Dallas Fort Worth Insurance Lawyer Blog

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.

Suing The Insurance Company Adjuster In A Proper Manner

March 26, 2022 | Mark S. Humphreys

Bad Faith Insurance Lawyers learn early on that the preferred places to litigate claims against insurance companies are State and County Courts, not Federal Court. Here is a 2022, opinion from the Northern District of Texas, Dallas Division, wherein the insureds prevailed in their attempt to litigate in State Court. The opinion is styled, Searcy Ferguson and Hanna Ferguson v. Cincinnati Insurance Company and John W. Schuster.

This is a claim for residential property insurance coverage after a hail storm. Plaintiffs suffered hail damage and filed a claim with their insurer, Cincinnati. Cincinnati assigned Schuster to adjust the claim.

Schuster issued a report denying Plaintiffs claim for benefits based on an engineering from EDT, an engineering firm. Plaintiffs hired their on engineer to provide Schuster and Schuster turned the report over to EDT. EDT determined there was some damage but that the damage was minimal compared to Plaintiffs report.

Attorneys For Roofing/Hail Claims

March 21, 2022 | Mark S. Humphreys

The Amarillo Court of Appeals issued an opinion on February 2, 2022, that is important as it relates to cases involving hail and wind damages to roofs of structures. This opinion has a bit less to do with insurance and more to do with the roofing contractor business as it is regulated by the Texas Department of Insurance. The opinion is styled, Stonewater Roofing, Ltd. Co. v. Texas Department of Insurance et al.

Here is some background.

In 2005, the Texas Legislature enacted provisions under the insurance code
regulating “public insurance adjusting.” Public insurance adjusters are frequently hired by an insured to help resolve and settle insurance claims. The enacted provisions, Texas Insurance Code, Sections 4102.051, provide that a public insurance adjuster must be licensed in order to adjust insurance claims on an insured’s behalf. Under these provisions, pursuant to Code Section, 4102.163, any person or entity defined as a contractor is prohibited from adjusting insurance claims for properties at which the contractor is, or will be, providing contracting services. Likewise, licensed public insurance adjusters are prohibited from providing any contracting services on property at which they are, or will be, providing public insurance adjusting services. In other words, acting as a public insurance adjuster and a contractor on the same claim is a statutorily
defined conflict of interest according to Section 4102.158(a)(1).

Negligence And Insurance Agents

March 19, 2022 | Mark S. Humphreys

Insurance companies and insurance agents have no general duty to obtain coverage nor to make sure the coverage is adequate. On the other hand, courts have found insurance companies liable for affirmative misrepresentations, and an insurance agent who undertakes to procure insurance for another owes a duty to a client to use reasonable diligence in attempting to place the requested insurance and to inform the client promptly if unable to do so. This is discussed in numerous cases, including, the 1992, Texas Supreme Court opinion, May v. United Services Ass’n of America. Also, the 1999, 1st Court of Appeals opinion, Frazier v. Texas Farm Bureau Mutual Ins. Co.

An agent has a duty to keep the customer informed about the insurance policy’s expiration date when the agent receives information pertaining to expiration date that is intended for the customer. This was discussed in the 1985, Texas Supreme Court opinion, Horn v. Hedgecoke Ins. Agency.

Additionally, the court in May suggested an agent could be found negligent if an explicit agreement or course of conduct showed the agent undertook to determine the customer’s insurance needs and counseled the customer as to how they could be met.

Negligence And Claims Denial

March 14, 2022 | Mark S. Humphreys

Insurance claims denial and negligence related to the insurance policy and claims are questions for insurers and the insured. Here is a few things to keep in mind.

Negligence, in the insurance context as in others, consists of three elements:

(1) a legal duty owed by one person to another;

ERISA And Life Insurance

March 12, 2022 | Mark S. Humphreys

Here is an opinion from the United States 5th Circuit dealing with ERISA. This particular case discusses the Employee Retirement Income Security Act of 1974 (ERISA). While the case is not a life insurance case, the ruling would also apply to life insurance situations. The style of the case is Ramirez v. Inter-Continental Hotels.

Ramirez had filed suit in State Court, asserting various contract, tort, and statutory causes of action against his former employer and its insurance carrier, Travelers. The Defendants removed the case to federal court, asserting ERISA.

Ramirez concedes, this lawsuit is essentially one to recover benefits from an ERISA plan. As such, it comes within the scope of ERISA’s civil enforcement provision, Section 502(a)(1)(B), 29 U.S.C. Section 1132(a)(1)(B), which allows a civil action to be brought (1) by a participant or beneficiary (B) to recover benefits due to him under the terms of the plan, or to clarify his rights to future benefits under the terms of the plan.

Read The Policy!

March 7, 2022 | Mark S. Humphreys

Reading the life insurance policy all the way through is vital to understanding the coverage therein. This is illustrated in a 2022 opinion from the U.S. 5th Circuit. The style of the opinion is Landmark American Insurance Company v. SCE Memorial Place II, L.L.C.

This case is about whether an insurance policy covered flood-related damages sustained by a building during Hurricane Harvey. The district court decided in favor of SEC on competing motions for summary judgment. This appeal followed and this appeals court ruled in favor of Landmark.

The “Insuring Clause” of the Landmark policy outlines the type of damage for which it would cover the deductible of the primary insurance policy. Specifically, Landmark agreed to indemnify the insured for damage “caused by any of such perils as are set forth in item 3 of the schedule, and which are also covered by . . . the ‘Primary Insurer(s).’” It is an “All Risks” policy.

Who Is Entitled To The Life Insurance Proceeds

March 5, 2022 | Mark S. Humphreys

It is often times very difficult to answer the titled question. When there us uncertainty as to who is entitled to life insurance proceeds there is a process by which the life insurance company can “interplead” the life insurance proceeds into the registry of the Court. These are situation where the life insurance company knows they owe the life insurance money because the insured has died. What they sometimes don’t know is, who is entitled to the money. This interpleader process allows those who believe they may have an interest in the proceeds to litigate their respective interests.

This issue was presented in a 2022 opinion from the Northern District of Texas, Dallas Division. The style of the case is Sun Life Insurance Company of Canada v. Elizabeth McKinney, Tisha Diante, and Teresa Morris.

Here, Sun Life knew they owed the life insurance proceeds to someone, but was not sure who. After filing a lawsuits to interplead the money, the life insurance company must serve the potential beneficiaries with legal papers so that they may come to court and litigate between themselves as to who is entitled to the proceeds. In this case, Sun Life was having difficulty locating McKinney to have her served with the legal papers.