Dallas Fort Worth Insurance Lawyer Blog

Suing The Adjuster

November 17, 2015 | Mark S. Humphreys

Duncanville insurance attorneys need to know how to properly sue an insurance adjuster who improperly adjusts a claim. This issue was brought in a U.S. District Court, Dallas Division opinion. The style of the case is, The Denley Group, LLC v. Safeco Insurance Company Of Indiana and Lisa Seutter.

After a fire loss, Denley sued Safeco and Seutter for wrongful denial of full coverage stained to their insured property.

The lawsuit was filed n Dallas District Court for violations of Chapters 541 and 542 of the insurance code and other causes of action. Safeco had the case removed to Federal Court, asserting that Seutter had been improperly joined in the lawsuit.

Residential Premises And Fences

November 15, 2015 | Mark S. Humphreys

Arlington insurance attorneys, as well as all insurance attorneys might run across a situation that was seen in a recent 14th Court of Appeals opinion. The style of the case is Nassar v. Liberty Mutual Fire Insurance Company.

This is an appeal from a motion of summary judgment in favor of Liberty.

The Nassars owned a residence situated on six acres. In addition to the residence itself, these six acres contain a system of fences, barns, and outbuildings. Liberty insured the dwelling and other structures pursuant to a Texas Homeowners Policy Form A. This policy was in effect when Hurricane Ike hit the area and caused losses.

Hail Claims And Appraisal

November 14, 2015 | Mark S. Humphreys

Forth Worth lawyers handling hail damage claims need to read a recent opinion from the Amarillo Court of Appeals. The case is styled, In Re GuideOne National Insurance Company.

The case involves two insurance claims: one for fire damage and another for wind or hail damage to property. The insurer is GuideOne who sought appraisal in this case. A lawsuit had been filed and the property owners requested that the Court not allow the appraisal. This request was sought long after the law suit had been filed and the property owners had incurred substantial costs. The Court denied the appraisal request and this mandamus action followed. This Court upheld the trial Court decision.

Appraisal clauses provide a means to resolve disputes about the amount of loss for a covered claim. As the Texas Supreme Court has explained: “In every property damage claim, someone must determine the ‘amount of loss,’ as that is what the insurer must pay. An appraisal clause ‘binds the parties to have the extent or amount of the loss determined in a particular way.'”

Misrepresentation In Application

November 12, 2015 | Mark S. Humphreys

Fort Worth insurance lawyers have to be able to answer the question – What if there is a misrepresentation in an insurance application. The Dallas Court of Appeals helped give guidance to an answer in a case styled, Medicus Insurance Company v. Frederick Todd, II, M.D. This was an appeal by Medicus in a take nothing declaratory judgment.

Medicus provides medical malpractice insurance for physicians and health care practitioners. The company began selling insurance in September 2006. Its business plan is to keep its costs low by offering insurance at low premiums only to physicians with few claims, generally fewer than five claims.

Dr. Todd handled his malpractice insurance through his insurance broker, Larry Zimmer. When Dr. Todd applied for insurance in October 2006, Medicus did not ask him to fill out its nineteen-page application. Instead, it permitted him to submit only its two-page application and the Texas Standardized Credentialing Application, a form that physicians use to receive credentials to practice in a particular hospital. Dr. Todd sent Medicus a credentialing application he had signed on May 4, 2005. The credentialing application asked if Dr. Todd had “ever been the subject of an investigation by any licensing authority,” and he checked the “No” box. In fact, Dr. Todd had been twice investigated by the Texas Medical Board for having three or more medical malpractice claims in a five-year period. The credentialing application also asked if he had “ever had any malpractice actions within the past 5 years pending, settled, arbitrated, mediated or litigated,” and appellant checked the “Yes” box and attached a description of four lawsuits filed against him between May 2000 and when he signed the application in May 2005. Dr. Todd omitted one lawsuit from the list of claims filed between May 2000 and May 2005. Dr. Todd also failed to disclose another lawsuit filed between his signing the credentialing application and his applying to Medicus.

Insurance Agent Committing Fraud

November 10, 2015 | Mark S. Humphreys

Dallas area insurance lawyers can tell lawsuit stories where they have represented clients who have been ripped of and cheated by insurance agents. The Insurance Journal published a story in October of 2015, that was an article about an agent getting caught stealing from his customers. The title of the article is, Former Southern California Insurance Agent Sentenced For Felony Fraud.

Hesham Saleh Ibrahim, 57, of Palmdale, Calif., pleaded no contest to felony insurance fraud and was sentenced to three years felony probation, 30 days community labor and ordered to pay nearly $1,000 in restitution and fines. Ibrahim was an insurance agent licensed to conduct business in California.

Ibrahim was charged in July 2015 with six misdemeanor counts of transacting insurance without a license for issuing 114 auto insurance policies. He was also charged with one count of felony insurance fraud for issuing a fraudulent insurance certificate for a $2 million commercial liability policy and pocketing the $350 premium.

Life Insurance And The Texas Insurance Code

November 8, 2015 | Mark S. Humphreys

Weatherford insurance attorneys see all kinds of gimmicks by insurance companies in their attempts to not pay claims. One of these is to try and cause a beneficiary under a life insurance policy to believe they are not a proper party to make the claim. The U.S. District Court, Tyler Division issued an opinion dealing with this issue. The style of the case is, Marcia Slack v. The Prudential Insurance Company of America.

Marcia sued Prudential for violations of the Texas Insurance Code, among other things, for their refusal to pay benefits on a life insurance policy her deceased husband had purchased wherein she was the named beneficiary. The fact pattern is a little complicated but one of the challenges to her lawsuit made by Prudential was that she did not have standing to under the Texas Insurance Code.

Prudential filed for Motion for Judgment on the Pleadings and argued that Marcia does not have standing to assert a claim under the Texas Insurance Code because she is merely a third party to the Policy. Prudential also contended that “claims under the Texas Insurance Code do not survive following the insured’s death.” Prudential attempted to bolster its argument by stating that (1) Plaintiff does not assert that any of Defendant’s representations reached Plaintiff (and instead were only made to Mr. Slack), (2) Plaintiff only asserts that Mr. Slack paid the Policy premiums, (3) Plaintiff was not designated as the beneficiary until after Mr. Slack took out the Policy, and (4) Plaintiff did not allege any reliance on Defendant’s representations.

Forging Insurance Documents

November 7, 2015 | Mark S. Humphreys

Dallas area insurance lawyers who handle many cases will run across a situation where insurance documents have been forged. The Insurance Journal published an article in September of 2015, that briefly discusses this topic. The title of the article is, North Carolina Man Arrested For Forging Insurance Documents.

Keep this in mind when reading the post. The article deals with an insured committing a fraud against an insurance company. What a lot of people don’t realize is how often an agent or an adjuster or some other representative of an insurance company will also commit fraud with insurance papers. This involves forging signatures, writing in false information on an application or claims form, and checking boxes on pre-printed forms that should not be checked. The motives are simple, to keep from playing claims. For an insurance agent, it often means the difference in their commissions and bonuses.

Here is what the article says:

Uninsured Drivers

November 5, 2015 | Mark S. Humphreys

Insurance attorneys can attest to the number of uninsured drivers in Texas. The Austin American Statesman published an article this week discussing this issue. The title of the article is, “Damage From Uninsured, Unlicensed Drivers Last Well Past Crashes.”

It was just after midnight on Dec. 28 as Nicole DeAngelis was returning from the airport when a car with a black racing stripe suddenly cut across her lane and braked. She tried to stop but slammed into it. As she pulled over, the car sped away.

Luckily for her — less lucky for the young driver with whom she collided — the road he chose for his escape was a dead end, according to court accounts describing the incident. By the time Hector Gutierrez-Chavez returned, Austin police were waiting. It turned out to be DeAngelis’ last piece of good news. Police and court records show that Gutierrez-Chavez, 20, shouldn’t have been driving the 2014 Dodge Challenger at all. He had no valid license — something for which Austin police had cited him five times previously. He was also uninsured.

Life Insurance And The DTPA

November 3, 2015 | Mark S. Humphreys

Life Insurance lawyers need to know the relevant issues regarding the Texas Deceptive Trade Practices Act (DTPA) and how they interact with life insurance policy issues. This is discussed to a certain extent in a recent U.S. District Court, Tyler Division opinion. It is styled, Marcia Slack v. The Prudential Insurance Company of America.

Tom Slack, purchased a life insurance policy from Prudential in 2001. Mr. Slack named Marcia as the beneficiary of the Policy. After Mr. Slack died on December 2, 2012, Marcia filed a claim for death benefits under the Policy, and Prudential paid Mrcia $274,391.56.

Marcia contends that after purchase of the Policy, Pruential represented to the Slacks that Ronnie William Shaffer was the “representative with whom they should and could communicate regarding the Policy, including any questions concerning payment of premiums.” Marcia contends that the Slacks used community funds to pay the annual premium payment of $10,580.00 plus an additional payment of $6,720.00 from 2001 to 2010 because Prudential represented to them that if they made the additional payment, the premium due under the Policy would vanish after ten years.

Named Driver Policies

November 1, 2015 | Mark S. Humphreys

Arlington lawyers looking at insurance claims need to be aware of new laws governing the issuance of auto policies. The particular type of policy effected by these new laws are what are known as “Named Driver Automobile Insurance Policies” and knowing whether or not one of these policies is enforceable or not is necessary to properly advise a client about potential claims.

The new law is found in the Texas Insurance Code, Section 1952.0545 and says this:

REQUIRED DISCLOSURE REGARDING NAMED DRIVER POLICIES; PERSONS IN INSURED’S HOUSEHOLD.