Prior to filing a lawsuit, if the lawsuit is filed making claims for violations of the Texas Deceptive Trade Practices Act, or the Texas Insurance Code, Chapters 541 or 542A, it is required that at least a 61 day pre-suit notice be given if the claimant wishes to recover all that is legally allowed under those laws.

A 2020 case from the Western District of Texas, San Antonio Division, makes this clear.  The opinion is styled, PMG International, LTD. v. Travelers Indemnity Company of America.

This lawsuit results from an insurance dispute between PMG and Travelers related to storm damage to one of PMG’s properties insured by Travelers.  PMG sued Travelers alleging breach of contract and various violations of the Texas Insurance Code after the claim was denied.

Attorneys who handle Employee Retirement Income Security Act (ERISA) cases need to be able to explain to potential clients how ERISA cases are handled / looked at, by the Courts.  This is explained in a 2020 opinion from the Western District, San Antonio Division, case.  The case is styled, Ramon Hernandez v. Life Insurance Company of North America, Schlumberger Group Welfare Benefits Plan.

The case needs to be read to grasp an understanding of the underlying facts.  Here, we are looking at the law the Court used in reaching its determination.

In this case, the Court granted summary judgment against Hernandez.  In reaching the decision, the Court restated law as it relates to ERISA cases.  The Court looks at these cases under an “abuse of discretion” standard, not a de novo standard.

Home owners claims are a frequent source of litigation.  Here is a case from the Northern District of Texas, Fort Worth Division, that has a little different twist to it.  The case is styled, Allen Ripley, et al v. State Farm Lloyds.

Ripley’s home was damaged by a hail storm and he was insured by State Farm.  A dispute arose about the damages and there was ultimately an appraisal award.  State Farm did not pay the full appraisal amount due to their assertion that part of the damages were not covered by the policy.  This lawsuit resulted with Ripley alleging breach of contract and various violations of the Texas Insurance Code.

State Farm filed a motion to dismiss for failure to state a claim.

Personal Injury Protection (PIP) is a coverage which is required by Texas law to be offered when a person purchases automobile coverage.  One of the questions regarding this coverage is, why is it paid.  This issue was partially addressed in the 2020, Texas Supreme Court opinion styled, Farmers Texas County Mutual Insurance Company v. Rodney Beasley.

In this case the Court had to decide whether a plaintiff had standing to file a lawsuit against his PIP insurer after the insurer paid the incurred medical expenses pursuant to the PIP policy, but the amount paid was the negotiated rate between the plaintiff’s health care provider and the insurer — not the medical providers’ list rate.  This Court concluded that plaintiff could not show harm and thus, the case should be dismissed.

Here, Beasley was injured in a car accident.  Beasley sought medical treatment and incurred expenses with a list rate of $2,662.54.  Beasley’s health insurer, Blue Cross Blue Shield (BCBS) has a negotiated rate with the medical providers and paid $1,068.90, and no attempt was made against Beasley by the medical providers to recover any further monies.

Insurance lawyers know the insurance laws change every year and know that they have to keep up with those changes.  One significant change was when Texas Insurance Code, Section 542A was added.  While this change is to the advantage of the insurance company, there are times when the insurance company does not properly take advantage of the change.

This happened in a 2020 case in the Southern District of Texas, Houston Division, styled, Mohammad Shenavari v. Allstate Vehicle and Property Insurance Company, et al.

Shenavari, a homeowner with insurance through Allstate suffered storm damage and made a claim with Allstate.  Allstate assigned adjuster Idolina Stockert to the claim.  Stockert made an offer to Shenavari that was unacceptable and a lawsuit being filed in State Court suing Allstate and Stockert resulted.

Here is a 2020, case wherein the Court allowed a petition to be amended and the result being that diversity jurisdiction was defeated.  The opinion is from the Southern District of Texas, Houston Division.  It is styled, Robert Jones v. State Farm Mutual Automobile Insurance Co.

State Farm provides uninsured motorist (UIM) coverage to Jones.  Tho Thi Le struck Jones.  Jones sued State Farm in State Court seeking UIM coverage on September 26, 2019.  Le is uninsured.  State Farm removed the case to this Federal Court on October 31 after filing its answer on the 25th.  Le is a resident of Texas and State Farm is not.

Jones sought permission to amend his pleadings on November 8, seeking to add Le as a defendant.

The purpose of exemplary damages is to punish someone for wrongful conduct.  So, should an insurance company be required to pay for exemplary damages when the policy does not provide coverage for exemplary damages?

This issue was addressed in a 2020, Western District of Texas, San Antonio Division, opinion styled, Richard Brett Frederking v. Cincinnati Insurance Company.

Frederking had been seriously injured in an auto accident wherein Carlos Sanchez, while driving for his employer, caused the wreck while driving while intoxicated (DWI).  The case went to trial and Frederking was paid for his injuries and the jury also awarded exemplary damages of $207,550.00.  The insurer, Cincinnati paid the injuries portion of the judgement but refused to pay the exemplary damages and this lawsuit for that amount resulted.

How much should a person be compensated when their vehicle is declared a total loss?   A better question is – what are the elements that make up the total amount to be compensated?

This issue is discussed in a 2020 opinion from the United States Fifth Circuit.  The opinion is styled, Jessica Singleton and Tony Cooper v. Elephant Insurance Company.

When an insured automobile is so damaged that it would cost more to repair than to replace, it is usually deemed a total loss.  The insurance company then reimburses the policyholder for the value of the vehicle, with the expectation that the policyholder will probably use this money to purchase a replacement.  Of course, purchasing and registering the replacement vehicle requires the payment of taxes and fees to the state.

The concurrent-cause doctrine is a source of much litigation as it relates to storm damage to roofs and structures.  This was the issue in a 2020, Western District of Texas, San Antonia Division, opinion styled, Ironwood Building II, LTD. and Principle Auto Management, LTD. v. Axis Surplus Insurance Company.

This is an opinion issued on competing motions for summary judgment.  The Court denied both motions.

The Plaintiffs suffered a hailstorm in 2016, and were paid money related to the damages by the insurance company who provided coverage at the time of the loss.  Only minor repairs were made and there were no leaks occurring on the property.  After this, Plaintiffs purchased another insurance policy with Axis.

For Insurance Lawyers, Covid-19 has become a hot topic.  Hardly a day goes by that a client is not asking questions regarding their insurance policy and whether or not the policy covers losses stained due to Covid-19.  The National Law Review published an article recently that needs to be read by lawyers handling these Business Interruption cases.

The article tells us that the legal media have been inundated with articles by lawyers who represent policyholders and insurance companies discussing business interruption claims arising from the COVID-19 pandemic.  Some of this discussion has carried over into the mainstream media, including a recent Wall Street Journal article titled, “Restaurants v. Insurers Shapes Up As Main Event In D.C. Lobbying Fight.”  Much of the discussion focuses on two issues.  The First, property insurance policies require “direct physical loss or damage” to property (either to the insured property, or non-insured property within a certain distance of the insured property for a coverage called “civil authority”).  A virus has never been found to cause damage to property.  Second, most, but not all, of these policies have a virus exclusion.  We are not writing here about those issues.  Plenty of barrels of ink has been already spilled on those issues.  But I haven’t seen any authors write about another exclusion that seems likely to apply to these claims if policyholders can somehow convince a court that there was “direct physical loss or damage” to property: it is the the ordinance or law exclusion.

The ordinance or law exclusion typically provides that the insurer “will not pay for loss or damage caused directly or indirectly by . . . the enforcement of or compliance with any ordinance or law . . . regulating the . . . use . . . of any property . . . .”  That seems to be precisely what many of the governmental orders being issued do.  For restaurants, for example, government orders typically regulate the use of the business premises by limiting operations to takeout and delivery, prohibiting dine-in service.  At some point it is expected that dine-in service will be allowed, but limited to tables spaced six feet or more apart, as has begun occurring in some other countries.  With respect to other businesses, governmental orders may limit their operations to curbside delivery of items purchased by phone or online, or require or urge them to have employees work from home except for certain limited operations that can only be conducted in the office.

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