Dallas Fort Worth Insurance Lawyer Blog

Long Term Disability Claims

June 12, 2021 | Mark S. Humphreys

Long Term Disability (LTD) claims are not uncommon in the insurance world. Some of these claims are easy to see and understand, such as an amputation. Other LTD claims are less easy to see and understand, such as chronic conditions and conditions that do not show up easily on tests and can be very subjective. It is the other type of LTD claims that end up being denied by insurance companies.

While many denied claims can be contested by hiring an insurance lawyer, many are complicated legal battles. What makes too many of these LTD claims even harder to contest if denied, is when the plan is through a person’s employer and governed by the Employee Retirement Income Security Act (ERISA).

A 2021 opinion from the Southern District of Texas, Houston Division, deals with an LTD claim that is governed by ERISA. The opinion is styled, Mark Calkin v. United States Life Insurance Company In The City Of New York.

Hail Damage Claims –

June 7, 2021 | Mark S. Humphreys

This is a case about hail damage. But, this is not the significance of the case.

The Northern District of Texas, Dallas Division, issued an opinion on April 28, 2021. The opinion is styled, Alejandro Martinez Perez and Claudia A. Lopez Orozco v. Allstate Vehicle And Property Insurance Company and Stephen McKinney.

The significance of this case is that the Plaintiff’s filed a motion for summary judgement and Allstate did not respond to the motion. In 27 years of practicing law, this is the first time I have noticed an insurance company law firm not respond to a summary judgment motion.

Bad Faith Insurance – Multiple Inspections

June 5, 2021 | Mark S. Humphreys

There are many actions or inactions an insurance can be accused of that may amount to bad faith. One of those is discussed in a 2021 opinion from the Northern District of Texas, Sherman Division. The opinion is styled, Deanne M. Hinson v. State Farm Lloyds.

A Magistrate Judge was assigned to hear a Motion for Summary Judgment on the case. The Magistrate Judge ruled in favor of State Farm and Hinson appealed that ruling to the sitting Judge. The sitting Judge affirmed the finding of the Magistrate.

This is a hail damage claim that was originally filed in State Court and then removed to Federal Court. The Magistrate ruled in favor of State Farm on all of Hinson’s causes of action. Hinson is appealing the decision as to one cause of action only.

Reasons For Insurance Company Denying An Insurance Claim

May 31, 2021 | Mark S. Humphreys

When an insurance lawyer has someone call about an insurance company denying a claim, an experienced insurance lawyer will always ask if the potential client knows about any other reasons the claim could be denied. The reason this question is asked is that an insurance company can deny a claim for one reason today and if that reason ends up being faulty, the insurance company can find another reason for denying a claim. As long as one reason for denying a claim is a proper reason, it does not matter that another reason for denial turns out to be incorrect.

This is partially discussed in a 2021, opinion from Houston First Court of Appeals. The opinion is styled, Amy Powell v. USAA Casualty Insurance Co.

This Court ruled in favor of USAA after USAA filed a motion for summary judgment.

Accidental Death Insurance Policy – ERISA

May 29, 2021 | Mark S. Humphreys

Life insurance lawyers will have situations where a person has died and the issue is whether or not the death was an “accidental death” and did any exclusion apply to the accidental death.

Here is a 2021, opinion that deals with an accidental death policy with an exclusion and on top of that, the policy is governed by the Employee Retirement Income Security Act (ERISA). The opinion is from the United States Court of Appeals, 5th Circuit. It is styled, Luis Lebron v. National Union Fire Insurance Company of Pittsburgh, Pennsylvania; AIG Claim, Incorporated.

Luis had an accidental death policy he purchased through his employer that insured himself and his wife, Barbara. The policy was issued by National Union and contained an exclusion for death caused “in whole or in part” by “illness, sickness, disease, bodily or mental infirmity, medical or surgical treatment (unless treating a covered injury), or bacterial or viral infection, regardless of how contracted (except when bacterial infection results from an accidental cut or wound or accidental food poisoning).” Under this ERISA plan National Union had authority to determine benefit eligibility as the plan administrator.

Bad Faith Insurance Claim – Breach Of Contract

May 24, 2021 | Mark S. Humphreys

An argument that insurance companies make in many “bad faith” claims is that there can be no bad faith unless or until there is a breach of the insurance contract. To reach the level of bad faith insurance, most of the time there has to be a breach of the insurance contract – but not all the time.

The Dallas Court of Appeals says there it is not necessary to have a breach of the insurance contract for there to be a bad faith claim. And the Court backs up his decision by citing the Texas Supreme Court. The opinion is styled, In Re Allstate Fire And Casualty Insurance Company and Latina Foster.

Before the Court are relators’ petition for writ of mandamus, real party’s response, and relators’ reply to the response. Relators contend they are entitled to mandamus relief because the trial court abused its discretion by denying their special exceptions complaining about real party’s failure to plead a claim for breach of contract, and by failing to quash relator Latina Foster’s deposition because it is premature. Entitlement to mandamus relief requires relators to show both that the trial court clearly abused its discretion and that relators have no adequate appellate remedy. Although the Court questions the scope of the identified deposition topics, based on relators’ arguments and the record, we conclude relators have failed to show a clear abuse of discretion. Further, in light of the Texas Supreme Court’s recent opinion in, In re State Farm Mutual Automobile Insurance Co., from Mar. 19, 2021, the trial court did not abuse its discretion by denying relators’ special exceptions. In that opinion the Texas Supreme Court concluded the insurer was not required to plead a breach of contract claim to recover for extra-contractual claims.

Life Insurance Claims – Interpleader

May 22, 2021 | Mark S. Humphreys

Life insurance claims attorneys will eventually have a case where the life insurance company knows they owe the life insurance benefits on a policy but are unsure about who to pay. When this situation arises the Texas Insurance Code, Section 542.058(c), has specific provisions for how the situation should be handled. Specifically, the life insurance company, when it is unsure who it should pay the policy benefits, has 90 days to interplead the funds into the registry of the Court.

A 2021, from the Northern District of Texas, Dallas Division, discusses how the Federal Courts handle interpleader cases. This case is styled, American General Life Insurance Company v. Carol Corzo, Brenda Lizbeth Melgar Cruz, Adan Alberto Melgar Cruz, and Daniel Melgar Cruz.

This interpleader action concerns the proceeds of a life-insurance policy issued by American General. In September 2016, Ottoniel Melgar Perez purchased a $300,000 life-insurance policy from American General. He named Defendants, who are his relatives, as primary beneficiaries on the Policy. A few years later, Perez married Blanca Nelis Chicas (Chicas). Subsequently, Perez passed away, leaving his $300,000death benefit from the Policy behind. Chicas and Defendants both submitted claims to American General for the death benefit.

Insurance Law Case – A Laugh At The End

May 17, 2021 | Mark S. Humphreys

Maybe the title of this blog should be a little different but for insurance lawyers dealing with insurance companies all the time the comment by the Judge at the end of the case is worthwhile.

As all insurance lawyers know, the insurance companies prefer to litigate denied claims in Federal Court rather than the State and County Courts. It’s really simple to understand, the rules and handling of cases in Federal Court tend to favor insurance companies.

The case here is from the Northern District of Texas, Fort Worth Division. It is styled, Gina Lewis et al. v. Safeco Insurance Company of Indiana et al.

Hail Damage Claims – Segregating Damage

May 15, 2021 | Mark S. Humphreys

Insurance attorneys are well aware of the changes in the Texas Insurance Code statutes that effect hail damage claims and other damages resulting from Mother-Nature. What cannot not be overlooked is the responsibility to make clear what caused the claimed damages. In other words are all the damages from a particular event or are some of the damages being claimed the result of another event or are simply wear and tear.

A 2021, opinion from the Northern District of Texas, Fort Worth Division, explains the necessity of segregating damages in a claim for insurance coverage. The style of the opinion is, Harold Franklin Overstreet v. Allstate Vehicle and Property Insurance Company.

Pursuant to the 1999, San Antonio Court of Appeals opinion styled, Wallis v. United Servs. Auto. Ass’n, an insured can only recover for covered events under his policy; therefore, he bears the burden of segregating the damage attributable solely to the covered event.

Life Insurance Claim Denied Because Policy Was Cancelled

May 10, 2021 | Mark S. Humphreys

Often times when a claim for benefits is denied, the reason for the denial is that the policy has been cancelled.

“Cancellation” refers to the insurer’s termination of coverage before the end of the policy period. A cancellation is in contrast to a non-renewal, which involves an insurer’s unwillingness to reissue the policy following the completion of the policy term of coverage.

Most insurance policies contain provisions regarding cancellation and the Courts honor this provisions as can be seen in the 1994, Waco Court of Appeals opinion styled, Truck Ins. Exch. v. E.H. Martin, Inc. Specific provisions for cancellation of coverage must be precisely followed by the insurer and will be strictly construed by the courts. This was seen in the 2001, Corpus Christi Court of Appeals opinion styled, Jones v. Ray Ins. Agency.