Dallas Fort Worth Insurance Lawyer Blog

Getting Insurance Company Records

November 6, 2009 | Mark S. Humphreys

In the State of Mississippi, a policy holder filed a lawsuit seeking access to Mississippi Insurance Department records. The lawsuit is seeking records that would show the dollar amount of Katrina claims denied by insurance companies.

The courts in Mississippi and other coastal areas have loaded up with lawsuits related to claims denials by insurance companies. The claims get denied for a range of reasons but a lot deal with issues of whether or not the damage to property is the result of floods, the result of winds, storm surge, or flying debris.

The person filing the lawsuit, a Kevin Buckel, is also trying to get passed into law in Mississippi, a Policyholders Bill of Rights. Each time this proposal has been introduced into the State Legislature, the legislation has died in committee.

Private Causes Of Action Against Texas Insurance Companies

November 4, 2009 | Mark S. Humphreys

Yesterdays blog discussed actions that can be taken by the Texas Department of Insurance when a person commits a deceptive act or practice under Chapter 541 of the Texas Insurance Code or Section 17.46, Business & Commerce Code. Here the discussion will be about a persons’ “private causes of action”.

Texas Insurance Code, Section 541.151, says that a person who sustains actual damages may sue the other person (insurance company or agent) who caused the damages. If the other persons’ actions are defined by Subchapter B to be an unfair or deceptive act or practice in the business of insurance or an unlawful deceptive trade practice in Section 17.46(b), Business & Commerce Code, then an action may be brought against that person.

A person who prevails is entitled to the amount of the actual damages suffered, plus court costs and reasonable and necessary attorney’s fees, according to Section 541.152. Plus, if the person committing the acts did so knowingly, then there may be an award in an amount up to three times the amount of actual damages.

The Texas Department Of Insurance Going Against Insurance Companies

November 3, 2009 | Mark S. Humphreys

Subchapter C, of the Texas Insurance Code deals with how the Texas Department of Insurance examines, investigates, and determines whether a person engaged in the business of insurance has engaged in an unfair method of competition or unfair or deceptive act or practice prohibited in the business of insurance. This is not a private cause of action, rather this is where the department is taking action.

Texas Insurance Code, Section 541.102, states that when the department has reason to believe a violation has occurred that it shall issue and serve on the person, 1) a statement of the charges, and 2) at least a six day notice of the hearing on the charges, including the time and place for the hearing. This hearing is required before the department issues a cease and desist order to the person.

Section 541.104 sets out the hearing procedures to be followed. Section 541.105 requires that a record be made of the hearing.

Insurance Fraud In Texas

November 1, 2009 | Mark S. Humphreys

Insurance Fraud is a crime in Texas. A person can go on-line to the Texas Department of Insurance to get a lot of information about insurance fraud.

According to the National Insurance Crime Bureau (NICB), insurance fraud is one of the most costly white collar crimes in America, ranking second only to tax evasion. NICB also says that 10% of all property and casualty insurance claims are fraudulent.

NICB has figures showing that property and casualty based insurance fraud costs Americans about $30 billion each year. To make a comparison, Hurricane Andrew, which was a devastating storm, only cost about $17 billion. Further if you added all types of insurance claims that are thought to be fraud, then the number jumps to $120 billion each year. What these numbers mean to the person buying insurance is an average of $200 to $300 each year in increased premiums. The hidden costs in the form of higher goods and services makes the costs to the average family about $1,000 per year.

Insurance Companies Dropping Policies

October 31, 2009 | Mark S. Humphreys

A recent article originating in Florida, highlights a problem that many homeowners face and none wished they faced. The article title “Insurers dropping Chinese drywall policies”, talks about some new homes being built with a Chinese drywall that emits sulfuric fumes and corrodes pipes. Sounds pretty bad, and it is, especially if it’s your house this drywall is in.

The problem could be very large considering there appears to have been 500 million pounds of this drywall imported into the United States between 2004 and 2008. The houses constructed with this drywall seem to be concentrated in the Southeast, especially Florida and coastal areas of Louisiana and Mississippi. Texas and the Dallas, Fort Worth, Arlington, Weatherford, and most of the areas of the State seem to have escaped this problem

Most the insurance companies are denying the claims submitted by homeowners. The basis for the denials will vary but most of the time the reasons have to do with the problem being a “pre-existing” condition, or some type of construction defect exclusion. Both of these are often times omitted coverages in the homeowners policies.

“Claims Made” v. “Occurrence” Policies In Texas

October 30, 2009 | Mark S. Humphreys

The Supreme Court of Texas decided a case this year wherein the distinction between “claims made” policies and “occurrence” policies was discussed. This case is, Prodigy Communications Corp. v. Agricultural Excess & Surplus Insurance Company.

As discussed in an earlier case on this blog, the PAJ case, the main issue was whether or not the inusrance company was still responsible under the terms of the insurance policy even though the insured person or entity did not timely notify the insurance company of the claim. As in PAJ, the court ruled that because the insurance company could not show it was harmed by the delay in being informed of the claim, the court ruled that the insurance company must provide coverage.

The difference in this case, Prodigy, as compared with PAJ, was the different types of policies at issue. When dealing with insurance policies it is important to understand the distinctions between these two types of policies.

Subrogation In Texas Auto Claims

October 29, 2009 | Mark S. Humphreys

Texas Insurance Code, art. 5.06-1 and the particular policy’s “Right to Recover Payment clause create a statutory and contractual right of subrogation against a third party motorist to recover uninsured and underinsured payments the insurance company makes to its customer. If the insurance company makes a payment to any person under this coverage, the insurance company is entitled to recover up to the amount of the payment from the proceeds of any judgement or settlement with the person. This is spelled out in art.5.06(6).

The result of this rule is that a person who collects uninsured or underinsured benefits from their insurance company as the result of someone else’s negligent actions in a car wreck type of situation, cannot turn around and sue that individual. Or, if you do sue the responsible party and they are successful in collecting money from that individual, then they must pay back the insurance company for the benefits they have paid on the insured persons behalf. This of course is limited to paying the insurance company back only up to the amount they have paid out. Any excess would belong to the injured, insurance company customer. The purpose of this rule is to prevent a double recovery by the injured party.

What happens most of the time in real life is that the injured, not at fault person, makes a claim against the person who caused the injury. The injured person then discovers that the atfault person is either uninsured or underinsured. They then make the uninsured or underinsured claim against their own insurance company. Rarely, or almost never does the injured party pursue a further claim against the atfault party. However, the insurance company that paid the benefits will do an asset check on the atfault party and make a determination as to whether or not it is financially worthwhile to pursue the atfault party.

Limitations Periods In Texas Insurance Cases

October 28, 2009 | Mark S. Humphreys

An opinion issued by the Texas Court of Appeals in Houston on October 15, 2009 is noteworthy. Atleast one part of this decision addresses a law in Texas that most attorneys do not know.

The case is Anthony Sheppard v. Travelers Lloyds of Texas Insurance Company. This case discusses limitations periods. Limitiations periods are the timelines within which a lawsuit must be filed or otherwise it is barred. These limitations periods are in Chapter 16 of the Texas Civil Practice & Remedies Code. There are 44 sections in Chapter 16 addressing different causes of actions and the limitations applicable to them. Plus there is a ten page chart that breaks down these sections and tries to make them easier to understand.

A carefull reading of Sheppard goes a long way in making these limitations periods as they relate to insurance contracts understandable. And it is important to understand that breaches of an insurance contract usually go hand in hand with other violations of the Texas Insurance Code. Most Insurance Code violations, which are also violations under the Texas Deceptive Trade Practices Act have a 2 year statute of limitations. Texas Insurance Code, Section 541.162 sets out the limitations period for insurance code violations at two years with some variations to the two year period.

Your Duties After An Accident Or Loss In Texas

October 27, 2009 | Mark S. Humphreys

An appeal from a Dallas, Texas Court decision was decided by the Texas Supreme Court, in the case PAJ, Inc., d/b/a/ Prime Art & Jewel, v. The Hanover Insurance Company. This case was decided in January, 2008. It discussed the responsibilities of holders of an insurance policy as it relates to their duties after an accident or loss and how the failure of fulfilling those duties affects coverage under an insurance policy.

As a general rule almost all insurance policies require the policy holder to do the following: 1) promptly notify the insurance company of any loss or claim, 2) cooperate with the insurance company investigation of the claim or loss, 3) take reasonable actions to protect against further loss.

When a claim is denied due to a policy holder not promptly notifying the company of the claim or loss the insurance company has the burden of proving that this failure to promptly notify caused harm to the insurance company. This was the issue in PAJ.

Cancellation And Nonrenewal Of Certain Liability Policies In Texas

October 26, 2009 | Mark S. Humphreys

In Texas, there are rules regulating the conditions for an insurance company to cancel certain liability policies or to opt to nonrenew the policies. These rules are found primarily in Section 551 of the Texas Insurance Code.

To begin with, one rule found in Section 551.052 says that an insurance company cannot cancel a liability policy that is a renewal or continuation policy. This makes sense, otherwise, why would anybody buy this type of policy.

Another rule in this section says that an insurance company may not cancel a liability policy during the initial policy term after the 60th following the date the policy was issued. So if you buy a one year policy on September 15, it cannot be cancelled after November 15.