Dallas Fort Worth Insurance Lawyer Blog

Subrogation – What Is It?

March 25, 2010 | Mark S. Humphreys

Someone in Grand Prairie has their insurance company pay a benefit for them. Or maybe the person is in Arlington, Dallas, Fort Worth, Mansfield, or out in Weatherford, Texas. When a claim is paid by a person’s own insurance company, and the claim resulted from the fault of another person or company, then the person’s own insurance company has a subrogation right. Well, what does that mean to you?

One web-site defines subrogation as the substitution of one person in the place of another with reference to a lawful claim or right. Subrogation commonly occurs in insurance matters, when an insurance company which pays its insured client for injuries and losses then sues the party which the injured person contends caused the damages.

There are three types of subrogation: equitable, contractual, and statutory.

Prompt Payment Of Claims Act

March 24, 2010 | Mark S. Humphreys

A Grand Prairie resident makes a claim to his insurance company for benefits. This could be a resident of Arlington, Dallas, Fort Worth, Weatherford, or any other city in Texas.

A question often comes up that goes like this, “How long does the insurance company have before they have to pay me?” The answer is “It depends.” Sounds lawyerly, right. Well it does depend. It depends on a number of factors, including the type of claim, the circumstances surrounding the claim, the type of insurance and the type of insurance company. However, guidelines to go by, are laid out in the Texas Insurance Code, Section 542.051 thru 542.061.

This area of the Texas Insurance Code is know as the “Prompt Payment of Claims statute”. It imposes certain deadlines for an insurance company to acknowledge, investigate, and accept or reject a claim. In situations where the insurance company violates the statute, they are punished by being liable for attorney’s fees and an additional 18% per annum penalty on the amount of the claim. These penalties are set out in Section 542.060.

Health Insurer Loses In California

March 23, 2010 | Mark S. Humphreys

It would be interesting to see if what happened out west, would happen here in Texas, with a resident of Grand Prairie, Dallas, Arlington, Fort Worth, Mansfield, or Weatherford. It probably depends on your insurer.

The Los Angeles Times ran an article on March 15, 2010, about a health insurer in California. The title of the article is, “Anthem Blue Cross Should Reimburse California Man For Transplant, Jury Says”.

This article tells about a Los Angeles jury finding that Anthem Blue Cross (Anthem) should cover the cost of an out-of-state liver transplant that a California man paid for after Anthem Blue Cross balked at paying. The liver transplant cost $206,000.

Texas Unfair Insurance Practices

March 23, 2010 | Mark S. Humphreys

Regardless of what kind of insurance you have purchased or where in Texas the purchase occurred, the same law applies. So residents of Grand Prairie, Arlington, Mansfield, Dallas, Fort Worth, or Weatherford, all get treated the same.

This will be the first part of a several part writing on “unfair insurance practices”.

Chapter 541 if the Texas Insurance Code, is where the definition and prohibition for unfair and deceptive insurance practices is found. These sections of the Insurance Code are Sections 541.001 thru 541.061, Section 541.151 thru 541.162, and 541.453.

Texas Health Insurance Cancellation

March 22, 2010 | Mark S. Humphreys

Everybody in the Dallas, Fort Worth area, including Grand Prairie, Arlington, Mansfield, and out in Weatherford have some form of health insurance. The majority of this insurance is private plans.

The Texas Supreme Court decided a case in 1994 that still has relevance today. The style of the case is, Union Bankers Insurance Company v. Thomas D. Shelton and Ann Shelton. The issue in the case dealt with misrepresentation in the insurance policy application.

Here are the facts. In April 1988, Mr. Shelton applied to Union Bankers Insurance Company (Union) for a health insurance policy. Mr. Stone completed the application with the agent’s assistance. In response to certain medical history questions, Mr. Shelton indicated that he had never been treated for, and had no indications of, any disorders of the skeletal or muscular systems. Union subsequently issued a policy. Seven months after the policy was issued, Mr. Shelton underwent a total hip replacement to correct necrosis of his left hip joint. He then filed a claim for benefits. Union denied the claim, saying that the necrosis was an undisclosed pre-existing condition.

Commercial Insurance Policy and Interpretation

March 21, 2010 | Mark S. Humphreys

How an insurance policy is interpreted by Texas Courts is important. This is true whether you live in Grand Prairie, Arlington, Weatherford, Fort Worth, Mansfield, Dallas, or anywhere else in Texas.

A commercial insurance policy was recently interpreted by the United States District Court, Southern District of Texas, Houston Division. The style of this case is National Casualty Insurance Company v. Orion Transport, Inc. and Silvia Brune, Individually and as Representative of the Estate of James Brune, Deceased and Cody Brune and Cory Brune. The case was decided on February 22, 2010.

The undisputed facts in this case are that on February 4, 2009, Orion Transport, Inc. (Orion) hired welder, James Brune, to perform maintenance on its 1977 Heil Tanker Trailer. While Brune was performing the requested maintenance the trailer exploded injuring Brune, who later died of his injuries. The Brune estate and his survivors sued Orion and ETOCO. L.P., and ETOCO Management, LLC. in State District Court. National Casualty Insurance Company (National) brought this instant case in Federal District Court asking the court to rule that National had no duty or obligation under its policy of insurance with Orion to defend Orion or to pay any claims against Orion.

Insurance Company Gets Caught Cheating

March 20, 2010 | Mark S. Humphreys

The insurance company in this headline does business in all of Texas, including Weatherford, Grand Prairie, Arlington, Mansfield, Fort Worth, and Dallas. This story originates out of Ohio.

The Columbus Dispatch published an article on March 10, 2010 titled, “Nationwide Lawsuit Settled For $6 Million”. The lawsuit was a case filed in the Franklin County Common Pleas Court in 2005. In the lawsuit, it is alleged that Nationwide collected more than the maximum annual premiums outlined in their term-life insurance policies. This atleast is what court documents say. The allegations include accusing Nationwide of fraud and violating State of Ohio consumer protection laws. More than likely, these Ohio consumer protection laws are similar in many ways to the Texas consumer laws found in the Texas Business & Commerce Code and known as the Texas Deceptive Trade Practices Act.

A Nationwide spokeswoman declined commenting on the case and the settlement. Further, Nationwide, in agreeing to the settlement, is not admitting to any wrongdoing. Nationwide claims to be entering into the settlement agreement to avoid any additional expense, inconveniences, burdens, and distractions associated with the lawsuit.

Coverage Or No Coverage?

March 19, 2010 | Mark S. Humphreys

The first thing a person wants to know who has insurance is; Does my policy protect me? This is true no matter if you are living in Grand Prairie, Fort Worth, Arlington, Mansfield, Dallas, or out in Weatherford, Texas.

The United States District Court, Southern District, Corpus Christi Division, had that decision to make in a case styled, National Fire Insurance Company of Hartford, et, al. v. Radiology Associates, LLP, et al., and issued an opinion on March 3, 2010. In this case, a couple sued Radiology Associates, LLP. (Radiology) and one of their employees, Brian K. Riley. Radiology had three insurance companies providing policies for them and Radiology presented the lawsuit to all three companies to provide a legal defense and settle any potential claims.

The facts in the case were that, Mrs. Pecore, a patient of Radiology, was to have a trans-vaginal ultrasound. It was alleged that during this exam, Riley inserted a finger into Mrs. Pecore’s vagina without permission and that Radiology should have informed Mrs. Pecore she had a right to have a chaparone present during the exam and that if a chaparone had been present the “assault” to Mrs. Pecore would not have occurred. There was nothing about the precedure involving the trans-vaginal exam that would have called for Riley to have committed the act he is accused of commiting.

Texas Underinsured Motorist Case

March 18, 2010 | Mark S. Humphreys

Grand Prairie policy holders, Arlington, Fort Worth, Weatherford, or anybody else in Texas who has a policy with underinsured motorist coverage (UIM) should be aware of a recent case decided in Texas.

The case is Mid-Century Insurance Company of Texas v. Synthia McClain. This case was an appeal from the 42nd District Court in Taylor County, Texas. The appeal was heard by the Eleventh Court of Appeals and an opinion was issued on March 11, 2010.

The facts are pretty simple. Synthia was injured in a wreck caused by Becky Morey. Becky had insurance which paid to Synthia the policy limits of $20,100. Synthia, then made a claim against her own insurance company, Mid-Century Insurance Company of Texas (Mid-Century), for UIM benefits. Synthia’s policy with Mid-Century provided UIM benefits of $20,000. Mid-Century had already paid the personal injury payments limits of $2,500 and Mid-Century made an offer of $1,500 additional money. Synthia then filed this lawsuit to recover the full measure of her damages.

Texas Homeowners Policy’s

March 17, 2010 | Mark S. Humphreys

Homeowners in Grand Prairie, Arlington, Weatherford, Fort Worth, Mansfield, Dallas, and the rest of the State of Texas, need to have a basis understanding of homeowners policies when it comes to buying homeowners insurance. There a several different types of homeowners policies available for the Texas consumer.

Because of “form deregulation”, insurance companies now may offer approved alternative policies. There are differences in coverage, which may be significant. These different forms have been the source of much confusion for consumers looking to purchase a homeowners policy. A tool for comparing coverage is provided by the Office of Public Insurance Counsel. This a good resource for consumers to look and compare the various policies being offered by insurance companies. It is a good way to make sure apples are being compared with apples and not with oranges.

The most common policy is the Texas Homeowners Policy — Form B (HOB). This article is briefly discussing only the HOB.