Dallas Fort Worth Insurance Lawyer Blog

Insurance Agent Liability In Mineral Wells

March 17, 2015 | Mark S. Humphreys

Mineral Wells insurance lawyers already know about this case from the Eastland Court of Appeals. It is styled, Spurlock v. Beacon Lloyds Insurance Company.

Kelly Spurlock (Spurlock), as legal representative for the Estate of J.O. Spurlock, brought suit against Beacon to recover proceeds under a homeowner’s insurance policy for the loss of personal property that was allegedly stolen from a residence. Spurlock also named Grantham-Adkins Insurance Agency (Grantham-Adkins) as a defendant. Spurlock asserted that, if the homeowner’s insurance policy that was issued by Beacon did not provide coverage for the loss of personal property, Grantham-Adkins was negligent in failing to procure coverage for the loss. Beacon and Grantham-Adkins filed motions for summary judgment on Spurlock’s claims. The trial court granted the motions in separate orders. Spurlock appealed the trial court’s orders. This Court affirmed the Orders.

Spurlock owed and lived in a house in Mineral Wells, Texas, that was insured with Beacon through Grantham-Adkins.

Mineral Wells Home Owners Claim

March 15, 2015 | Mark S. Humphreys

Mineral Wells insurance attorneys probably already know about this case. It is an Eastland Court of Appeals case styled, Spurlock v Beacon Lloyds Insurance Company.

This case involves the interpretation of a homeowner’s insurance policy. The Court had to construe a policy to determine if coverage exists for a personal property loss alleged to have occurred after the death of the named insured. Kelly Spurlock, as legal representative for the Estate of J.O. Spurlock, brought suit against Beacon to recover proceeds under a homeowner’s insurance policy for the loss of personal property that was allegedly stolen from a residence.

J.O. Spurlock owned and lived in a house in Mineral Wells, Texas, that he insured with Beacon. The policy was effective from May 31, 2008, to May 31, 2009. The “RESIDENCE PREMISES/DWELLING” listed in the declarations page of the policy was identified by the legal description of J.O. Spurlock’s house. The street address of the house was 704 Cedar in Mineral Wells. The policy provided dwelling coverage and personal property coverage.

Giving Notice To The Insurance Company

March 14, 2015 | Mark S. Humphreys

Insurance lawyers in Aledo Texas will tell you that you need to give notice to your insurance company as soon as possible when you know of a potential claim. The United States 5th Circuit dealt with this notice issue recently in a case styled, Berkley Regional Insurance Company v. Philadelphia Indemnity Insurance Company.

This case involves an insurance claim, controlled by Texas law for this diversity action, arising from an injury sustained on the property of Towers of Town Lake Condominiums. Towers, in an attempt to satisfy the notice requirements of an umbrella insurance policy with Philadelphia, sent notice of the claim to the broker of that policy. The core of the dispute is whether this notice satisfied the requirements of the umbrella policy, and, if not, whether Philadelphia was prejudiced as a result. Finding notice to the broker insufficient and Philadelphia prejudiced, the district court granted summary judgment in favor of Philadelphia. This Court affirmed that decision.

In 2004, Venus Rouhani (Rouhani) sued Towers in Texas state court for injuries she sustained at Towers, and a jury awarded her $1,654,663.50 plus interest and costs (totaling $2,167,300.30) in 2006. The damages were covered by a $1,000,000 primary policy issued by Nautilus Insurance Company (Nautilus) and a $20,000,000 umbrella policy (Umbrella Policy) issued by Philadelphia. Nautilus tendered its policy limits plus interest in the amount of $1,457,561.41 to satisfy the judgment, but Philadelphia refused to pay the remainder of the judgment, arguing that Towers failed to give Philadelphia notice of Rouhani’s claim until after the verdict was rendered.

ERISA And Contributing To Impairment

March 12, 2015 | Mark S. Humphreys

North Richland Hills insurance lawyers who handle ERISA claims need to read the 2015, 5th Circuit Court of Appeals opinion styled, George v. Reliance Standard Life Insurance Company. There are a couple of issues in the case but only the issue in the title above will be discussed here.

George served as an Army helicopter pilot. In 1985 George was injured in a helicopter crash, and doctors were forced to amputate one of his legs at the knee. George retired in 1987. After retiring, George began flying helicopters for PHI, Inc. PHI purchased a long-term disability insurance policy for George from Reliance (“RSL”). George flew for PHI for more than twenty years. But in 2008 he began experiencing severe pain at the site of his amputation, which prevented him from safely wearing his prosthetic limb. As a result, he was no longer able to operate the foot controls of a helicopter, and he was forced to retire from flying. George filed a claim for long-term disability benefits with RSL.

The Policy contains two definitions of “Totally Disabled” and “Total Disability,” which apply during different time periods. The Policy also contains a relevant limitation provision (the “Exclusion Clause”). The Exclusion Clause provides that “Monthly Benefits for Total Disability caused by or contributed to by mental or nervous disorders will not be payable beyond an aggregate lifetime maximum duration of twenty-four (24) months.” The Policy defines “Mental or Nervous Disorders” to include “anxiety disorders” and “mental illness.”

Disability Claims And ERISA

March 10, 2015 | Mark S. Humphreys

De Sota insurance lawyers who handle ERISA claims need to read this opinion issued by the United States 5th Circuit Court of Appeals. It is styled, Robert George v. Reliance Standard Life Insurance Company.

Reliance denied George’s claim for benefits for two reasons, one of which will be discussed here.

George served as a helicopter pilot in the United States Army. In 1985 George was injured in a helicopter crash, and doctors were forced to amputate one of his legs at the knee. George retired from military service in 1987. After retiring, George began flying helicopters for PHI. PHI purchased a long-term disability insurance policy for George from Reliance (“RSL”). George flew for PHI for more than twenty years. But in 2008 he began experiencing severe pain at the site of his amputation, which prevented him from safely wearing his prosthetic limb. As a result, he was no longer able to operate the foot controls of a helicopter, and he was forced to retire from flying. At that time, he was earning $75,495 per year. George filed a claim for long-term disability benefits with RSL.

Underinsured Coverage And Pain And Suffering

March 8, 2015 | Mark S. Humphreys

Mansfield lawyers who handle underinsured motorist claims will make claims for medical bills, lost wages, and paid and suffering. So,what about the paid and suffering aspect of a claim – is it compensable? The general rule is Yes. However, a Houston Court of Appeals case styled Calderon v. Home State County Mutual Insurance Company is worth reading with regards to pain and suffering as an element of damages.

After he was involved in a car accident, Cesar Calderon sued Home State to recover under his underinsured motorist policy. A jury awarded Calderon some of the medical expenses that he claimed to have incurred following the accident, but it denied his request for past and future pain and mental anguish. Calderon contested the jury award of zero damages for pain and mental anguish as against the great weight and preponderance of the credible evidence. Finding no error, this court affirmed the jury finding.

Christine Verhardt was driving when took her eyes off the road for four to five seconds, and rear-ended Calderon, who had stopped due to traffic congestion. Immediately after the accident, Calderon was dizzy and felt pain in his shoulder, neck, and legs. About 20 minutes later, he felt pain in his back, and had trouble standing. An ambulance transported him to the emergency room. The EMS report noted lower back pain with no abnormalities, and upper right leg pain. The damage to Calderon’s car cost $3,610.92 to repair.

Hail Claims – Removal To Federal Court

March 7, 2015 | Mark S. Humphreys

Mansfield attorneys handling hail damage claims can tell you that the insurance companies are always trying to have lawsuits in Federal Court rather than State Court. Here is another opinion on that issue from the US Court, Northern District, Dallas Division. The style of this case is Ocotillo Real Estate Investments I, LLC, v. Lexington Insurance Company, et al.

This action arises from an insurance claim Ocotillo submitted to Tudor Insurance and Lexington Insurance Company regarding property loss from hail. Ocotillo filed suit against Defendants in state court. Ocotillo alleged claims for violations of the Texas Insurance Code, violations of the Texas Deceptive Trade Practices Act, breach of contract, and negligence. The carriers removed the state court action to Federal Court. Ocotillo moved to remand.

A defendant may remove a state court action to federal court if he establishes the federal court’s original jurisdiction over the action. It is the defendant’s burden to establish the existence of federal jurisdiction. Thus, to remove a case, a defendant must show that the action either arises under federal law or satisfies the requirements of diversity under 28 U.S.C. § 1441(b). Because removal raises significant federalism concerns, the removal statute is strictly construed and any doubt as to the propriety of removal should be resolved in favor of remand. A district court must remand a case if, at any time before final judgment, it appears that the court lacks subject matter jurisdiction. 28 U.S.C. § 1447(c).

Hail Claim – Declaratory Judgment

March 5, 2015 | Mark S. Humphreys

Burleson lawyers handling hail damage claims will know that insurance companies try to get cases into Federal Court. The US District Court, Northern District of Texas, Dallas Division issued an opinion in a case, illustrative of this tactic. The style of the case is, Tudor Insurance Company, et al. v. Ocotillo Real Estate Investments I, LLC.

This is declaratory judgment action in which Tudor and Lexington Insurance Company seek a declaration that they have no duty to provide coverage to Ocotillo for losses resulting from alleged hail damage to Ocotillo’s property. In its motion to dismiss, Ocotillo argues that because it has filed a state court action that will resolve all issue between the parties, the Court should abstain from considering this case.

Ocotillo filed the State Court Action on August 1, 2014. In the State Court Action, Ocotillo alleges claims against Carriers and additional defendants for violations of the Texas Insurance Code, violations of the Texas Deceptive Trade Practices Act, breach of contract, and negligence. Carriers timely removed the State Court Action. By separate order of this date, the Court denied the motion to remand on the grounds that Ocotillo had improperly joined in-state defendants.

Storm Damage Claims

March 3, 2015 | Mark S. Humphreys

Dallas insurance lawyers handling storm damage claims need to dread a recent opinion from the US District Court, Southern Division Texas, Houston Division. The opinion is styled, Nasti v. State Farm Lloyds, et al.

This is an insurance case arising from alleged storm damage to Nasti’s home which State Farm has filed a motion for summary judgment regarding. After the storm, Nasti was approached by Manley of Mac Roofing, who was offering free roof inspections to storm victims in the neighborhood. Both of Nasti’s neighbors on each side already had roofs replaced because of the storm. Nasti reported his claim to State Farm and requested an inspection with Mr. Manley present. State Farm adjuster Stewart Brown inspected Nasti’s roof and reported: “Reviewed 30yr fiberglass shingles for wind and hail damage with Mac’s Roofing present…. I did find damage that would be consistant w/ wind damage to the back left slope…. Inspected interior gameroom /entry and dining room and found water damage to ceilings.” Brown estimated the covered damage to be $3,107.54, less than the deductible of $6,584.00. Nasti requested a reinspection with a different adjuster. State Farm adjuster Dwight Johnson inspected Nasti’s roof and reported: “I inspected the roof with the contractor. My inspection revealed no evidence of storm related damage to the roof system…. The Shingle is a heavier 40 year shingle.” Despite finding no storm damage, Johnson did not alter Brown’s estimate of $3,107.54 damage. Nasti’s expert adjuster Shannon Kimmel inspected Nasti’s roof and reported:

I have visited Mr. Nasti’s home and inspected the damage to his roof. There is no question that Mr. Nasti’s roof was damaged by the severe wind and hail storm that hit The Woodlands, Texas, in June 2012…. I have adjusted thousands of these types of claims for various insurance companies, including State Farm…. In my opinion and based on my extensive experience as a former State Farm adjuster, inspections by Stewart Brown and Dwight Johnson were inadequate and unreasonable…. Photographs in the claim file clearly prove up covered damages resulting from wind and hail…. Mr. Brown’s and Mr. Johnson’s inspections and Mr. Brown’s damage estimate that was essentially rubber- stamped by Mr. Johnson-despite the fact that his findings contradicted Mr. Brown’s estimate-underestimated and/ or ignored obvious covered damaged [sic] that a reasonable adjuster, acting in good faith, would not have ignored.

ERISA Claims

March 1, 2015 | Mark S. Humphreys

Fort Worth insurance attorneys handling ERISA claims need to read this case from the US 5th Circuit Court of Appeals. It is styled, Killen v. Reliance Standard Life Insurance Company.

Killen worked for Covenant from 2002 until March 2009, when she claimed that neck, shoulder and upper back pain made it too difficult for her to continue. Reliance Standard administered Covenant’s long-term disability plan which is governed by ERISA.

Killen collected benefits from June 2009 to June 2011. During this time, Killen separately qualified for Social Security disability benefits. To continue receiving benefits under the Plan after two years, a claimant must be “totally disabled” such that she is incapable of performing the material duties of any occupation for which she is qualified by way of education, training, or experience. Under the contract, an insured is totally disabled if “due to an Injury or Sickness he or she is capable of only performing the material duties on a part-time basis or part of the material duties on a Full-time basis.”