Dallas Fort Worth Insurance Lawyer Blog

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.

ERISA Plan? How Do You Know?

March 26, 2015 | Mark S. Humphreys

Fort Worth lawyers who handle ERISA plans have learned that almost all companies that have their own employee insurance plans will claim they are ERISA plans. The real question though is – are they?

Knowing which employee plans are true ERISA plans and which are not is not always easy to discovery. There are two sections of 29 USC that are helpful in this regard.

Sec. 1022. Summary plan description

Hail Storm Claims

March 24, 2015 | Mark S. Humphreys

Parker County lawyers who handle hail storm claims should keep up legislation dealing with the topic. The Insurance Journal published an article that should be read. The title of the article is, Bills Aimed At Property Claims Litigation Expected In Texas Legislative Session. Here is what the article says.

Texas lawmakers are expected to file legislation this year aimed at stemming the tide of property claims litigation in the wake of catastrophic weather events, such as hailstorms.

Proponents of such legislation would like to see a measure that limits the time in which claims over property losses may be filed, similar to the limitations put in place for the Texas Windstorm Insurance Association after it was inundated with claims-related lawsuits following Hurricane Ike.

Renters Insurance And Breach Of Contract

March 22, 2015 | Mark S. Humphreys

Irving insurance lawyers wishing to sue for breach of contract in an insurance dispute need to read this Houston Court of Appeals opinion styled, Zatorski v. USAA.

Zatorski owned a high-rise, loft residence in Houston. A kitchen pipe broke and flooded the loft. Zatorski rented a single-family home while the loft was being repaired, and he called USAA to buy a renter’s insurance policy. He spoke with a USAA representative, paid for a one-year renter’s insurance policy over the phone, and did not review the written policy when he received it.

Armed intruders broke into Zatorski’s rental home and stole several firearms and his safe, which contained watches, jewelry, and cash; the items stolen had a total value of over $260,000. Zatorski made a claim against his rental policy for the value of the stolen items, and USAA responded that the policy limits were $1,000 for theft of jewelry, $2,000 for theft of firearms, and $200 for theft of cash. USAA paid Zatorski $4,500, which constituted payment of the policy limits for jewelry, firearms, and cash, plus $1,300 for the loss of the safe.

Renters Insurance And Misrepresentation

March 21, 2015 | Mark S. Humphreys

De Soto insurance lawyers who handle renters insurance need to read this case from the Houston Court of Appeals [1st. Dist.]. It is styled Zatorski v. USAA Texas Lloyds.

After Zatorski’s home was burglarized, he sued USAA, alleging that USAA had represented to Zatorski that his renter’s insurance policy would cover greater losses than it did. USAA moved for summary judgment and the trial court granted the motion. This appeals Court affirmed the ruling.

Zatorski owned a high-rise, loft residence in Houston. In October 2009, a kitchen pipe broke and flooded the loft. Zatorski rented a single-family home while the loft was being repaired, and he called USAA to buy a renter’s insurance policy. He spoke with a USAA representative, paid for a one-year renter’s insurance policy over the phone, and did not review the written policy when he received it.

Hail Damage Claims In Texas

March 19, 2015 | Mark S. Humphreys

Dallas lawyers handling hail damage claims need to be aware of the actions taking place in Austin. A recent article from the Insurance Journal needs to be read. The title of the article is, Attorneys, Insurers Facing Off Over Hail Litigation In Texas. Here is what it tells us about the battle between hail claims attorneys and insurance companies.

The vestiges of twin hailstorms that ravaged the south Texas coast in 2012 are now blowing through the halls of the Capitol in Austin.

Two of the state’s most-powerful lobbies, the insurance industry and trial lawyers, are gearing up for a fight over a push to ease penalties against companies that deny homeowners their hail-damage claims.