Dallas Fort Worth Insurance Lawyer Blog

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.

ERISA And Misrepresentation

October 31, 2015 | Mark S. Humphreys

ERISA lawyers need to read the 2015 opinion from the U.S. District Court, Houston Division. It is styled, Michael Nall, et al, v. BNSF Railway Company, et al.

Nall was an employee of BNSF Railway. He alleged that based on his employment he was entitled to receive certain benefits under the plan provided by BNSF. This benefit plan was an ERISA benefit plan.

Nall was diagnosed with Parkinson’s disease and was having many problems that are discussed in the opinion. The relevant issue in this case is that while Nall was out on disability in 2013, he received his annual enrollment package regarding his 2014 coverage. According to this enrollment package, Nall did not need to submit anything in order to continue coverage for 2014. Nall relied on this notification and assumed that his benefits would continue on just as in the past. After getting some further treatment, Nall received a bill from one of his doctors and then learned that his benefits had ended.

Insurance Companies Getting Agressive

October 29, 2015 | Mark S. Humphreys

Lawyers handling insurance claims can tell stories where an insurance company gets aggressive against an insured based on their belief that the insured is committing some sort of insurance fraud. The Austin-American Statesman ran a story highlighting this topic in September of 2015. The title of the article is “Private Insurer Pays Government Lawyers To Pursue Fraud Charges.”

The article starts out telling us that if he had it to do over again, Odessa native Roy Kyees would have ignored what the doctor told him. He would have walked out of that office and never filed a work injury claim for his back pain. He would have just paid for it out of his own pocket.

Then he never would have tangled with the largest provider of workers’ compensation insurance in Texas. He never would have gotten indicted for insurance fraud. Never would have been arrested and put in leg chains in his hometown jail.

Promptly Reporting Hail Damage

October 27, 2015 | Mark S. Humphreys

Fort Worth insurance attorneys tell their clients to report all claims immediately. A 2015, 5th Circuit Court of Appeals case is a good illustration of why. The opinion is styled, Carlos Alaniz v. Sirius International Insurance Corporation.

This is a summary judgment case granted in favor of Sirius.

Alaniz owns four rental properties. Each property contains four apartment units.

Hail Claims And Proper Pleadings

October 25, 2015 | Mark S. Humphreys

Grand Prairie attorneys handling hail damage claims will find this case helpful in their law practice. It is a 2015, U.S. Eastern District, Sherman Division opinion. The style of the case is, Calvary United Pentecostal Church v. Church Mutual Insurance Company, Donny Brown, and George Ben Hodges.

This case arises out of a hail damage claim filed by Calvary. Church Mutual insured the property and hired Brown and Hodges to adjust the hail damage loss. Brown and Hodges concluded the amount of the loss was $17,285.38. Calvary hired their own adjuster who concluded the total damage was $964,124.98.

Calvary filed this lawsuit in State Court and Church Mutual had the case removed to Federal Court claiming that Brown and Hodges had been improperly joined in order to defeat Federal Court jurisdiction in the matter.