Dallas Fort Worth Insurance Lawyer Blog

Claims Against Insurance Companies – Not Just Bad Faith

July 10, 2023 | Mark S. Humphreys

Insurance transactions tend to resemble one another, so disputes arising from them tend to resemble one another. There are only so many ways that an insurer and an insured can get crossways. Most cases present recurring problems that can be grouped into categories. Insurance law is even more precedent-driven than other areas, as courts try to construe similar policy language consistently. It is not surprising that cases start to look alike.

The starting point is the contract itself. The initial inquiry always begins with the language of the contract to determine what is covered and what is not. Other tort and statutory theories may logically depend on the existence of coverage, or may exist independent of coverage. The interplay between recovery for breach of contract and recovery under other theories needs to be studied. Beyond suit for breach of contract, most insurance cases can be grouped into three categories:

(1) misrepresentations

Bad Faith Lawyers – Be Aware How Insurers Can Get Around Prompt Payment

July 8, 2023 | Mark S. Humphreys

The Texas Prompt Payment of Claims Act has lots of helpful law for insured when an insurance company doesn’t pay a claim timely. However, there the Act also has a lot of benefits for the insurers that might help them avoid liability. Here are a few.

a. Being an eligible surplus lines insurer extends the deadlines for acknowledging receipt of the claim, commencing the investigation, and requesting information. This is found in section 542.055(a).

b. Also, being a surplus lines insurer extends the deadline for paying a claim from five business days to 20 business days after the insurer notifies the claimant that the claim will be paid, or after the claimant performs any condition imposed on payment of the claim. This is found in section 542.057(c).

Late Payment Of Claims – How To Make A Claim

July 3, 2023 | Mark S. Humphreys

When making a claim, what is required of the claimant? Here is some guidance.

Pursuant to Texas Insurance Code, Section 542.051(4), there is no particular content required, as long as the claim “reasonably apprises the insurer of the facts relating to the claim.”

The statute requires that the claim be in writing. The statute provides that “notice of claim” means “any written notification provided by a claimant to an insurer that reasonably apprises the insurer of the facts relating to the claim. A 2005, Austin Court of Appeals, in an opinion styled, McMillin v. State Farm Lloyds, has strictly applied the requirement of written notice, holding that a phone call was not sufficient.

Life Insurance = Misrepresentation – 3

July 1, 2023 | Mark S. Humphreys

Life Insurance claims denial attorney are well aware of this 2023 opinion from the Texas Supreme Court. The opinion is styled, Arce v. American National Insurance Company.

In the opinion the Texas Supreme Court discussed “intent.”

American National argued that, because the Texas Legislature included the word “intent” in other provisions of the Texas Insurance Code, the absence of such a phrase in Section 705.051 indicated the Legislature’s intent Not to require “intent.”

Life Insurance Denial – Misrepresentation – 2

June 26, 2023 | Mark S. Humphreys

Life Insurance claims denial attorney are well aware of this 2023 opinion from the Texas Supreme Court. The opinion is styled, Arce v. American National Insurance Company.

The Court discussed the plain text of Texas Insurance Code, Section 705.051 wherein it states: “a misrepresentation in an application for a life, accident, or health insurance policy does not defeat recovery under the policy unless the misrepresentation:

(1) is of a material fact; and

Life Insurance Denial – Misrepresentation – 1

June 24, 2023 | Mark S. Humphreys

Life Insurance claims denial attorney are well aware of this 2023 opinion from the Texas Supreme Court. The opinion is styled, Arce v. American National Insurance Company.

On April 28, 2023, the Texas Supreme Court held that a life insurer seeking to avoid a life insurance policy via a Texas Insurance Code statutory misrepresentation defense must, just like under a common-law misrepresentation defense, prove the insured had “intent to deceive” when it made a misrepresentation in a life, accident, or health insurance application.

In making this ruling, the Texas Supreme Court rejected American’s argument that Texas Insurance Code, Section 705.051 did not require intent to deceive just because the statute was silent on whether intent to deceive was required.

Credit Life Insurance – Date Of Termination

June 19, 2023 | Mark S. Humphreys

Credit Life Insurance policies always list specific termination times. Here is a 1985, San Antonio Court of Appeals opinion that deals with credit life insurance and the issue of when the policy terminated. The opinion is styled, Eagle Life Insurance v. G.I.C. Insurance Co.

This lawsuit was tried before the Judge and the judgment was in favor of G.I.C. Eagle filed this appeal. This Court reversed the trial Court and stated as follows:

The agreed undisputed facts are as follows. G.I.C. and Eagle Life, entered into a reinsurance treaty. Under the terms of this treaty, G.I.C. wrote credit life insurance policies which were re-insured with Eagle Life. Eagle was given most of the insurance premiums and in turn agreed to reimburse G.I.C. “for all losses arising under the specific terms and provisions of the policies and certificates of insurance re-insured hereunder.” Under the terms of the reinsurance treaty, G.I.C. retained the first $5,000.00 of each policy written, so Eagle Life’s obligation to reimburse G.I.C. was limited to amounts above $5,000.00 which G.I.C. properly paid out on valid claims.

Life Insurance – Date Of Termination – Claims Denial Attorney

June 17, 2023 | Mark S. Humphreys

Credit Life Insurance is the type of policy at issue in this 1979 opinion from the Fort Worth Court of Appeals. The opinion is styled, Leach v. Eureka Life Insurance Company of America.

Tommy Leach took out a loan from a bank and as part of the loan agreement, Tommy was required to purchase credit life insurance. The credit life insurance was for six months which began on March 13, 1977, and ended on September 13, 1977. Tragically, Tommy was reported killed in an auto accident that is showed a time of death as 12:45 a.m., September 14, 1977, Central Daylight Time.

Tommy’s widow, Mary Leach, made a demand on Eureka to pay the loan balance to the bank. Eureka refused payment, stating that the policy had terminated on September 13, 1977. This lawsuit resulted and the trial resulted in a ruling in favor of Eureka.

Force Placed Insurance Policies

June 12, 2023 | Mark S. Humphreys

Force Placed Insurance Policies are unique. The biggest thing to know about these policies is that their purpose is to protect the lender, not the homeowner. This is illustrated in a 2023 opinion from the Southern District of Texas, Houston Division. The opinion is styled, Peter Garcia v. Great American Assurance Company.

Peter Garcia (“Plaintiff”) filed this action against Great American Assurance Company (“Defendant”) alleging that Defendant failed to pay for covered damage to his home under an insurance policy purchased by his mortgagee, Carrington Mortgage Services LLC (“Carrington”). Pending before the court is Defendant’s Motion for Summary Judgment. The Court granted the motion.

Plaintiff’s home is mortgaged in favor of Carrington. Lenders often require borrower-mortgagors to purchase insurance on their home. When the borrower does not do so, the lender might purchase a “force-placed” policy and include the cost in the borrower’s mortgage payments. Carrington purchased a force-placed insurance policy (“the Policy”) covering its interest in Plaintiff’s home. Plaintiff is not a party to the Policy, and all payment for loss is
to be made to Carrington.

Life Insurance And More Than One Beneficiary – Life Insurance Claim Denial Attorney

June 10, 2023 | Mark S. Humphreys

Here is an unusual life insurance situation. It is an opinion from 1992. The opinion is from the Amarillo Court of Appeals and is styled, Ester Belle Medlin, Appellant v. Earnest G. Medlin, Floyd W. Medlin, Brenda E. Burford and Carolyn E. Medlin, Appellees.

The question to be determined in this matter is whether appellant Esther or appellees are entitled to one-half of insurance proceeds which had become payable due to the death of Jessie F. Medlin, Jr. (Jessie), the insured. Appellant is the insured’s mother and appellees are the insured’s children by a previous marriage. From a trial court judgment awarding those proceeds to appellees, appellant brings this appeal. For reasons hereinafter expressed, we reverse the judgment of the trial court and render judgment awarding the proceeds in question to appellant.

The beneficiary clause of the insurance policy provides in pertinent part: