Dallas Fort Worth Insurance Lawyer Blog

Bad Faith Insurance Claims Lawyer – Read This

September 25, 2021 | Mark S. Humphreys

Hee is a 2021, opinion dealing with bad faith claims by an insured and the insurance company efforts to dispose of the bad faith claim via summary judgement. The opinion is from the Southern District of Texas, Houston Division, and is styled, GeoVera Specialty Insurance Company v. Sam Walker.

The insured is Walker. The insurance company is GeoVera. Walker suffered wind damage and a subsequent theft claim. There are other issues in the case, but only the bad-faith / extra=contractual issues will be looked at here.

Geovera denied the claim and then sued Walker seeking a declaratory judgment that it did not owe any damages to Walker.

Insurance Lawyers – When Is A Case A Bad Faith Case

September 20, 2021 | Mark S. Humphreys

The question asked in the title is a good question. However, it is a hard question to answer. A 2021, opinion from the Northern District of Texas, Fort Worth Division, lends some insight into how bad faith is analyzed by the courts. The opinion is styled, Cocanougher Asset No. 3, LLC v. Twin City Fire Insurance Company.

The facts of the case can be read in the opinion and will not be rehashed here.

Twin City filed a motion for summary judgement on the bad faith allegations of the plaintiff. In deciding the motion in favor of the plaintiff, the court explained how these situations are analyzed.

Life Insurance Lawyers – Rescission Of An Insurance Policy

September 18, 2021 | Mark S. Humphreys

Life Insurance Claim Denials are getting more and more common. But, the insurance companies are beginning to jump ahead of the denials and starting to rescind the policies based on their assertion that there were/are misrepresentations in the insurance application.

Statutory Requirements – In addition to common law standards, several statutory provisions regulate an insurer’s ability to avoid coverage based on a misrepresentation by the insured. These are found in the Texas Insurance Code, Chapter 705.

The statutes provide:

Bad Faith Claim – Attorney Fees

September 13, 2021 | Mark S. Humphreys

Insurance lawyers are frequently asked, “Can you make the insurance company pay my attorney fees?”

Here is a case from the Southern District of Texas, Houston Division. The case is styled, Shane and Shannon Richardson v. Liberty Insurance Co.

Most case, over 98%, get resolved short of a trial. Some cases get dismissed for legal reasons soon after the lawsuit is filed or at the Motion for Summary Judgment stage of the case. The others reach a settlement. When a case is settled, the insurance company really doesn’t care how the settlement money is applied. They are going to pay a certain sum of money and how that money gets distributed, i.e., actual damages, exemplary damages, interest, court costs, or attorney fees is not really important to them.

Life Insurance Lawyers And Attorneys – Claim Denied Due To Misrepresentation

September 11, 2021 | Mark S. Humphreys

Life Insurance Lawyers who handle claims denied due to the claim that a misrepresentation was made in the life insurance application must read this 2021, opinion from the Amarillo Court of Appeals. It is styled, Bertha Arce, Individually And As Representative Of All Others Similarly Situated v. American National Insurance Company.

The deceased insured, Sergio Arce, Jr. took out a policy of life insurance with American. Within days, Sergio was killed in a car accident and a claim for benefits was made by Bertha Arce (Arce). American denied the claim based on the assertion that Sergio misrepresented his health condition in the application for the life insurance.

American filed a motion for summary judgment in the trial court which was granted and this appeal followed.

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.