Dallas Fort Worth Insurance Lawyer Blog

Life Insurance Claims Denial

April 12, 2015 | Mark S. Humphreys

Fort Worth life insurance lawyers need to read the 1983 case Gloria Cartusciello v. Allied Life Insurance Company of Texas. The case is from the Houston Court of Appeals [1st Dist.].

The facts are simple and virtually undisputed. Michael Cartusciello obtained a credit life insurance policy from the Allied after executing an application on March 7, 1978, which stated in pertinent parts as follows:

I hereby certify that I am in good health and gainfully employed and that my age is as stated above,… I certify that I have read and that the information provided hereinbefore to the best of my knowledge is true and I understand that any false statement, inaccuracy, or misrepresentation material to the risk, may be used by Allied Life Insurance Company of Texas to contest a claim. I have not been attended by a physician or been a patient in a hospital within the last 12 months preceding the date of this Application for any of the following impairments: Diseases of the (1) heart, (2) lungs or respiratory system, (3) stomach or digestive system, (4) brain or nervous system, or (5) cancer to any part of the body, except as follows:

Insurance For Identity Theft

April 11, 2015 | Mark S. Humphreys

Palo Pinto County lawyers who handle insurance related claims may someday have to deal with a situation regarding identity theft and insurance. If so, this article may be of interest. It is from the Claims Journal and is titled, “Identity Theft Insurance: Is It Worth It?

The article tells us that anyone who isn’t in a high state of alert about safeguarding his or her identity is either in massive denial or is a fatalist. The data breach at Anthem put about 80 million consumers at risk of ID theft, states are seeing a spike in fraudsters using stolen identities to file for income tax refund checks and new hacks seem to be discovered every week. That’s made ID theft protection a booming industry, with new products being launched and existing ones tweaked to help with, and profit from, the anxiety.

H&R Block is the latest player to get into the business. In January, it launched “Tax Identity Shield,” which, for $29.95 a year, does an annual, pretax season scan for your name on websites suspected of selling personal information, sends an e- mail if your information is on another tax return filed through H&R Block, and gives basic help navigating red tape. TransUnion also unveiled a new product in January, a mobile app that, among other things, lets users paying $17.95 a month freeze and unfreeze their credit report with a swipe of their finger. Existing products are going strong: The largest niche player, Lifelock, saw 40 percent of all new members in 2014 join in the year’s final quarter.

Texas Homeowners Policy’s And Costs

April 9, 2015 | Mark S. Humphreys

Dallas insurance lawyers need to keep up with general information in the insurance world. Claims Journal published an article recently worth reading. It is titled, State Farm to Pay $352.5M to Settle Texas Residential Overcharge Case. It says:

A settlement has been reached in a long-running dispute between the nation’s largest homeowners’ insurer and the state of Texas over premium overcharges.

The Texas Office of Public Insurance Counsel (OPIC) announced Feb. 27 that a settlement had been reached requiring State Farm subsidiary, State Farm Lloyds, to refund $352.5 million in premium overcharges and interest to its Texas policyholders.

Health Insurance Claim Denied

April 7, 2015 | Mark S. Humphreys

Dallas insurance lawyers need to know about this ruling from the Northern District, Fort Worth Division. The case is styled, Hinna v. Blue Cross Blue Shield of Texas.

This is a lawsuit for declaratory relief filed by Kelly Hinna. Hinna sued for a declaration that Blue Cross had an obligation to pay claims under her health insurance contract and for breach of contract, violations of the Texas Insurance Code, and other causes of action. Blue Cross filed a motion for summary judgment, which was DENIED.

Hinna applied for individual health care coverage with Blue Cross and on her application gave a “No” answer to each of the following questions:

There Must Be Intent To Deceive

April 5, 2015 | Mark S. Humphreys

Palo Pinto life insurance lawyers who handle life insurance claims that are denied need to read this case from the Houston Division of Texas Southern District. The case is styled, Kirk v. Kemper Investors Life Insurance Company. The case deals with misrepresentations made in an application for life insurance.

This case arises from a life insurance policy issued by Kemper Investors Life Insurance Company (“KILICO”) to Walta G. Kirk, on March 14, 2002. Ms. Kirk passed away on August 31, 2003, while the policy was in effect. Because her death occurred within two years of the policy’s issuance, KILICO 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 KILICO life insurance policy. Based on these alleged misrepresentations, KILICO denied payment of any benefits on the policy.

The beneficiaries then filed this lawsuit. KILCO filed a motion for summary judgment saying stating Kirk misrepresented her medical conditions.

Proposed New Insurance Laws

April 4, 2015 | Mark S. Humphreys

Here is information for Texas insurance lawyers. The following are a few new laws being proposed by the Texas Legislature concerning insurance. These proposed laws change existing statutes.

HB 3646 – Insurance Claims and Cerlaln Prohibited Acts and Practices Relating to the Business of Insurance Summary: HB 3646, would amend various sections of the Insurance Code to do, among other things, the following:

The definition of “person” would no longer include an adjuster or any third-party individual or entity “engaged by an insurer to provide adjusting, estimating, consulting, engineering, or other services related to the insurer’s adjustment of a claim.

Misrepresentation – Knowledge of Agent

April 2, 2015 | Mark S. Humphreys

Dallas and Fort Worth Life insurance attorneys need to read this 2006, opinion from the United States District Court, Southern District of Texas, Houston Division. The style of the case is, Kirk v. Kemper Investors Life Insurance Company.

This case arises from a life insurance policy issued by Defendant Kemper Investors Life Insurance Company (“KILICO”) to Walta Kirk. Ms. Kirk passed away while the policy was in effect. Because her death occurred within two years of the policy’s issuance, KILICO 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 KILICO life insurance policy. Based on these alleged misrepresentations, KILICO denied payment of any benefits on the policy.

An insurer’s actual knowledge of a misrepresentation by an insured will defeat a defense based upon misrepresentation. It is not enough, however, for a party seeking to collect insurance benefits to show that the insurer could have discovered the misrepresentations through due diligence or proper care. Rather, only actual knowledge on the part of the insurer will prevent the insurer from showing that it relied on a misrepresentation made by the insured.

Intent To Deceive

March 31, 2015 | Mark S. Humphreys

Life insurance attorneys in the Dallas and Fort Worth area need to know this 1991 case. It deals with how an insurance company must prove “intent to deceive” when asserting that an applicant for insurance has misrepresented their health in a life insurance policy. The case, from the Houston Court of Appeals [14th Dist.] is styled, Betty Flowers v. United Insurance Company of America.

This is an appeal from a summary judgment granted in favor of United.

The basic facts of the case are not in dispute. Betty and her husband, Edward Flowers, applied for and were issued a joint life insurance policy with United. In the application for the policy Mr. Flowers was asked a series of questions regarding his health history. In pertinent part, the question asked:

Misrepresentation In Life Insurance Application

March 29, 2015 | Mark S. Humphreys

Dallas life insurance lawyers want to know this case. It is from the San Antonio Court of Appeals and styled, Garcia v. John Hancock Variable Life Insurance Company.

This is an appeal of a summary judgment granted in favor of John Hancock.

In support of its motion for summary judgment, John Hancock submitted the following: in February and March of 1986, Garcia’s husband, Alfredo R. Garcia, applied for and was issued a life insurance policy with John Hancock. In two policy applications, Mr. Garcia was asked a series of questions regarding his health history. The first application, dated February 25, 1986, was signed by Mr. Garcia and an agent of the Insurance Company. On that application, Mr. Garcia represented that he had never been treated for or had any known indication of diabetes. He also represented that he (1) had not consulted a physician or been examined or treated at a hospital or other medical facility within the last five years; (2) was not being treated by a physician or taking any prescription drug; and (3) did not have a personal physician.

Roof Damage Claims

March 28, 2015 | Mark S. Humphreys

Dallas insurance lawyers who handle roof damage claims will want to ready this “Order” from a Fort Worth Federal Court. The style of the case is, Living Word Teaching Center v. Robert Morris Adams, Jr. and Allstate Insurance Company.

Living Word, a church, secured an insurance policy from Allstate covering its 5,000 square foot church. Living Word later built a large arena next to the church and sought additional coverage for the arena from Allstate. In December 2013, the arena suffered a collapse and was damaged. When Living Word filed an insurance claim with Allstate for the damage suffered, Allstate advised Living Word that the arena was not listed on the policy and therefore, was not covered.

Living Word brought the following claims against Defendants: (1) violations of the Texas Deceptive Trade Practices Act against Allstate insurance agent, Adams; (2) negligent misrepresentation against Adams; (3) negligence/negligent procurement against Adams; and (4) agency and vicarious liability against Adams and Allstate.