Dallas Fort Worth Insurance Lawyer Blog

Coverages In Disability Policies

May 19, 2015 | Mark S. Humphreys

Arlington insurance attorneys who handle disability policy claims would want to read this 1978, Beaumont Court of Appeals case. It is styled, Lone Star Life Insurance Company v. Griffin.

Griffin testified that as he was returning to his home from his farm, he passed by his drugstore. As was his custom, he entered the store to see if everything was normal (having been burglarized several times in the past). He smelled smoke which he found to be coming from the rear of his building. He testified that he emptied his fire extinguisher but his efforts were futile; that he was trying to get out of the building when an aerosol can exploded in his face; that he lost consciousness while upon the floor of the store near a door, and regained consciousness later in a hospital in Jasper.

Dr. Lee Popejoy testified as to his treatment of Griffin beginning at about two in the morning following the fire. He told of finding external burns on several parts of Griffin’s body but the most serious injury was to his lungs from the inhalation of smoke and fumes. Griffin was hospitalized for several weeks and testified that he was unable to do any work for several months thereafter.

Policy Definition Of Total Disability

May 17, 2015 | Mark S. Humphreys

Arlington lawyers handling insurance disability claims need to know all the places to look to find law helpful to their client. This includes not only the Texas Insurance Code, but also the Texas Administrative Code.

But first, a case helpful to disability case understanding is a 1970, El Paso Court of Appeals case styled, Travelers Insurance Company v. Solomon.

Solomon received a jury verdict in his favor against Travelers for anticipatory breach of an insurance contract. The contract was an accidental disability policy issued by Travelers. Under the policy Travelers agreed to pay the sum of $200.00 per month during the period of any total disability sustained by Soloman which commenced within 30 days after he received accidental injuries. The policy defines ‘total disability’ as meaning an inability of the insured to perform any and every duty pertaining to his occupation during the first 24 months of any period of disability; thereafter, the term is defined to mean complete inability of the insured to engage in any and every occupation or employment for wage or profit.

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: