Dallas Fort Worth Insurance Lawyer Blog

Proving A Delay In Paying A Claim

June 3, 2014 | Mark S. Humphreys

Dallas insurance lawyers will tell you that when involved in a lawsuit, it is necessary to prove the case. In this regard, a recent opinion from the United States District Court for the Northern District of Texas, Dallas Division, needs to be read and understood. The style of the case is, Robert Bell and Cheryl Bell v. State Farm Lloyds. Here is the relevant information from the opinion.

Plaintiffs Robert and Cheryl Bell (“Plaintiffs”) purchased from Defendant an insurance policy covering property damage to Plaintiffs’ property. On June 22, 2012, after a hail and wind storm, Plaintiffs made a claim to Defendant for damage resulting from the storm. On June 27, 2012, Defendant acknowledged receipt of the claim and commenced an investigation. On July 24, 2012, State Farm adjuster Donald Kimberlin inspected Plaintiffs’ property with Mr. Bell and Plaintiffs’ contractor, Roland Vitullo. Kimberlin determined that Plaintiffs’ roof had been damaged and agreed that replacement was required. On August 21, 2012, Vitullo sent a copy of his estimate to Defendant. Defendant requested additional information.

On September 16, 2012, Defendant received an estimate from a public adjuster hired by Plaintiffs, Steve Whitehood of H&S Claim Recovery, that was lower than both Vitullo’s estimate and Defendant’s adjuster’s estimate. On September 21, 2012, Plaintiffs requested Defendant make a second inspection of their property. On October 6, 2012, Defendant sent another adjuster, Brandon White, who conducted an inspection with public adjuster Elvis Spoon. White estimated $32,907.45 in damages, which exceeded Kimberlin’s estimate. White’s estimate was sent to Plaintiffs. On December 13, 2012, after receiving a purported “final invoice,” for $32,879.33 from the construction firm that did the repair work, State Farm sent a payment for $32,907.45 less Plaintiffs’ deductible.

Insurance And The Workplace

June 1, 2014 | Mark S. Humphreys

Aledo insurance attorneys are already aware of statistics reported recently by the Texas Tribune. An April 22, 2014, article tells us a half million employees in Texas are without workplace insurance. Here is what the article says.

At least a half-million Texas workers have no occupational insurance coverage, either from a state-approved workers’ compensation plan or from a private equivalent, state insurance officials said Tuesday.

The figures, provided by the Texas Department of Insurance, provoked impassioned debate at a legislative hearing about policy solutions in the only state in the country where the decision to carry workers’ compensation insurance or a private equivalent is voluntary for companies of any size.

Pre-Existing Condition And Health Insurance

May 31, 2014 | Mark S. Humphreys

Fort Worth insurance attorneys will get calls from people who have been denied benefits by their insurance company because the insurance company claims the person has a pre-existing condition. KSAT recently posted an article about this practice. Here is what the article tells us.

The KSAT 12 Defenders uncovered a little-known fact that insurance companies consider a person’s weight when awarding settlement monies for accident claims.

Maria Vasquez was in a wreck caused by the other driver in May 2013 and found out State Farm is considering her weight while deciding how much to award her in damages.

Disability Claim And ERISA

May 29, 2014 | Mark S. Humphreys

Attorneys who do not handle ERISA claims often times make the mistake that there is not much difference between an ERISA insurance claim and a regular insurance claim. This is a mistake. The United States Court of Appeals for the Fifth Circuit issued an opinion on April 18, 2014, that discusses how courts looks at ERISA claims. The case is styled Cynthia Spenrath v. The Guardian Life Insurance Company of America. Here is some of the relevant information related to the case. However, for anybody dealing with an ERISA case, it is necessary to read the entire case and other cases dealing with ERISA law and issues.

Spenrath worked at Protect Controls, Inc. as an order entry manager. In 2005, Spenrath started having seizure-like episodes in which she would be non-responsive for about five minutes. She asserted that the episodes were accompanied by swishing in her ears, limb weakness, and an inability to move or speak. Spenrath’s primary care physician, Dr. Michael DiTeresa, referred her to two neurologists, Dr. Balbir Singh and Dr. J. William Lindsey. Neither neurologist made a definitive diagnosis, but they mentioned the possibility of multiple sclerosis based on abnormal MRI results and recommended additional testing. Spenrath did not undergo additional testing. Though she continued to take anticonvulsant medication, Spenrath did not visit the neurologists after 2005. In 2008, Spenrath experienced difficulty doing her job, with a diminished ability to focus and type information into the computer. When she failed to complete several assignments, she was given a negative performance review and a salary reduction. Shortly after the negative review, she ceased working on February 22, 2008. On May 7, Spenrath submitted a claim for long-term disability benefits under the company’s ERISA Plan, and claimed commencement of disability as of February 22, 2008.

The Plan’s administrator, Guardian Life Insurance Company (“Guardian”) began a review of the long-term disability claim. Under the Plan, Guardian has “discretionary authority to determine eligibility for benefits and to construe the terms of the [Plan] with respect to claims.” In order to receive long-term disability payments, the plan sets forth several requirements:

Forwarding Lawsuit Papers To The Insurance Company

May 27, 2014 | Mark S. Humphreys

Arlington insurance lawyers should advise their clients to forward any lawsuit papers they receive to their insurance company immediately upon receipt. A 1954, Amarillo Court of Appeals case illustrates this. The style of the case is, Klein v. Century Lloyds. Here is some of the relevant information from that case.

Howard Klein and daughter, Mary Genevieve Klein, were injured in an automobile collision with Charles Gunter, a 21-year old man employed as a rough-neck in the oil fields. Century Lloyds, is the insurer of Charles Gunter. The Kleins after obtaining a judgment against Charles Gunter in amount $10,799.51, sought a recovery of the same against Century as his insurer. The trial court disregarded the findings of the jury as detailed hereinafter and entered judgment for Century.

The record reveals that Gunter failed to notify Century, his insurer, in writing of the occurrence of the accident until approximately 31 days had elapsed thereafter. It is an undisputed fact and stipulated by the parties to this appeal that no copy of the citation served upon Gunter in Cause No. 1012 was ever forwarded to Century.

Injuries To An Insured

May 25, 2014 | Mark S. Humphreys

Benbrook attorneys handling insurance claims need to know about this case dealing with a home owners policy. It is a 2000, case from the Austin Court of Appeals styled Easter v. Providence Lloyds Ins. Co. Here is some relevant information.

Bonnie Easter was having a difficult time dealing with the emotional and behavioral problems her daughter M.D.E. was exhibiting, and in February 1995 she placed M.D.E. in the care of Joseph and Grace Bossette, licensed foster parents. M.D.E. was nine years old at the time. Easter intended the placement to be for no more than six months.

Soon after M.D.E.’s arrival in the Bossettes’ home, Joseph Bossette began sexually molesting her. After approximately five months, M.D.E. reported the abuse to Child Protective Services. She was removed from the Bossettes’ home and returned to her mother. In February 1996, Easter brought suit on M.D.E.’s behalf against Joseph Bossette for an intentional tort for committing the abuse, and against Grace Bossette for negligence for failing to stop or report the molestation. A default judgment was rendered against the Bossettes for $300,000. Easter then brought the present action against Providence Lloyds to enforce the judgment against the Bossettes’ homeowners’ insurance carrier.

Intentional Acts Exclusion – Sexual Molestation

May 24, 2014 | Mark S. Humphreys

Attorneys in Weatherford who handle insurance claims need to be aware of the exclusions that apply to home owners policy. One of those exclusions is an exclusion for intentional acts. The courts have interpreted sexual molestation to be an intentional act as a matter of law. The 1996, Houston Court of Appeals case, J.E.M. v. Fidelity & Casualty Company is the case to know about. Here is some of the relevant information.

Fidelity issued a standard homeowner’s policy to the home owners. The policy included coverage for personal liability, but excluded coverage for bodily injury or property damage caused intentionally by or at the direction of the insured or to sickness or disease transmitted through sexual contact.

J.E.M. and S.J.B. sued the home owners. The petition alleges that James B. sexually abused his stepdaughter, J.E.M., in 1977, 1978, and 1979. The petition also alleges that James B. sexually abused his step-grandson, J.B., Jr., during December 1990, and that the sexual abuse was “either intentional torts or the result of uncontrolled sexual urges brought about by an underlying psychosexual disorder.” The petition states that James B. “was negligent in failing to inform other responsible adults of his conduct, in failing to seek professional held, and in continuing to allow himself to be alone with his stepdaughter and step-grandson.”

Intentional Acts Exclusion – Shooting

May 22, 2014 | Mark S. Humphreys

Insurance lawyers in the Dallas and Fort Worth area need to have an understanding as to intentional acts that are not covered under an insurance policy. Many times the only way to actually recover money for a clients injuries such as medical bills, lost wages, pain, etc. is to have an insurance policy to recover under. Being aware of this Houston Court of Appeals [14th Dist.] case is important. It is a 1992 case styled, Bonner v. United Services Automobile Association. Here is some relevant information.

This is an appeal from a take nothing judgment in favor of United Services Automobile Association (USAA). The issue involved is whether a Texas Homeowner’s Insurance Policy issued by USAA to Gloria Padgett provided liability coverage to her son, Roger Padgett, for damages for the death of Roger’s girlfriend, Linda Tarrant, or whether there was no coverage for such death because of specific exclusions contained in the policy.

The insurance policy involved in this case is a Texas Standard Homeowners Policy issued by USAA to Gloria C. Padgett, mother of Roger Padgett. The premises covered by the policy is defined as a dwelling located at Route 3, Box 5388, Canyon Lake, Comal County, Texas. The Liability Section of the policy provides under coverage D that USAA will pay on behalf of the Insured all sums which the Insured shall become legally obligated to pay as damages because of bodily injury. That same Liability Section of the policy also contains the following exclusion:

Intentional Acts And Intoxication

May 20, 2014 | Mark S. Humphreys

Palo Pinto County insurance lawyers will need to be aware of this case from the Dallas Court of Appeals. It is a 1997, case styled, Wessinger v. Fire Insurance Exchange. Here is some of the relevant information.

Morrison initially sued Wessinger in a Dallas County district court, alleging that Wessinger negligently caused him injury when, in a drunken fit, Wessinger punched Morrison repeatedly in the head. A jury found Wessinger liable and awarded Morrison $127,187 in damages.

Fire Insurance Exchange, Wessinger’s homeowner’s insurance company, then filed this declaratory judgment action challenging coverage for the incident made the basis of Morrison’s original lawsuit.

Life Insurance – Misrepresentation As To Net Worth

May 18, 2014 | Mark S. Humphreys

A trial result regarding the above issue is something a Dallas Fort Worth insurance lawyer wants to know.

An opinion from the Houston Court of Appeals (14th Dist.) deals with this issue. The style of the case Vasquez v. Reliastar Life Insurance Co. Here is the relevant information.

In March 2008, Russell Mackert and Beatrice Ramon submitted an application with ReliaStar for insurance on the life of Ramon, seeking an initial term of ten years for an amount of $2.5 million. The application named the Trust as the proposed beneficiary and owner of the policy and Mackert as trustee. The asserted purpose of the Trust was “Estate Conservation.” Mackert and Ramon also represented in the application that Ramon’s total net worth was $2.4 million, her annual interest and other income was $150,000, and she had never declared bankruptcy. Mackert and Ramon signed the application acknowledging that ReliaStar may seek to rescind coverage due to material misrepresentations.