Dallas Fort Worth Insurance Lawyer Blog

Interpreting An Insurance Policy In Texas

March 5, 2010 | Mark S. Humphreys

When a Court in Texas makes a ruling on an insurance issue in Texas, that ruling has the same effect on Texas residents regardless of where they live in the State. Living in Grand Prairie, Arlington, Dallas, Fort Worth, or out in Weatherford or anywhere else in the State, would all be the same.

What happens if an insurance contract is ambiguous? Ambiguous is when an insurance policy is subject to more than one reasonable interpretation. When an insurance policy is ambiguous the Courts in Texas have ruled that the interpretation of the policy that is most favorable to providing coverage will be adopted, as a matter of law. The reasoning for this is discussed in a line of Texas Supreme Court cases. A few of these cases are: (1) Grain Dealers Mutual Insurance Company v. McKee, decided in 1997, (2) State Farm Fire & Casualty Company v. Vaughan, decided in 1998, (3) Kelly Associates., Ltd. v. Aetna Casualty & Surity Company, decided in 1984.

The above cases say that it is for the Judge of the Court to decide if a reading of the insurance policy is ambiguous. If the policy is found to be subject to more than one interpretation, then the Court “must” rule in favor of coverage being provided under the policy. The intention of the insurance company in drafting the policy does not matter.

Excluded Drivers In Texas

February 26, 2010 | Mark S. Humphreys

There are lots of people in the Fort Worth, Dallas, Grand Prairie, Arlington, and Weatherford, areas of Texas who have problems getting affordable insurance. The reasons can be many, examples are, they are young, too many tickets, too many wrecks, a DWI conviction, license suspension issues, and medical conditions.

What happens if you have insurance on your car but when you bought the insurance you signed a document called a “named driver exclusion” on your spouse because the insurance company would not cover her because she suffered from epileptic seizures. That is what happened in the case, Janie Zamora, Pete Zamora, Jesus Toe, and Gracie Vela v. Dairyland County Mutual Insurance Company. This case was decided by the Court of Appeals in Corpus Christi, Texas.

The facts are, on December 2, 1993, Gracie Vela (wife of Jesus Toe) was operating Jesus’ automobile when she was involved in an accident with Pete and Janie Zamora. At the time of the accident, Gracie was named as an excluded driver in Toe’s policy with Dairyland County Mutual Insurance Company. The Zamora’s sued Gracie for her negligence and Jesus for negligently entrusting his car to Gracie. Dairyland denied coverage to Gracie and Jesus based on the named driver exclusion in the policy.

Permission? To Operate The Vehicle

February 25, 2010 | Mark S. Humphreys

A Dallas Appeals Court upheld a lower Court ruling in an interesting case. The ruling applies to the same facts anywhere in Texas, including, Fort Worth, Arlington, Grand Prairie, or Weatherford.

This case is valid law today but was decided in 1989. The fact pattern is unique. The style of the case is United States Fire Insurance Company v. United Service Automobile Association.

The underlying liability lawsuit arose out of an accident that occurred when an Anna Milliken was riding as a passenger, with a Douglas Martin, being the driver. The car Douglas was driving was owned by his father and was covered by the United States Fire Insurance Company (U.S. Fire) policy. Anna’s insurance was United Service Automobile Association. Douglas testified about some swerving and horseplay prior to the accident. Anna testified that Douglas was zigzagging the wheel back and forth and that she grabbed the wheel on two occasions prior to the accident. She was doing this to play back with Douglas. The first time she did this, Douglas did not object, and the second time was when the accident occurred causing serious injury to Douglas. Douglas sued Anna for his injuries.

Cooperating With Your Own Insurance Company

February 24, 2010 | Mark S. Humphreys

A case decided in Fort Worth, Texas on June 11, 2009, is important to understand. The result of this case is the same in Weatherford, Grand Prairie, Arlington, or Dallas.

The style of this case is Garry Jenkins v. State and County Mutual Fire Insurance Company. The facts in this case are undisputed. Garry Jenkins foot was crushed when a tank skid fell off a truck driven by Mark Lemmon. The accident happened when Mark applied the brakes too quickly, causing the skid to break free and fall on Garry’s foot. Both Garry and Mark were working as independent contractors for L & G Pipe. L & G Pipe was owned by two people, Deborah Grisamer and Richard Lemmon.

At the time of the accident, State and County Mutual Fire Insurance Company had a policy of insurance with Deborah as the named insured. The policy was in effect on the date of the accident and the policy listed the truck as a “covered auto.” The wording in the policy is important in this case and provided as follows:

Deceptive Trade Practices Act

February 23, 2010 | Mark S. Humphreys

The people living in Weatherford, Grand Prairie, Arlington, Dallas, or Fort Worth, is protected by the laws in Texas, against businesses that try to take advantage of them. These laws are found in the Texas Business & Commerce Code, Section 17.

To be eligible for protection under the DTPA, all you have do is prove your status as a consumer. Proving consumer status under the DTPA requires the plaintiff to prove it was a person or entity listed in Texas Business & Commerce Code, Section 17.45(4) that sought or acquired goods or services by purchase or lease. In determining the plaintiff’s consumer status, the focus is on the plaintiff’s relationship to the transaction, not on the plaintiff’s contractual relationship with the defendant. Thus, the plaintiff does not need to prove it is in privity of contract with the defendant to have standing as a consumer. Instead of privity, the plaintiff is required to show that the defendant was “connected with” the transaction.

This Blog primarily deals with issues related to different forms of insurance issues. The importance of the DTPA is that most violations of the Texas Insurance Code are also violations of the DTPA and subject to the penalties of both sets of laws regulating the matters. Relevant Insurance Code Sections are, 541.003, and 541.051 thru 541.061.

How To Beat Appraisal Clause In Insurance Contract

February 22, 2010 | Mark S. Humphreys

A lot of homeowners insurance policies in Texas have “appraisal” clauses written into them. So whether you live in Weatherford, Texas, or in Grand Prairie, Arlington, Fort Worth or Dallas, if you have homeowners insurance you need to be aware of these appraisal paragraphs.

An appraisal paragraph is of benefit to the insurance company. That is why they put it into the insurance policy. When the homeowner and the insurance company cannot reach an agreement on the amount of money that should be paid on a claim, the insurance company will try to invoke the appraisal clause in the insurance contract. Appraisal happens when the insurance company knows they owe the homeowner money, but there is a dispute as to how much money is owed.

The United States District Court, Southern Division, recently handled a case where the issue was whether the homeowner properly defeated the insurance company trying to invoke the appraisal process. The style of the case is, Hector Sanchez v. Property and Casualty Insurance Company of Hartford and Irene Bernardo. The courts’ opinion was handed down on January 27, 2010.

Claim For Underinsured Benefits Denied

February 21, 2010 | Mark S. Humphreys

It is always smart to purchase uninsured motorist benefits coverage because of the number of people driving around with no insurance or insufficient insurance to cover a lot of losses that occur. This is particularly true in the Grand Prairie, Arlington, and Dallas – Fort Worth areas of Texas.

Uninsured or underinsured motorist coverage is required to be provided to drivers purchasing auto coverage in Texas. This requirement is found in the Texas Insurance Code, Section 1952.101.

The Court of Appeals, Texarkana, Texas, recently ruled in a case involving underinsured coverage benefits. The style of the case is Myrtis Williams v. State Farm Mutual Insurance Company. This case was decided on February 5, 2010.

Health Insurance And What They Pay Doctors

February 21, 2010 | Mark S. Humphreys

People living in Grand Prairie, Arlington, Dallas, Fort Worth, Weatherford, or any where in Texas or the nation have a hard time understanding how their health insurance works when it comes to paying medical providers. This is particularly true with the “out of network” medical providers involved in a health claim.

The Palm Beach Post recently published an article. The article addressed the possibility that a class action lawsuit was going to get traction against some of the larger medical insurance companies. The Palm Beach Post article is titled “Lawsuits Filed Against Blue Cross Claims Reimbursement Rates Kept “Artificially” Low”.

The first line in the article starts out; “Ever wonder why your insurance company claims a procedure that cost you dearly could be gotten for a fraction of the price you paid?” An example of this is given in the article where a Palm Springs resident was charged $1,210 for an MRI. Blue Cross said the cost should have been $419. Since he had not met his deductible, it would not cover the MRI. Further, it would not allow him to claim the full amount toward his deductible.

Uninsured Coverage and Punative Damages In Texas

February 20, 2010 | Mark S. Humphreys

Punative damages and “exemplary” damages are essentially the same thing in Texas. The way exemplary damages works in Texas is the same regardless of whether you live in Arlington, Grand Prairie, Fort Worth, Dallas, or Weatherford.

The Texas Court of Appeals in Houston, Texas, recently dealt with the issue of how exemplary damages are handled when the claim made is a claim against a person’s own insurance carrier for uninsured motorist benefits. This case was decided on February 4, 2010. The style of the case is, Sandra Gervais Laine, v. Farmers Insurance Exchange.

In this case Laine’s mother was killed in an auto accident. The other driver was at fault and was intoxicated. Laine made a claim against Farmers Insurance Exchange for benefits under her uninsured motorist benefits portion of the auto policy. Farmers paid the uninsured benefits limit of $250,000. She then made a claim against her umbrella policy which provided the same benefits as the auto policy except for a higher amount. The limit under the umbrella policy was $1,000,000.

Where Will An Insurance Company Lawsuit Be Fought?

February 18, 2010 | Mark S. Humphreys

Most insurance company’s have their main offices located outside of Texas. If you live in Weatherford, Texas, Arlington, Grand Prairie, or the Dallas – Fort Worth area, and you sue an insurance company, how do you know you won’t have to travel to Delaware or some other state to fight the lawsuit?

The United State District Court, Southern District, Houston Division, recently had a case dealing with this issue. The case decision was handed down on January 26, 2010, and was styled, Houston Baptist University, v. Ace American Insurance Company and York Claims Service, Inc.

Houston Baptist University (HBU) had a policy of insurance with Ace American Insurance Company (Ace). HBU suffered losses as the result of Hurricane Ike hitting the Houston area and made a claim against Ace. Ace assigned York Claims Service, Inc. (York) to adjust and inspect the claim. HBU and Ace could not reach an agreement on the value of the claim and HBU filed a lawsuit against Ace and York. The insurance policy had a policy provision that read: Any dispute arising under this policy shall be exclusively subject to the jurisdiction of the federal and state courts located in the Commonwealth of Pennsylvania.