Dallas Fort Worth Insurance Lawyer Blog

Delay In Paying Claim – Claim Denial

March 6, 2021 | Mark S. Humphreys

Claim Denial Attorneys need to read this opinion from the Southern District of Texas, Houston Division. It is styled, Caramba, Inc. d/b/a Pueblo Viejo v. Nationwide Mutual Fire Insurance Company.

This is a summary judgment case in favor of Nationwide.

This insurance coverage dispute arises out of claim filed seeking damages for various violations of the Texas Insurance Code. The focus here is on Section 542.058. The timeline of Facts of the case by a reading of the case. Discussed here is the Courts reasoning in the case so that Insurance Lawyers can understand how the Courts interpret Section 542.058 when deciding the case.

Life Insurance – ERISA – Part 4

March 1, 2021 | Mark S. Humphreys

This post is a continuation of Parts 1, 2, and 3, posted earlier. This case involves a life insurance policy claim denial that is governed by the Employee Retirement Income Security Act (ERISA).

The opinion is from the Southern District of Texas, Houston Division, and is styled, Erica Talasek v. Unum Life Insurance Company of America, et al.

As in most ERISA claims, the case is being decided on competing Motions for Summary Judgement. The Court found in favor of Unum and explained it’s finding in detail.

Texas Winter Weather Claims Denial

February 27, 2021 | Mark S. Humphreys

Texas homeowners have just experienced the worst loss state wide that has ever been experienced. Homeowners will be reeling from the damage and hopefully the insurance companies treat all their customers fairly. Unfortunately, there will be many customers who end up having their claim denied for one reason or another.

Here are some things to think about as it relates to weather related property claim.

After the historic and widespread property loss and damage resulting from the recent Texas freeze, home and business owners will be turning to their insurance provider for help. Some of those insurance claims will be denied unfairly and property owners will turn to Texas Trial Lawyers Association (TTLA) members for assistance in getting their homes and businesses repaired.

Life Insurance Claim – ERISA – 2

February 22, 2021 | Mark S. Humphreys

Repeating what was stated in the post immediate to this one, “It is important to understand how difficult claims that are governed by the Employee Retirement Income Security Act (ERISA) can be. The law in this area of law is very tough for claimants.” This is illustrated again in a December 2020, opinion styled, Erica Talasek v. Unum Life Insurance Company of America, et al. The opinion is from the Southern District of Texas, Houston Division.

The insured, Ben Talasek, had life insurance through a Plan his employer, NOV, offered. NOV delegated authority and discretion to UNUM to handle claims and made benefit determinations.

Ben was covered by basic life insurance coverage and Ben also enrolled in a voluntary supplemental plan during November 2013. Unlike the basic life insurance, which did not require medical underwriting, the supplemental life insurance required an employee to submit evidence of insurability and obtain approval for coverage by Unum. On January 18, 2014, Unum sent Ben a letter informing him of an error in his application and the need for additional information. Around this time, Ben was diagnosed with pancreatic cancer. Ben called Unum on January 21, 2014 to check on the status of his application and was told about the January 18 letter. Ben corrected the error on the Evidence of Insurability Form and supplied additional information. Ben called Unum again on February 12, 2014 to check on the status of the application and was told that the standard turnaround time for a coverage decision was 4-6 weeks. On March 3, 2014,several weeks after receiving his cancer diagnosis, Ben provided blood and urine samples and basic health history as part of Unum’s requirement that he prove insurability prior to approval of coverage. He did not mention the cancer diagnosis.

Life Insurance Claim Denial – ERISA

February 20, 2021 | Mark S. Humphreys

It is important to understand how difficult claims that are governed by the Employee Retirement Income Security Act (ERISA) can be. The law in this area of law is very tough for claimants. This is illustrated again in a December 2020, opinion styled, Erica Talasek v. Unum Life Insurance Company of America, et al. The opinion is from the Southern District of Texas, Houston Division.

The insured, Ben Talasek, had life insurance through a Plan his employer, NOV, offered. NOV delegated authority and discretion to UNUM to handle claims and made benefit determinations.

Ben was covered by basic life insurance coverage and Ben also enrolled in a voluntary supplemental plan during November 2013. Unlike the basic life insurance, which did not require medical underwriting, the supplemental life insurance required an employee to submit evidence of insurability and obtain approval for coverage by Unum. On January 18, 2014, Unum sent Ben a letter informing him of an error in his application and the need for additional information. Around this time, Ben was diagnosed with pancreatic cancer. Ben called Unum on January 21, 2014 to check on the status of his application and was told about the January 18 letter. Ben corrected the error on the Evidence of Insurability Form and supplied additional information. Ben called Unum again on February 12, 2014 to check on the status of the application and was told that the standard turnaround time for a coverage decision was 4-6 weeks. On March 3, 2014,several weeks after receiving his cancer diagnosis, Ben provided blood and urine samples and basic health history as part of Unum’s requirement that he prove insurability prior to approval of coverage. He did not mention the cancer diagnosis.

Insurance Claims Denial Law Firms – Hail Damage Claims

February 15, 2021 | Mark S. Humphreys

Insurance lawyers who handle hail damage claims will need to read this opinion from the Western District of Texas, San Antonio Division. It is styled, Mazhar Footsteps, LLC v. Amguard Insurance Company and Michael Clayton Hepburn.

This lawsuit arises from damages incurred by a hailstorm. Based on the way the claim was handled, Mazhar sued Amguard and the adjuster, Hepburn. The lawsuit was filed in State District Court. Amguard timely removed the case to Federal District Court based on diversity jurisdiction and in its notice of removal, Amguard elected under Texas Insurance Code, Section 542A.006, to accept whatever responsibility Hepburn might have to Mazhar for Hepburn’s acts or omissions related to the claim.

Mazhar timely filed this Motion To Remand.

Insurance Claims Denial Law Firm – Federal Court Motions

February 13, 2021 | Mark S. Humphreys

Insurance companies always want to litigate cases in Federal Court. The Judges and rules related to proceedings tend to skew in favor of insurance companies. Here is a 2020 opinion where the insured actually got a favorable ruling. The opinion is from the Southern District of Texas, Houston Division, and is styled, Caramba, Inc. v. Nationwide Mutual Fire Insurance Company.

Caramba is the named insured under a Nationwide policy.

Caramba filed a claim for damages after Hurricane Harvey in August 2017. On August 27, 2020, Nationwide filed a Motion for Judgment on the Pleadings pursuant to Federal Rule of Civil Procedure 12(c).

Insurance Claim Denial Lawyers – Mechanical Breakdown

February 8, 2021 | Mark S. Humphreys

Here is an interesting case from the San Antonio Court of Appeals. The opinion is styled, Infinity County Mutual Insurance Company v. Michael Tatsch.

Tatsch had auto insurance with Infinity. Tatsch made a claim for engine damage. Infinity denied the claim and sent Tatsch a letter explaining its decision. The letter read:

The vehicle damage occurred due to poor quality fuel being added to the vehicle which caused mechanical failure to your insured vehicle. There is an applicable exclusion in Your Texas Commercial Auto Policy that states we do not provide comprehensive coverage for damages resulting from mechanical failure.

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.