Dallas Fort Worth Insurance Lawyer Blog

Insurance Claim Denial Lawyer – Reading The Policy

February 6, 2021 | Mark S. Humphreys

Insurance Policy interpretation is something the Courts are often called upon to do. Here is a twist to that. A 2020, case from the Southern District of Texas, Houston Division, was asked to require appraisers to use a specific format for an appraisal. The Court refused this request.

The case is styled, Mt. Hawley Insurance Company, et al. v. Harrod’s Eastbelt, Ltd.

Harrod’s had invoked the appraisal provision in the policy issued by the insurer. Mt. Hawley, requested the Court to require the appraisers to use a specific format for the appraisal and to select an umpire.

Insurance Claim Denial Law Firms – The Ways Insurance Companies Look At Lawsuits

February 1, 2021 | Mark S. Humphreys

In order to successfully pursue lawsuits against insurance companies, an insurance attorney must understand how the insurance company looks at their case.

A big part of a lawsuit is deposition witnesses who are controlled by the insurance company. These people are usually the corporate representative, the adjuster, and experts. Hear is a perspective that is primarily from the viewpoint of the insurance company lawyer.

Corporate representative depositions are make-or-break propositions. Sometimes, that choice is out of the hands of the insurance company lawyer but many insurance carriers have identified particular employees for whom giving testimony on behalf of the company is part of their job description. An ideal corporate representative will be someone with general knowledge of the case and the willingness to become a case expert. He or she should also have an unflappable demeanor.

Insurance Claim Denial Law Firm – First Party Property Insurance Case

January 30, 2021 | Mark S. Humphreys

First Party Property Insurance Cases are handled by insurance defense firms in certain ways. Here is a look at how most are handled, starting with answering the lawsuit.

If the attorney for the plaintiff/insured has not sent a proper notice, the insurance lawyer may want to file a verified answer seeking an abatement until such notice has been properly received. Although proper notices do not have to be detailed, they do need to comply with all the elements set forth in Chapter 542 of the Texas Insurance Code. Once the defense firm is armed with a specific number that the claimant is seeking, the defense attorney can better evaluate the potential range of damages the insurance company is having to deal with.

Because insurance carriers are among the least popular defendants in courts across the country, it is important to take advantage of any rules to ensure a favorable forum. Cases that are originally filed in state court may be removed to federal court where there is diversity of citizenship and an amount in controversy of more than $75,000. In Texas, where state trial court judges are selected through partisan elections, federal forums will often be more favorable. Federal judges with lifetime appointments often have more time and staff available to consider dispositive motions. In addition, jurors are drawn from a broader area, which generally results in more rural, conservative jurors. For these reasons, attorneys for plaintiffs may include a Texas-resident adjuster as a defendant to defeat diversity. It is important to consider whether the case can still be removed by arguing that the adjuster was improperly joined and her citizenship should be disregarded. For cases governed by Section 542A of the Texas Insurance Code (which applies to weather-related claims), the carrier has the option to elect to assume the liability for acts of its individual adjusters. Such an election may or may not mean that the individual adjuster is not properly named as a defendant. This election must occur prior to suit being filed to render the lawsuit removable, so the window to elect liability is short.

Claims Denial Attorneys – Attorney Misrepresentations

January 25, 2021 | Mark S. Humphreys

Here is a strange case from the Southern District of Texas, Houston Division. It is a 2020 opinion styled, Pruco Life Insurance Company v. Blanca Monica Villarreal, Transamerica Life Insurance Company v. Blanca Monica Villarreal.

This is a hard fought dispute over a large life insurance policy and discovery being conducted in two countries. Many accusations of misconduct are being hurled by both sides.

The two life insurance companies were trying to depose Villarreal’s investigator. Villarreal’s attorney objected to the questions based on it protected by attorney work-product rules.

Claim Denial Lawyer – Segregating Damages

January 23, 2021 | Mark S. Humphreys

Here is an opinion from the Northern District of Texas, Dallas Division, that concerns hail damage and segregating damages. The opinion is styled, Frymire Home Services, Inc. and Whitfield Capital, LLC v. Ohio Security Insurance Co.

This is a summary judgement opinion in filed by Ohio and the Court granted the summary judgment in favor of Ohio.

This is a hail damage insurance dispute. Ohio insured Property owed by Plaintiffs. The policy was in effect from March 23, 2018, until March 23, 2019.

Claim Denial Law Firms – Proper Pleadings

January 18, 2021 | Mark S. Humphreys

Insurance lawyers can tell a client that proper pleadings, especially in Federal Court, are essential to being able to have a day in Court. This is illustrated in a 2020, opinion from the Eastern District of Texas, Sherman Division. It is styled, Albion Investments, Inc. v. Travelers Casualty Insurance Company of America.

Albion owned property that was insured by Travelers insurance. Albion filed a claim with Travelers for property damage after a storm struck the property with hail and high winds. The claim was ultimately denied based on the amount of damages falling below the deductible of the policy.

Albion filed suit alleging that Travelers did not conduct a thorough investigation of the claim, failed to account for all of the damages covered, failed to fairly evaluate and adjust the claim, failed to perform its contractual duty to compensate Albion under the policy, made misrepresentations to Albion regarding the damages to the Property and whether it was covered, failed to make an attempt to settle the claim in a prompt and fair manner, and failed to explain why full payment was not being made.

Insurance Denial Attorneys – Cattle?

January 16, 2021 | Mark S. Humphreys

Here is a case that may apply to many of the rural areas of Texas. The case is a 2020, opinion from the Corpus Christi Court of Appeals and is styled, State Farm Mutual Insurance Company v. Rolando Lopez, Individually and Rolando Lopez D/B/A R&A Transport.

This is an appeal of a summary judgment in favor of Lopez and against State Farm. This Court reversed the trial court and rendered judgment in favor of State Farm.

The main point of this case is the interpretation of the words “in use” in the commercial policy at issue. The policy provides in part:

Insurance Claims Denial Lawyers – Bad Faith And Pleading Requirements

January 11, 2021 | Mark S. Humphreys

Here is a claims denial opinion worth reading. It is a 2020 opinion from the Northern District of Texas, Dallas Division. It is styled, DFWS, LLC v. Atlantic Casualty Insurance Company.

Atlantic insured DFWS. DFWS alleges it suffered damages as the result of a tornado and high winds. After making a claim for damages, DFWS alleges that Atlantic “engaged in a results-based investigation to find a non-covered cause of loss to the detriment of DFWS and contrary to the clear evidence otherwise.”

The resulting lawsuit sued for violations of Texas Insurance Code, Sections 541.060(a)(1), (2), (3), (4), and (7). Atlantic files a Rule 12(b)(6) motion to dismiss in response to the lawsuit.

Insurance Claims Denial Lawyer – Bad Faith Pleadings

January 9, 2021 | Mark S. Humphreys

Here is an opinion from the Northern District of Texas, Dallas Division, that discusses the pleadings in a lawsuit where in the property owner claims to have suffered hail damage and the insurer denied the claim. The opinion is styled, Valtex Properties LLC v. Central Mutual Insurance Company.

The insured, ValTex, sued Central for various violations of the Texas Insurance Code. The allegations are that Central violated sections, 541.060(a)(1), 541.051, 541.052, and 541.061. In response, Central filed a Rule 12(b)(6) motion to dismiss. This blog will deal with only Section 541.060(a)(1). However, the case is a good read on how the Court dealt with remaining Insurance Code sections.

To survive a motion to dismiss, a plaintiff must plead enough facts to state a claim to relief that is plausible on its face. Thread bare recitals of the elements of a cause of action, supported by mere conclusory statements, do not suffice. A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged. The plausibility standard is not akin to a ‘probability requirement,’ but it asks for more than a sheer possibility that a defendant has acted unlawfully. When well-pleaded facts fail to achieve this plausibility standard, the complaint has alleged—but it has not shown—that the pleader is entitled to relief.

Insurance Claims Denial Attorneys – ERISA

January 4, 2021 | Mark S. Humphreys

The Employee Retirement Income Security Act of 1974 (ERISA) offers many of the same types of insurance coverage for individuals as other plans. The distinctions with ERISA is that the plan is a plan for employers to offer to employees that is set and governed by Federal Law rather than State Law.

ERISA plans offer retirement programs, life insurance, disability insurance, and health insurance. The Southern District of Texas, Houston Division, issued an opinion in November 2020, on a case that is governed by ERISA. The opinion is styled, Wagna Mina huerta v. Shell Oil Company and Shell Oil Comprehensive Welfare Benefits Plan.

This case discussed a couple of issues. One of those, rarely seen in an opinion, is discussed here.