Dallas Fort Worth Insurance Lawyer Blog

Claims Denial And Suing The Insurance Adjuster

September 6, 2021 | Mark S. Humphreys

Claims denial attorneys usually see situations where a claim is denied and it was the adjuster who acted improperly in his handling of the claim.

Allegations that the adjuster acted improperly were alleged in this 2021, opinion from the Northern District of Texas, Dallas Division. The opinion is styled, Beverly Oderbert v. State Farm Lloyds and Richard Kundee.

Oderbert had a plumbing issue wherein she made a claim against her home insurer, State Farm. State Farm assigned as the adjuster, Kundee.

Life Insurance Denial And Who Gets The Benefits

September 4, 2021 | Mark S. Humphreys

Life insurance claims can take many turns, as any attorney who handles very many of these life insurance claims can tell you. Here is a 2021, opinion from the Southern District of Texas, Houston Division. It is styled, New York Life Insurance Company v. Srinivas Varati.

New York has filed a Rule 12(b)(6) motion to dismiss and a motion for judgment on the pleadings. The Court granted the motions.

Here is some background. Varati is the administrator for the estate of Shanti Nakirekanti. Shanti died on February 18, 2019, the same day as her late spouse, Sreenivas Nakirekanti (Sreenivas). Sreenivas died by suicide. On March 30, 2017, New York had issued a term life policy to Sreenivas. The policy had a face value of $500,000 and listed Sreevinas as the sole “owner.” The policy, and Sreenivas’s application for the policy, listed Sreenivas’s children Pranay and Nitya, each as 50% beneficiary. Section 3.4 of the Policy’s base provisions (the Base Policy) defines “Beneficiary” as “the person or entity named in the application, or in a notice you sign that gives us [the Company] the information we need[.]”

Accidental Death Claims Denial

August 30, 2021 | Mark S. Humphreys

Life insurance claims attorneys are needed any time an insurance company denies a claim. Some cases the attorney will help the client make a recovery and other cases, at least the client had the claim investigated.

The Northern District of Texas, Dallas Division, issued an opinion in July 2021, dealing with a claim for accidental death life insurance benefits. The styled of the case is, Damon Stewart, et al v. Mutual of Omaha Insurance Company. The facts of the case are tough.

The insured had an accidental death policy with Mutual of Omaha. The insured is alleged to have died after suffering a fall and hitting his head that caused his death. A claim for benefits was denied and this lawsuit was filed. Mutual of Omaha filed a motion for summary judgment based on the records they obtained in their investigation and there being no reliable evidence to the contrary.

Claims Denial – Suing Adjuster

August 28, 2021 | Mark S. Humphreys

Here is another case illustrating that when suing an insurance company adjuster that it is vital to properly plead the case against the adjuster. This 2021, opinion is styled, Detavia Wilson v. State Farm Mutual Automobile Insurance Company, Robert Nash, and Yulonda Jones. The opinion is from the Northern District of Texas, Dallas Division.

Wilson was injured in a hit-and-run vehicle collision. Wilson recovered from the third-party tortfeasor and sought under-insured motorist coverage from State Farm.

Wilson sent documents to State Farm to evaluate the claim. The adjusters, Nash and Jones, sent requests for more records to Wilson. After this request, Wilson sued State Farm, Jones, and Nash for violations of the Texas Insurance Code in State Court.

Long-Term Disability Benefits & ERISA

August 23, 2021 | Mark S. Humphreys

Lawyers who handle long-term disability (LTD) claims that are governed by the Employee Retirement Income Security Act of 1974 (ERISA), will want to read this opinion. The opinion is titled, Enrique Talamantes v. Metropolitan Life Insurance Company. It is a 2021, opinion from the United States Fifth Circuit. It is a ruling that is favorable to the insured, which is unusual in cases governed by ERISA.

Plaintiff, was an engineer for him employer, BD. BD provided its employees LTD coverage through plans governed by ERISA. During the relevant time period, BD used two insurers, Standard Insurance Co. (“Standard”) for the 2016 calendar year and MetLife Insurance Co. (“MetLife”) for the 2017 calendar year, to fund LTD payments under the Plan.

On November 9, 2016, Plaintiff became disabled due to trigeminal neuralgia and underwent microvascular decompression surgery. In light of this disability, Plaintiff was approved for and paid short-term disability(“STD”) benefits for 34 days under the Plan from November 18, 2016 through December 22, 2016. The Plan’s STD benefits were paid by BD and administered by Sedgwick Claims Management Services (“Sedgwick”) and did not involve Standard or MetLife. On December 23, 2016, Plaintiff returned to full-time active work. Standard’s policy terminated on December 31, 2016, and MetLife’s policy became effective on January 1, 2017. On January 12, 2017, Plaintiff stopped working and again became disabled because of a relapse in his trigeminal neuralgia symptoms.

Accidental Death Insurance Policy – ERISA

August 21, 2021 | Mark S. Humphreys

Life insurance denials are much more common than people realize. Most people would be of the opinion that once a person had paid for life insurance and then a death occurs, that the policy would pay. That is not the case.

Here is an opinion from the Southern District of Texas, Houston Division. It is styled, Sydney Joe Gray v. Minnesota Life Insurance Company. This case involves an accidental death policy that is governed by the Employee Retirement Income Security Act of 1974 (ERISA).

The lawsuit is brought under 29 U.S.C., Section 1132(a)(1)(B). The deceased, Michael Gray had an accidental death policy he obtained through his employment. Sydney Gray is the beneficiary of the policy.

Claims Denial – Suing The Adjuster

August 16, 2021 | Mark S. Humphreys

Insurance lawyers time and time again have a difficult time properly suing insurance adjusters when their case is in Federal Court. This is illustrated in a June 16, 2021, opinion from the Northern District of Texas, Dallas Division. The opinion is styled, Thomas Paredes and Kerry Paredes v. The Cincinnati Insurance Company and John Schuster.

The Paredes had their property insured through Cincinnati. They incurred a hail storm loss properly reported it. Cincinnati assigned adjuster, Schuster to the claim. The Paredes were dissatisfied with the way the claim was handled and filed the present suit. The lawsuit was timely removed to Federal Court on the basis that Schuster (the Adjuster) was improperly joined and that without the Adjuster, diversity jurisdiction existed. The Paredes filed a motion to remand which is the subject of this opinion.

Cincinnati says the Adjuster was improperly joined in the lawsuit because the Paredes have not stated a cause of action against him.

Life Insurance Attorney’s And Beneficiary Dispute

August 14, 2021 | Mark S. Humphreys

Life Insurance lawyers often see disputes over who is entitled to life insurance proceeds.

A 2021, opinion from the Southern District of Texas, Houston Division, is a dispute over who is entitled to life insurance proceeds. Also, the life insurance policy at issue in this case is governed by the Employee Retirement Income Security Act of 1974, (ERISA). The opinion is styled, Christine and Denise Morgan v. Prudential Life Insurance – Prudential Life Insurance v. Linda Arriazola and Elvia Barrera.

This case was decided on competing motions for summary judgment.

A Unique Way To Stay Out Of Federal Court

August 9, 2021 | Mark S. Humphreys

Here is a unique way to stay out of Federal Court. It is applicable to suing a Lloyd’s of London insuring entity. The case is a 2021, opinion from the Northern District of Texas, Fort Worth Division. It is styled, Certain Underwriters At Lloyd’s, London Subscribing Severally To Policy No. B0595NOHW46387019 v. Block Multifamily Group, LLC D/B/A Block Multifamily Power Group.

Following an insurance dispute with Lloyd’s, Block filed a lawsuit in a State Court. Lloyd’s removed the case to Federal Court , and then Block filed a motion to remand, which is the subject of this opinion.

Defendant removed the case to this Court on the basis of diversity jurisdiction, alleging that Plaintiffs are foreign citizens of England and that Defendant is a citizen of Missouri. Defendant further alleged that the amount in controversy exceeds $75,000 because the value of the underlying dispute based on Plaintiffs’ own estimate is at least $177,023.21. Shortly thereafter, Plaintiffs filed their Motion to Remand on the ground that Defendant has improperly conflated Lloyd’s of London—a specific entity—with the Plaintiffs in this case—over 1,600 individual underwriters or “Names.” Relying on Corfield v. Dallas Glen Hills, L.P., 355 F.3d 853 (5th Cir. 2003), Plaintiffs explain the distinction as follows:

Suing The Business Entity Rather Than The Insurance Company

August 7, 2021 | Mark S. Humphreys

Here is an unusual situation from the Northern District of Texas, Dallas Division. The opinion is styled, Barry Green, Individually and as Attorney in Fact for Billie Green and Billie Green, Individually v. Allstate Texas Lloyds, Inc.

If the unusual aspect of this case is not pointed out in the beginning, some will miss it. The Plaintiffs sued Allstate Texas Lloyds, Inc., rather than the insurance company Allstate Texas Lloyds.

The Plaintiffs had homeowners insurance coverage and sued Allstate Inc. in State Court. Allstate Inc. then removed the case to Federal Court citing that the wrong entity had been sued and that Allstate Inc. was a Texas Company but Allstate Lloyds was not a Texas company and thus, the correct party, Allstate Lloyds created diversity jurisdiction, making removal proper.