Dallas Fort Worth Insurance Lawyer Blog

ERISA Payback

December 12, 2015 | Mark S. Humphreys

ERISA lawyers will be watching this United States Supreme Court case. It is styled Montanile v. National Elevator Industry Health Benefit Plan. The Insurance Journal published a story discussing this case. The story is titled, Supreme Court in Bind Over Insurer’s Right to Insured’s Damages Money.

Which do the conservative justices hate more: personal-injury lawyers or interpreting a law loosely to expand the power of lower courts? That question was to be on the table Monday at the U.S. Supreme Court. The justices are hearing oral argument in a potentially important case about whether you have to pay back your insurance company for medical bills after you’ve sued and recovered from the person who injured you in the first place.

Montanile v. National Elevator Industry Health Benefit Plan has all the marks of a case only lawyers could love. It involves insurance, money, a drunken driver and what may arguably be the most complicated statute in the entire U.S. Code, the Employee Retirement and Income Security Act of 1974, known as ERISA.

Liability Claims

December 10, 2015 | Mark S. Humphreys

Insurance lawyers need to recognize when coverage will be provided in cases when an insured is being accused of being liable for harm caused to a third party. A 1988, Texas Supreme Court case is insightful to this issue. The style of the case is, Adela Snellberger v Rosita Hernandez.

This is an appeal in a wrongful death action brought by the heirs of Harold Snellenberger against Rosita Hernandez Rodriguez. The trial court granted a summary judgment for Rodriguez. This Court affirmed that finding.

Rodriguez drove her automobile over and critically injured a small child. At the time of the accident, Snellenberger was employed as a police officer. When he and another officer were notified of the accident, they immediately proceeded to the scene in their separate patrol cars. Upon arrival, the other officer administered CPR to the child, while officer Snellenberger moved back the crowd of people which had gathered at the scene. Included in the crowd was the grief-stricken mother of the injured child. As officer Snellenberger began controlling the crowd, he suddenly collapsed and later died of a heart attack. His widow and children brought this action relying upon the rescue doctrine.

Insurance Policy Language

December 8, 2015 | Mark S. Humphreys

Dallas insurance lawyers can tell a client that one of the most important things to do when looking at an insurance claim is to read the policy. What the policy says, coupled with the facts of the claim, go a long way in determining whether or not a claim should be paid. The Texas Supreme Court issued an opinion in 2015, that is a must read for insurance law attorneys. The case is styled, RSUI Indemnity Company v. Lynd Company.

This claim involves two insurance companies, RSUI which provided excess coverage and Westchester Fire Insurance Company which provided a $20 million dollar limit. The total loss was $24.5 million spread over several properties owned by Lynd. The parties agreed that the loss was from a loss from a single occurrence. Westchester paid it’s $20 million dollar limit but RSUI refused to pay the remaining $4.5 million and instead paid Lynd only $750,000.

RSUI cited the excess policy’s “Scheduled Limit of Liability” endorsement as the basis for its denial of coverage. Lynd sued RSUI to recover the difference between its $24.5 million in losses and the $20,750,000 Westchester and RSUI paid out under the policies. As a result, the question of whether coverage existed under the excess policy depended on the interpretation of the “Scheduled Limit of Liability” endorsement.

Put Names On Those Beneficiary Forms Or Else

December 6, 2015 | Mark S. Humphreys

Springtown life insurance lawyers would want to know about an opinion from a Florida Court dealing with beneficiaries under a life insurance policy. The Court looked at the law in Florida at issue and then looked at the language of the policy and issued a ruling that many would disagree with. The opinion is discussed at WealthManagement.com. The article is titled, When Is An Adoption Not Effective To Change Inheritance Rights?

In a case styled Lubin v. AT&T Ret. Sav. Plan (2015 WL 4397703), an adoption was not given effect in determining who would receive the life insurance benefits at issue.

In this case, Austin Hardy participated in a Retirement Savings Plan (“Plan”), which included a life insurance benefit. At his death, he was survived by his sisters, Pauline Lubin and Frances Koryn (Plaintiffs), and his biological daughter, Jennifer Krokey. Although Krokey was Hardy’s biological child, she had been subsequently adopted by a step-father. Under Florida law, a child who is adopted is the child of the adopting parent and ceases to be a child of the biological parent for all purposes.

Insurance Companies Buying Justice In Texas

December 5, 2015 | Mark S. Humphreys

Insurance lawyers keeping up with insurance news will find a recent Texas Tribune article interesting. The title is, “Emails: Prosecutors Got Texas Mutual Great Publicity.”

The article says that Travis County prosecutors say the money they get each year from a large insurance company to prosecute workers’ compensation fraud helps both consumers and businesses by holding down premiums and maintaining a stable market for employers.

But behind the scenes, top officials in the district attorney’s office are highlighting other benefits: They say they’re generating a lot of money and good PR for Texas Mutual Insurance Company.

Wildfire Insurance Claims

December 3, 2015 | Mark S. Humphreys

Texas insurance lawyers will see wildfire insurance claims. Texas Watch published an article that is helpful for Texas insurance attorneys and people who experience damage due to a wildfire. The title of the article is, 5 Things To Know When Filing A Wildfire Insurance Claim.

The article tells us that firefighters continue to bravely battle the Hidden Pines wildfire in Bastrop County Texas, with 80% of the fire contained. The fire has already damaged or destroyed dozens of residential and commercial properties. As families and businesses begin the process of rebuilding, here are some tips for property owners when dealing with their insurance company.

Demand that your insurance company hold up its end of the insurance contract you have with them.

Hail Damage Claim And Adjusters

December 1, 2015 | Mark S. Humphreys

Fort Worth insurance lawyers handling hail damage claims need to ready an opinion from the U.S. District Court for the Southern District of Texas Houston Division. It is styled, Dianne Leidy, et al v. Alterra America Insurance Company, et al.

Leidy sued Alterra and the adjusters assigned to her claim for hail damage. Leidy alleged her property was damaged during a hail storm on August 16, 2013. Leidy alleged she noticed the damage right after the storm and contacted Alterra by phone. Alterra assigned independent adjusters to adjust the claim. Leidy alleged the adjusters failed to conduct a reasonable and adequate investigation, which resulted in the improper denial of Leidy’s claim. The lawsuit was filed in State Court. Alterra removed the lawsuit to Federal Court asserting that the adjusters had been improperly named as defendants in order to defeat diversity jurisdiction. Leidy then filed a motion to remand the case back to State Court.

In response to Leidys’ Motion to Remand, Alterra concedes that independent insurance adjusters can be liable for violations of the Texas Insurance Code. Alterra argues, however, that Leidy failed to allege an adequate factual basis for imposing such liability on the adjusters, Colley or Voelkner in this case. The adequacy of the allegations in Plaintiffs’ complaint is evaluated, for purposes of the improper joinder analysis, under the “fair notice” pleading standard in Texas courts.

Actual Cash Value versus Replacement Value

November 29, 2015 | Mark S. Humphreys

Insurance lawyers in Parker County need to read a Houston Court of Appeals [1st Dist.] opinion issued in October 2105. It is styled, John Davis D/B/A J. D. House of Style v. National Lloyds Insurance Company.

This is an appeal by Davis from a Judge’s ruling on a JNOV in favor of National.

The court submitted two measures of damages to the jury, and the jury determined that Davis sustained $0 damages based on the actual cash value of the property claim and that he sustained $100,000 in damages based on the replacement value of the property claim. National Lloyds moved to disregard the replacement value finding, arguing, in part, that the plain language of the policy itself limited Davis to recovery for the actual cash value of his property damage claim.

Two Hail Storms – Two Different Insurance Companies

November 28, 2015 | Mark S. Humphreys

Layers who handle hail damage claims will frequently run into the situation where an adjuster admits there is hail damage on a roof but that the damage is old or there is old damage and new damage to the roof. The question becomes, what is the best course of action in getting a full recovery. The answer is to file claims / sue both insurance carriers. The U.S. District Court, Western District of Texas, Austin Division had this issue in a recent case. The style of the case is, Evridges, Inc. v. The Travelers LLoyds Insurance Company.

In this case, Evridges filed suit against Travelers for hail damage to its property. When evidence that some of the damage was from another storm when another insurance company and policy were in force, Evridges sought to have Travelers added to the lawsuit. This insurer is Landmark American Insurance Company.

Travelers opposed the joining of Landmark, arguing to the court that the joinder was improper under Federal Rule 20(a) because the claims against Landmark do not arise from the same transactions or occurrences as the claims against asserted against Travelers, and since the claims against Landmark do not present common questions of law or fact as the claim against Travelers, that the joinder is improper.

Concurrent Causation Clauses

November 26, 2015 | Mark S. Humphreys

Dallas area insurance attorneys are most likely to see insurance companies argue “concurrent causation” in claims related to homeowners policies. The Claims Journal published an article discussing this topic in October of 2015. The title of the article is “Texas Supreme Court Upholds Anti-Concurrent-Causation Clauses In Property Policies.”

The article tells us the Texas Supreme Court in JAW the Point, LLC v. Lexington Ins. Co., 460 S.W.3d 597 (Tex. 2015) held, on first impression, that losses incurred in demolishing and rebuilding property damage resulting from Hurricane Ike to comply with city ordinances were excluded under the policy’s anti-concurrent-causation clause. Prior to the Texas Supreme Court’s JAW decision, federal and lower state courts of appeal had interpreted and upheld the applicability of anti-concurrent-causation clauses under Texas law.

Taking its lead from the United States Circuit Court of Appeals for the Fifth Circuit, the Texas Supreme Court held that a policy anti-concurrent-causation clause together with an exclusion for losses caused by flood, when read together, excluded from coverage any damage caused by a combination of wind and water. Previously, the Fifth Circuit Court of Appeals in Leonard v. Nationwide Mut. Ins. Co., had concluded in situations involving combinations of covered wind damage and excluded flood damage that the only species covered under a policy with an anti-concurrent-causation clause is damage caused exclusively by wind. But when wind and water synergistically cause the same damage, such damage is excluded.