Dallas Fort Worth Insurance Lawyer Blog

Insurance Company Trying To Rescind A Policy

September 1, 2015 | Mark S. Humphreys

Life insurance lawyers need to know the facts in a 1980, Texas Supreme Court case. It is styled, Mayes v. Massachusetts Mutual Life Insurance Co. This case is important because a life insurance company often times to rescind a policy based on misrepresentations made in the policy application.

In Mayes, Massachusetts tried to rescind three policies of insurance on the life of Albert Hayes after he died. Mayes did not disclose that certain answers which were correct when made became false by the time the policies were delivered.

On May 6, 1976, Albert Mayes signed and delivered to an agent of Massachusetts Part 1 of two applications for life insurance. These applications had been filled out by the agent and his secretary from information secured from a previous policy issued to Mayes through this agent. The applications are identical except for the amount of insurance requested by each application. On page three of each application is the following paragraph:

Settling Liability Claims

August 30, 2015 | Mark S. Humphreys

Insurance attorneys need to know the law in Texas as it relates to the responsibility an insurance company owes to its insureds and liability coverage. The Insurance Journal published an article in July 2015, that discusses a Louisiana case but has applicability to Texas law.

The Louisiana Supreme Court recently ruled that an insurer can be liable for bad faith failure to settle even if it never receives a firm settlement offer and also that an insurer can be found liable for misrepresenting or failing to disclose “pertinent” facts to the insured.

The Court ruled in response to two certified questions from the U.S. 5th Circuit Court of Appeals, so its ruling wasn’t applied to the underlying facts in the case.

Life Insurance – Homicide

August 29, 2015 | Mark S. Humphreys

Life Insurance attorneys will eventually have a case where the benefits of a life insurance policy are being denied for the stated reason that the beneficiary of the life insurance policy willfully brought about the death of the insured. The United States District Court, Western District of Texas, San Antonio Division, had this issue in a case. It is a 2015 case styled, Garrett Bean and Aneilia Bean v. Minerva Alcorta.

Gary Bean was the father of Garrett and Aneilia Bean (plaintiffs). Gary was killed by a gunshot wound. Gary had life insurance and the insurance company inter-pled the life insurance benefits into the registry of the court.

Minerva was the primary beneficiary under the policy. Minerva was the boyfriend of Gary and at the scene of the homicide, Minerva hysterically told policy that she had shot her boyfriend. Due to the circumstances, plaintiffs made claim to the policy benefits stating the Minerva had forfeited her rights to the policy benefits by intentionally causing the death of Gary and that plaintiffs were, as a result, the proper claimants to the life insurance benefits.

ERISA And Life Insurance And Accidental Death Coverage

August 27, 2015 | Mark S. Humphreys

Fort Worth lawyers who handle ERISA claims will need to read this opinion out of the U.S. District Court for the Southern District of Texas, Houston Division. It is styled, Sandra James v. Life Insurance Company of North America and Geico.

This is an appeal of a Magistrates ruling on a summary judgment in favor of Life Insurance Company of North America and Geico (Geico).

Sandra’s husband was killed in a one vehicle accident with a tree and subsequent fire. The medical examiner stated Robert’s cause of death was “inhalation of combustion products and thermal injury.” The listed manner of death was an “accident.”

Exclusions In Policy – How To Interpret

August 25, 2015 | Mark S. Humphreys

Duncanville insurance lawyers have to be able to read an insurance policy and understand how the courts will interpret the language found in the policy. The Amarillo Court of Appeals issued an opinion in July of 2015, that deals with this issue. The opinion is styled, Doe #1, Doe #2 and Doe #3, v. National Union Fire Insurance.

The trial court granted summary judgment in favor of National Union and this appeal followed.

National Union issued a CGL policy to Watchtower Bible and Tract Society Et al. Watchtower sought coverage for coverage from conduct of a sexual nature, including the sexual abuse of minors.

ERISA – Summary Plan Description

August 23, 2015 | Mark S. Humphreys

Parker County ERISA attorneys know the two documents needed to be reviewed in an ERISA case are the Certificate of Coverage (COC) and the “summary plan description.”

The United States Court of Appeals for the Fifth Circuit issued an ERISA opinion in 2012, that is relevant to these documents. It is styled, Nancy Koehler v Aetna Health, Inc.

The case is an appeal from an adverse summary judgment against Koehler. Aetna refused to reimburse Koehler for an out of network specialist who had been referred by an in network physician. Aetna denied based on the referral not being pre-authorized by Aetna.

Offer And Acceptance

August 22, 2015 | Mark S. Humphreys

Irving insurance lawyers need to be able to discuss with clients when offers of settlement should be accepted and how to accept the claim. A good illustration of this is found in a 2015, Houston Court of Appeals [1st. Dist.] opinion. It is styled, Kamisha Davis v. Texas Farm Bureau Insurance.

Kamisha Davis sued Farm Bureau, asserting several causes of action. The trial court granted summary judgment against Davis in favor Farm Bureau.

On August 26, 2009, Kamisha Davis was involved in a motor vehicle accident with Farm Bureau’s insured. Davis hired attorney Corey Gomel to pursue a personal injury claim arising out of the accident. On April 19, 2011, Gomel sent Farm Bureau a letter, stating that Davis would be willing to settle her personal-injury claims against Farm Bureau’s insured for $37,500. Farm Bureau, through its claims adjuster, Jody Roe, made a counter-offer of $10,000 on May 2, 2011.

ERISA And A Jury Trial

August 20, 2015 | Mark S. Humphreys

Fort Worth ERISA attorneys already know that an ERISA case is not entitled to a jury trial. The U.S. District Court For The Southern District Of Texas Houston Division issued an opinion wherein that issue was a point of contention. The style of the case is Lucinda Francis v. South Central Houston Action Council, Inc. D/B/A Central Care Community Health Center.

Francis alleges that on July 25, 2013, Central Care terminated her employment. Francis filed her Complaint alleging that Central Care violated section 510 of ERISA when it terminated her employment soon after she elected to enroll in Central Care’s employee health insurance program because Central Care wanted to avoid covering Francis’s benefit plan expenses. Francis also alleges that Central Care’s motivation for terminating her employment violated the Age Discrimination in Employment Act and Title VII of the Civil Rights Act of 1964. She requested a trial by jury on all of her claims. In Defendant’s Answer Central Care alleged that Francis’s termination was based on Francis’s insubordination in failing to follow proper policies and procedures with regard to clocking in and out. Central Care moved to strike Francis’s ERISA claim, arguing that Francis lacks standing to bring an ERISA claim and that ERISA claims are not triable by a jury.

Central Care argues that Francis’s ERISA claim should be stricken based on lack of statutory standing because Francis does not qualify as a “participant” in Central Care’s benefit plan. Francis responds that a motion for summary judgment, rather than a Rule 12(f) motion to strike under the Federal Rules of Civil Procedure, is the appropriate vehicle for dismissal of an ERISA claim based on lack of statutory standing. Central Care responds that its Motion to Strike was not raised pursuant to Rule 12(f), and that Francis’s ERISA claim should be stricken because Francis lacks standing and the court therefore lacks subject-matter jurisdiction.

Bad Faith Claim

August 18, 2015 | Mark S. Humphreys

Grand Prairie insurance lawyers need to be aware of the opinions issued by the appeals courts dealing with bad faith issues. The Dallas Court of Appeals issued an opinion on June 30, 2015, that discusses bad faith in insurance cases. The style of the opinion is, Bruce E. Bernstien v Safeco Insurance Company of Illinois.

This is Berstine’s appeal of a summary judgement in favor of Safeco.

Bernstien had an automobile insurance policy from Safeco to provide insurance coverage for his Porsche. The Porsche was damaged in an accident, and Bernstien notified Safeco. Safeco acknowledged the Porsche was covered by the insurance policy, but disagreed with Bernstien about the amount of money Safeco should pay Bernstien for the Porsche. The dispute was submitted to an appraiser, who concluded the value of the Porsche was $4,900 plus tax, title, and license. Nine days after the date of the appraisal award, Safeco sent a letter to Bernstien enclosing a check for $5,287.05. The letter stated Safeco was not applying Bernstien’s $1,000 deductible nor deducting money for the salvage value of the car.

Hail Claims And Statute Of Limitations

August 16, 2015 | Mark S. Humphreys

Weatherford insurance lawyers need to have a clear understanding how the statute of limitations is calculated in a hail damage claim. A U.S. District Court case from The Southern District, McAllen Division is necessary reading. It is styled, Hector Chapa, et al v. Allstate Texas Lloyds, et al.

This is a summary judgement case, wherein Allstate filed the motion for summary judgment based on among other things, the statute of limitations.

The following facts are undisputed. On March 29, 2012, a wind and hail storm struck causing significant damage to Plaintiffs’ home. Plaintiffs immediately filed a claim with Allstate on March 30, 201. On April 9, 2012, an adjuster from Allstate inspected the claim and determined the replacement cost value for the hailstorm damage amounted to $24,713.17. To pay the claim, Allstate made an initial cash value payment to Plaintiffs on April 10, 2012, which is the date they assert the claim was settled in accordance with the policy, and provided a recoverable depreciation payment when the repairs were completed on June 22, 2012. Allstate closed the claim on June 22, 2012 and had no further communication with Plaintiffs for almost two years.