Dallas Fort Worth Insurance Lawyer Blog

Statement In Insurance Application

May 16, 2015 | Mark S. Humphreys

Dallas life insurance lawyers need to read this 1979, Amarillo Court of Appeals opinion. It is styled, Allied Bankers Life Insurance Company v. Mary De La Cerda.

On December 27, 1976, Paul A. De La Cerda secured a $9,000 group credit life insurance certificate from Allied. The certificate contained a statement that the insured had not been, nor was being, treated for certain diseases and that he was in good health.

On February 3, 1977, insured died. The cause of death was diagnosed as acute myocardial infarction superimposed upon a previous anterolateral infarction. The bank filed its claim under the certificate, which was denied by Allied. Thereafter, the bank assigned its interest to Mrs. De La Cerda.

Paying Back Health Insurance Company

May 14, 2015 | Mark S. Humphreys

Lawyers and attorneys handling insurance claims in the Dallas and Fort Worth areas need to be able to discuss subrogation issues with clients who have been injured by third parties. Bloomberg Businessweek published an article on April 7, 2015, that discusses this issue. It is titled, “How An Insurer Is Taking Money From The Fan Beaten At Dodger Stadium.” Here is some of what it tells us.

First he was assaulted for wearing the wrong team’s clothes. Then he was sucker-punched by the insurance system.

Four years ago, Bryan Stow was a strapping paramedic who spent his days off biking with his son and daughter. That was before March 31, 2011, when he and three friends made the mistake of wearing San Francisco Giants garb to an Opening Day game against the rival Los Angeles Dodgers at Dodger Stadium. They were harassed and threatened in the stands. Afterwards, two Dodgers fans beat Stow so savagely in a parking lot that doctors had to induce a coma to save him. He was hospitalized for seven months.

Life Insurance

May 12, 2015 | Mark S. Humphreys

Palo Pinto County insurance lawyers need to understand life insurance.

Life insurance pays a stated amount of benefits to the beneficiary upon the insured’s death. Typically, the policy has a “face amount” that is, a stated value that is payable. Some policies may offer increased benefits if the insured dies from certain causes. For example, some policies pay “double indemnity” benefits if the insured dies in an accident.

“Term” policies pay a fixed amount stated in the policy. Whole life policies accumulate cash value. On the other hand, if the policy allows the insured to borrow against the policy, the death benefit may be reduced by the amount of any outstanding loans.

Life Insurance Application

May 10, 2015 | Mark S. Humphreys

The life insurance application must be attached to the life insurance policy. Any experienced life insurance attorney in the Dallas and Fort Worth area can tell you this. It is emphasized in a Texas Supreme Court case in 1975, styled, Johnson v. Prudential Insurance Co. of America.

This is a lawsuit to collect benefits under a group life insurance policy. The insurance company resisted payment on the ground that the deceased insured willfully deceived the company by her statements made in procuring coverage; the company has obtained favorable findings to support this defense. This appealed followed.

Katherine Johnson was a teacher who obtained insurance upon her life under a group policy issued by the Prudential. She applied for insurance coverage on November 12, 1968. Prudential issued its certificate for her coverage, effective January 1, 1969. The amount of the original benefit was $10,000; it was raised to $12,000 in April of 1969 and then to $15,000 in 1970. Katherine Johnson died on November 16, 1970; her husband was the beneficiary on the insurance contract and brought this suit against the insurer on June 25, 1971.

Waiver Of Rights

May 9, 2015 | Mark S. Humphreys

Mineral Wells insurance lawyers know to tell clients to not negotiate checks from an insurance company that represent a refund of paid premiums. But what happens if the check is cashed by the client? A 2006, Federal District Court in Houston Texas is worth reading. The style of the case is, Kirk v. Kemper Investors.

This case arises from a life insurance policy issued by Kemper. Ms. Kirk passed away on while the policy was in effect. Because her death occurred within two years of the policy’s issuance, Kemper conducted a routine investigation, which revealed that Ms. Kirk had been treated for chest pain, respiratory disorder, mental disorder, and uncontrolled high blood pressure. Ms. Kirk had denied that she had ever had or been treated for any of these conditions in her application for the Kemper life insurance policy. Based on these alleged misrepresentations, Kemper denied payment of any benefits on the policy.

Kemper issued a refund check for the paid premiums that was cashed. Kemper then filed a motion for summary judgment saying Kirk had waived his rights to any benefits by cashing Kemper’s premium refund check.

Temporary Life Insurance Policy

May 7, 2015 | Mark S. Humphreys

Here is an interesting twist for local life insurance attorneys. This is a 1997, Fifth Circuit Court of Appeals case. It is styled, Riner v. Allstate Life Insurance Company.

Riner sued Allstate after Allstate refused to pay benefits under a temporary insurance agreement on the life of her father, Robert Marriott. Allstate defended on the theory that alleged misrepresentations in the insurance application absolved it of liability . The district court granted summary judgment (MSJ) in favor of Allstate, and Riner appealed. The Court reversed the MSJ and ruled in favor of RIner.

Prior to 1994, Mr. Marriott had five back surgeries, which left him with chronic back pain and in depression. Riner wanted to take a life insurance policy naming Riner as beneficiary. On June 29, 1994, Allstate sent an agent to Mr. Marriott’s home to take his application information. Allstate’s lengthy standardized application contained a list of medical questions. The applicant responded to those questions by checking boxes marked “yes” or “no.” When a box was marked “yes,” the application contained additional space for further explanation by the applicant. Mr. Marriott disclosed that he had chronic back problems and certain other medical problems. Mr. Marriott’s application is marked “no,” however, with respect to whether he had ever received treatment for the use of alcohol or received treatment for depression within the past three years.

Application As Part Of The Policy

May 5, 2015 | Mark S. Humphreys

Fort Worth life insurance lawyers can tell you that a policy of life insurance must have attached to it, a copy of the application. Texas Insurance Code, Section 705.103 clearly states:

Except as otherwise provided by this code, a life insurance policy must be accompanied by a copy of:

(1) the policy application; and (2) any questions and answers given in connection with the application.

Denial Of Life Insurance Claim Based On A Misrepresentation In An Application

May 3, 2015 | Mark S. Humphreys

Dallas insurance lawyers will see lots of situations where a person has their life insurance claim denied for the stated reason that the insured made a misrepresentation in the application for insurance. There are a few common law rules standards that apply. It is also important at this stage to understand what the Texas Insurance Code states.

There are several statutory provisions regulating an insurance company’s ability to avoid coverage based on a misrepresentation by the insured in their application for insurance. These statutes are found in the Texas Insurance Code sections 705 and 1201.

Texas Insurance Code, Section 705.003 states: A provision stating that a misrepresentation in a proof of loss makes the policy void or voidable is of no effect and is not a defense, unless the misrepresentation was:

Rescission Of Insurance Policy

May 2, 2015 | Mark S. Humphreys

Texas insurance lawyers need to have an understanding about the reasons an insurance can properly rescind a policy or to put it another way – the reasons an insurance company cannot properly rescind a policy.

As a general principle, prior to a loss an insurance company has the right to rescind a policy procured through mutual mistake or fraud. This was the ruling in a 1931, case from the Amarillo Court of Appeals and is still good law. The case is styled, Forrester v. Southland Life Insurance Company.

The 1980, Texas Supreme Court case styled, Mays v. Massachusetts Mutual Life Insurance Company has stated that an insurance company may rescind a policy based on the insured’s misrepresentation, if the insurance company pleads and proves the following elements:

DTPA Notice Letter Required

April 30, 2015 | Mark S. Humphreys

Mesquite insurance lawyers know that violations of Texas insurance laws are also violations of the Texas Deceptive Trade Practices Act (DTPA). They also know that a notice letter is required prior to pursuing a lawsuit under either category of statutes. A 1992, Texas Supreme Court case illustrates this point. The style of the case is, Hines v. Hash.

Dutch Hines sued C.W. Hash, Jr. for damages under the DTPA, complaining that the roof Hash had installed on his home leaked. In his original petition Hines alleged that notice of his claim had been sent to Hash by certified mail, return receipt requested, and had been returned unclaimed. In his original answer, Hash asserted as an affirmative defense that he had never received any notice of Hines’ complaint until he was served with suit papers, and therefore had not been able to tender Hines a settlement offer. However, Hash never requested the trial court to abate the suit so that he could make such an offer, nor does it appear that he was prevented from making a settlement offer even without the abatement. The evidence at trial concerning notice was undisputed. The notice letter to Hash and the envelope in which it was sent were admitted into evidence, showing three unsuccessful attempts at delivery before it was returned to Hines. Hash did not dispute that the envelope was accurately addressed to him. In fact, he testified he knew at the time that he had a certified letter at the post office but did not pick it up because he was leaving town each morning before the post office opened to work in another city and was not returning home until after the post office closed. He also testified that it was not convenient for him to arrange to have someone else pick up the letter. Hines did not challenge Hash’s explanation for not having received the letter. Hash moved for an instructed verdict after Hines rested and again at the close of all the evidence, urging lack of notice as a complete bar to Hines’ claim. The trial court denied Hash’s motions and refused Hash’s requested jury question on the issue of notice. The jury found that Hash knowingly violated the DTPA in several particulars and assessed Hines’ actual damages at $9,249.00. The trial court rendered judgment on the verdict for a total of $35,822.67, which included actual damages, twice that sum in statutory damages, prejudgment interest of $4,225.67, and attorney fees of $3,850.00.

The notice requirement of the DTPA is clearly mandatory.