeals case styled, Giles v. Wiggins. Here is what it says.

This suit involves ascertainment of the rightful claimant to the proceeds of a life insurance policy issued by National Life and Accident Insurance Company. The latter, as stakeholder, filed the suit and deposited $8,009.11 into the registry of the court for disposition by it to the claimants entitled thereto.

Vergia L. Giles, insured, was shot and killed by his wife, Evelyn Jean Wiggins, nee Evelyn Jean Giles, appellee and primary beneficiary of the policy.

Death, Life Insurance, Evidence

April 14, 2016 | Mark S. Humphreys

Arlington life insurance lawyers need to be aware of rules of evidence when presenting a case. This is illustrated in a1973, Eastland Court of Appeals case styled, Cooley v. Cooley.

The life insurance compan brought an interpleader action to determine the proper beneficiary under a policy of life insurance issued on the life of Melvin K. Cooley. The defendants were Mrs. Doris Cooley, the named beneficiary, Mary Helen Cooley as guardian of the estates of three minors and Sedco, Inc. and Sedco Persia, Inc., assignees of a portion of the insurance policy. Mary Helen Cooley contended that Doris Cooley should be disqualified as a beneficiary on the grounds that Doris Cooley willfully brought about the death of the insured, Melvin K. Cooley, being convicted and sentenced for same in the country of Iran. On the jury’s finding that Mrs. Doris Cooley did not willfully bring about the death of Melvin K. Cooley, the trial court entered judgment for Doris Cooley. Mary Helen Cooley appeals.

It was established on the trial of the cause that Mary Helen Cooley married Melvin Cooley in 1956. He was the father of her three children for whom she was duly qualified as guardian. This marriage terminated in 1962 by divorce.

Killing Insured In Self-Defense

April 12, 2016 | Mark S. Humphreys

Life insurance attorneys in the Dallas Fort Worth area will have occasion to see something similar to this 1941, Waco Court of Appeals opinion. It is styled, National Life & Accident Ins. Co.,Inc., et al. v. Thompson.

This is a suit by Velma Brewer Thompson against the National Life & Accident Insurance Company, Incorporated, for the recovery of $200 and statutory penalty alleged to be due plaintiff as beneficiary in a policy of insurance issued by defendant on the life of plaintiff’s husband, wherein a brother and sisters of insured filed their plea of intervention asserting right to recover proceeds due under the policy by reason of their allegation that plaintiff wilfully brought about the death of insured. From a judgment in favor of plaintiff, defendant and interveners appeal.

Judgment affirmed.