Dallas Fort Worth Insurance Lawyer Blog

Pre-Suit Notice Letter

April 30, 2022 | Mark S. Humphreys

Here is a case where the insurance company complains that it did not receive proper pre-suit notice of the claim. The Court disagreed with the insurance company.

This is a 2022 opinion from the Northern District of Texas, Dallas Division. It is styled, Douglas D. Dailey, et al., vs. Amguard Insurance Company.

Dailey sued Amguard in State Court and Amguard timely and properly removed the case to Federal Court then moved under the Texas Insurance Code, Section 542A.005(a)(1), to abate the case until the 60th day after Dailey give notice that complies with Section 542A.003 of the Texas Insurance Code.

Bad Faith Insurance

April 25, 2022 | Mark S. Humphreys

Bad Faith Insurance Lawyers need to read this 2022 opinion from the Northern District of Texas, Dallas Division. The style of the case is, Vernon Humphries and Rebecca Humphries v. State Farm Lloyds.

The Humphries sued State Farm alleging State Farm failed to pay the full amount of their claim. After litigating some of the case, State Farm filed a motion for summary judgment regarding Humphries’ bad faith claims.

We will not state the detailed facts of this case. To get the facts of this particular case, a reading of the opinion is necessary.

Insurance Claim Denial And Attorney Fees

April 23, 2022 | Mark S. Humphreys

An often asked question by insureds having a claim against their insurance company is, “Can I recover my attorney fees?” There is not a simple straight forward answer to this question. Many variables come into play. “Yes” is a simple answer but does not get into the variables.

A 2022, opinion from the Northern District of Texas, Dallas Division, discusses this issue as it relates to claims under Texas Insurance Code, Section 542A.003. The style of the opinion is, Betty Rahe v. Meridian Security Insurance Company D/B/A State Automobile Mutual Insurance Company and Larysa Santiago.

Plaintiff sued Defendant on a claim arising from wind and hail damage to her property.

Insurance Lawsuits Can Be A Lot Work For The Insured

April 18, 2022 | Mark S. Humphreys

There is lots of information available about actions to be taken before a lawsuit is filed. There is also a lot of information available about the potential wrongs of an insurance company, it’s agents and adjusters. What is rarely discussed is the work an insured has to do in a lawsuit. When we say”insured” we are speaking of the person, not the person’s lawyer.

This issue can be seen in a 2022 opinion from the Austin Court of Appeals. The style of the opinion is Michael V. Wright and Phyllis F. Wright v. State Farm Lloyds.

In this case, the Wrights sued State Farm for breach of contract and various violations of the Texas Insurance Code. The lawsuit arose out of the way the Wrights were treated after they made a claim for benefits after a fire loss.

Disability Claims – Full Time Employee

April 16, 2022 | Mark S. Humphreys

Here is a case wherein one of the issues was whether or not an employee was eligible for Long Term Disability (LTD) based on the definition in the policy of “full time” employee.

This is a 2022, case is from the 5th Circuit Court of Appeals. It is an appeal from the Northern District of Texas. The opinion in the case is styled, James W. Newsom v. Reliance Standard Life Insurance Company.

Newsome had a policy that, among other things, provided short term disability (STD) benefits and LTD benefits. The plan is governed by the Employee Retirement Income Security Act of 1974 (ERISA).

Claims Refusal And Notice

April 11, 2022 | Mark S. Humphreys

Insurance claims attorneys know that the insurance statutes require that a notice letter be sent to an insurance company before filing suit. The notice letter is to be sent 60 days before filing the lawsuit. The purpose is to allow a settlement or resolution of the case before either side incurs legal costs and fees.

Failure to provide the notice letter can result in not being able to make a claim for attorney fees among other claims. This notice letter requirement is the subject of a 2020, opinion from the Northern District of Texas, Dallas Division. The opinion is styled, Paradise Fruits And Vegetables, L.P. v. National Fire & Marine Mutual Insurance, et al.

The case is an insurance despite between Paradise and two of its previous property insurers. First, Paradise seeks payment from a company referred to as “National Fire” for its refusal to cover damage to Paradise sustained in two storms in 2019. Second, Paradise asserts its sustained storm damage in 2020 while insured by its new insurer, State Auto. State Auto denied the claim made related to the damage in the 2020 storm.

Hail Damage Claims – Allocation

April 9, 2022 | Mark S. Humphreys

Hail damage claims, like a lots of other types of claims, have their own nuances that an insurance attorney needs to be prepared to address.

Here is a 2022, opinion from the Northern District of Texas, Fort Worth Division, that addresses a hail damage claim and the assertion that that the insurer made, that at least part of the hail damage, while real, occurred at a time when the policy was not in effect. The style of the case is, Leo Parrish, et al. v. State Auto Insurance Company.

Parish had a policy with State Auto that covered the period November 2, 2019, to November 2, 2020. The policy has a hail damage deductible of $5,921. In March 2020, Parrish noticed neighbors receiving new roofs and subsequently had a neighbors roofer inspect his roof. Parrish was told that his roof was also damaged and then Parrish made a claim against State Auto.

Accidental Death Insurance Claim Denied

April 4, 2022 | Mark S. Humphreys

Accidental Death Insurance claim denials are all too common. This type of insurance is usually very inexpensive. This is for a couple of reasons. One is the vast majority of people die for reasons unrelated to an accident. The other is the policies have exclusionary language in them excluding coverage for deaths that most would consider to be accidental but they are not covered because of the exclusionary language. A common example is an exclusion for an accidental death involving drugs or alcohol.

Here is a case that does not involve drugs or alcohol. Its exclusionary language is different. This is a 2022 opinion from the Eastern District of Texas, Sherman Division. It is styled, Shemily Ortiz v. Reliastar Life Insurance Company.

The deceased, William Ortiz, had an accidental death policy with Reliastar. Upon his death, Shemily made a claim for benefits that was denied by Reliastar based on their contention that Williams death was not covered under the language stating there is no coverage for death “directly or indirectly caused by … Physical or mental illness.”

Claims Denial Attorney – Life Insurance – Divorce

April 2, 2022 | Mark S. Humphreys

Life Insurance claims and Divorce. Shall the two never intertwine.

Here is a 2022, opinion from the Northern District of Texas, Dallas Division, that will drive a life insurance attorney crazy. The opinion is styled, Amy Cannon v. Mae Katheryn Bryant.

This case is a life insurance case. The insured had a life insurance policy with State Farm. When the policy originated, the insured was married to Ms. Cannon and named her as the beneficiary. A year before the insured died, he and Ms. Cannon divorced. After the death of the insured, Ms. Bryant asserts that she is entitled to the Policy proceeds as the successor beneficiary under the Policy and as the mother and heir of her son because the Insured’s and Ms. Cannon’s January 22, 2016 divorce decree did not designate Ms. Cannon as a beneficiary under the Policy, and the Insured did not redesignate Ms. Cannon as his beneficiary under the Policy after their divorce as required by Texas law and section 9.301 of the Texas Family Code.

Insurance Penalty For Late Payment Of Claim

March 28, 2022 | Mark S. Humphreys

The Texas Insurance Code provides for penalties to insurance companies who pay a claim late. This is illustrated in a 2022, opinion from Texarkana Court of Appeals. The opinion is styled, State Farm Mutual Automobile Ins. Co. & State Farm County Mutual Ins. Co. Of Texas v. Greg Rumbaugh.

Greg Raumbaugh sued State Farm after State Farm failed to pay personal injury protection (PIP) benefits “not later than the 30th day after the date the insurer received satisfactory proof of a claim,” as required by Texas Insurance Code, Section 1952.156. Cross motion for summary judgement were filed and the trial court ruled in favor of Rumbaugh. This appeal followed. The sole question raised in this appeal is whether the trial court erred by resolving cross–motions for summary judgment in Rumbaugh’s favor, thereby determining that he was entitled to statutory penalties under Section 1952.157 of the Texas Insurance Code even though PIP benefits were paid before the lawsuit was filed.

PIP coverage is a form of no–fault insurance. PIP’s limitation to medical expenses and lost wages, along with its collateral-source and no-fault features, are designed to simplify and hasten claim resolution and payment. Because Section 1952.157 provides for “a penalty of 12 percent,” among other things, if an insurer fails to pay PIP benefits “when due,” the trial court properly ruled that Rumbaugh was entitled to statutory penalties when PIP benefits were paid past Section 1952.156’s statutory deadline, even though they were paid before the lawsuit was filed.