Insurance Claim Denial due to alleged misrepresentations is common in insurance disputes.  It is seen most often in life insurance claims.  Less common is in homeowners claims.  Here is a homeowner’s claim.  It is a 2024 opinion from the Western District of Texas, San Antonio Division.  It opinion is styled, Sanjay Malhotra, Monesha Gupta v. State Farm Lloyds.

This opinion is the result of State Farm filing a Partial Summary Judgment Motion.  The claim arose from alleged damages caused by an April 28, 2021, hailstorm.  The Plaintiffs sued State Farm alleging the claim  had not been properly handled.

Throughout its Motion, State Farm contends the undisputed evidence shows this case in-volves an honest dispute as to the extent of damage to Plaintiffs’ property caused by the subject hailstorm and the cost of the work necessary to rectify this damage, and therefore, the causes of action for bad faith and unfair settlement practice must fail.  As support for its argument that summary judgment should be granted for Plaintiffs’ common law bad faith claims, State Farm states the following: “The inspection included both the exterior and interior of Plaintiffs’ Property.  Multiple inspections were done at the property and during those inspections, State Farm noted damage to some of the roof tiles, soft metals, gazebo and interior water damage and subsequently prepared estimates for the covered damages and issued payments to Plaintiffs after application of their deductible.”

Here is a 1994 opinion regarding whether an estate can be the beneficiary of a life insurance policy.  The opinion is from the Fort Worth Court of Appeals and is styled Street v. Skipper.

Here the Court held the surviving wife’s share of proceeds from community life insurance policy that was gifted to husband’s estate was not unfair to surviving wife because husband had bequeathed to wife other portions of his share of community estate that balanced gift of insurance proceeds and that aptly made up the difference.

Here are some relevant facts and law from the opinion.

Some life insurance policies have language in them regarding divorces.  This was the case in the 1981 opinion from the Eastland Court of Appeals.  The opinion is styled Pilot Life Insurance Co. v. Koch.

This is a declaratory judgment case.  Here are the facts legal conclusion of the Court.

Pilot Life Insurance Company sought a judgment declaring that it had no duty to pay life insurance proceeds to Lawrence A. Koch because of the death of his wife.  Pilot Life had issued a policy of group insurance to Koch’s employer.  The policy afforded life insurance coverage for employees and their eligible dependents. Eligible dependents were defined to include “your husband or wife, unless you were legally separated or divorced.”  Pilot Life alleged that Mr. and Mrs. Koch were legally separated on the date of her death.  Koch filed a counterclaim seeking the policy proceeds of $5,000, 12% penalty and reasonable attorney’s fees.  The jury found that Mr. and Mrs. Koch were separated at the time of her death.  Although that separation was pursuant to a “temporary” court order entered in the pending divorce proceedings between Mr. and Mrs. Koch, the trial court entered judgment for Koch notwithstanding the verdict on the theory that under Texas law there is no status of legal separation of a husband and wife before the marriage is dissolved by a decree of divorce.  Pilot Life Insurance Company appeals. We affirm.

How does a divorce affect the named beneficiary in a divorce decree?  This is answered in a 1987 opinion from the 14th Court of Appeals.  The opinion is styled, Novotny v. Wittner.  The opinion is an appeal from a bench trial.  Here is are the facts and discussion.

Appellant and the decedent were divorced on May 24, 1982.  On June 14, 1982, just twenty-one days after the divorce, and before the formal divorce decree had been signed, Joseph Patrick Novotny died from a gunshot wound inflicted by Appellant.  At the time of his death he had not changed Appellant’s designation as beneficiary on his life insurance policy.  Appellant requested payment of the policy proceeds from the carrier, Massachusetts Indemnity and Life Insurance Company.  The carrier filed a petition for interpleader and paid the funds, totalling over fifty thousand dollars, into the registry of the court and was subsequently discharged from the suit.  The suit was then transferred to the probate court presiding over the decedent’s estate proceedings.  After a trial, the probate court awarded the proceeds of the life insurance policy to decedent’s children, Misty Marie and Robyn Lee Novotny, as his heirs at law.  Appellee, administrator of the estate of Joseph Patrick Novotny, does not object to this award.

Appellant maintains that the trial court erred in awarding the insurance proceeds to the decedent’s heirs and not to her.  She contends the language of the divorce decree was not specific enough to terminate Appellant’s beneficial interest in the insurance policy.

Insurance lawyers handling water damage claims under homeowners policies need to dread this 2024 opinion from the Western District of Texas, San Antonio Division.  It is styled, Ghassan Abulehieh v. State Farm Lloyds.

This is a water damage claim under a homeowners policy wherein the insureds assert a plumbing leak in a master bathroom resulted in water damage and mold growth to adjoining areas of the house.  The facts of the case can be gleamed from reading the facts in the opinion.

Here is the reasoning the Court used to deny State Farm’s motion for summary judgment.

For Insurance Lawyers handling claims caused by “Mother Nature” it is important to understand Texas Insurance Code, Section 542A.  This is a specific section for claims related to hail damage, tornados, hurricane’s, etc.  As it relates to attorney fees on this type of claim the Southern District of Texas, Houston Division, issued an opinion in June 2024, that needs to be read and understood.  The opinion is styled, Carole Baker v. American Economy Insurance Company.

In January 2023, Carole Baker’s home and contents suffered storm damage.  She filed an insurance claim with American, which had issued her homeowner’s policy, to recover her covered losses.  American sent two independent companies to inspect the residence and analyze mitigation and buildback costs.  Following these inspections and the reports on the estimated costs, American paid Baker in accordance with these estimates.

In a series of emails from May to July 2023, Baker contacted American with her own estimates of mitigation and buildback costs based on quotes from a different inspector.  Baker asked American to supplement its preceding payment based on the estimates from her own inspector.  Baker also asked American to reopen her claim for damage to her roof, which had previously been denied.   American sent Baker a revised repair estimate and made an additional payment based on the estimate she submitted.

Life insurance and a subsequent divorce will present problems, one of which was addressed by the United States 5th Circuit Court of Appeals.  This is a June 2024, opinion styled, Transamerica Life Insurance Company v. Holly L. Moore versus Jeffrey H. Simpson.

Texas Family Code, section 9.301 generally operates to strip “the insured’s spouse” of beneficiary interests in insurance policies once a divorce decree renders the policy beneficiary an ex-spouse.  This case turns on whether “the insured’s spouse” includes someone who was named a policy beneficiary before she became the insured’s spouse: Ian Simpson took out a life insurance policy and named his fiancée Holly Moore primary beneficiary and his father Jeffrey Simpson contingent beneficiary.  The couple then married, then divorced, and then Ian died without ever changing the policy beneficiaries.

The district court held that section 9.301 comes into play only if the insured and the beneficiary were married when the insurance policy was purchased.  The court reasoned that because a policy purchased prior to marriage did not name “the insured’s spouse,” a later divorce decree would not divest the beneficiary of insurance proceeds.  But section 9.301’s text indicates that “the insured’s spouse” centers on an individual’s status at the time a divorce decree is rendered, regardless of when a policy was first obtained.  Therefore, the Court reversed the district court’s judgment awarding Ian’s policy proceeds to Holly and rendering judgment in favor of Jeffrey Simpson.

he question presented here is in the title.  If the named beneficiary of a life insurance policy causes the death of the insured, does the beneficiary still get the life insurance proceeds.
The Texas Slayer’s Rule is found in the Texas Insurance Code, Section 1103.151.  It says:
Sec. 1103.151. FORFEITURE. A beneficiary of a life insurance policy or contract forfeits the beneficiary’s interest in the policy or contract if the beneficiary is a principal or an accomplice in wilfully bringing about the death of the insured.

There are situations where the person named as a beneficiary under a life insurance is responsible for the death of the named insured.  It doesn’t seem right that the person who kills an insured should be able to recover the life insurance benefits.  Well, it isn’t fight and there is a law to prevent that from happening.
The Slayer’s Rule is found in the Texas Insurance Code, Section 1103.151.  It says:
Sec. 1103.151. FORFEITURE. A beneficiary of a life insurance policy or contract forfeits the beneficiary’s interest in the policy or contract if the beneficiary is a principal or an accomplice in wilfully bringing about the death of the insured.
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