Dallas Fort Worth Insurance Lawyer Blog

Insurance Company Making Partial Payment Of Claim

May 20, 2020 | Mark S. Humphreys

Does an insurance company making a partial payment of a claim mean that they are responsible for the claim. The answer to this question and a couple of other questions was answered by the United States 5th Circuit in the April 2020, opinion styled, Sandford T. Pulley v. Safeco Insurance Company of America.

Safeco was the insurer for Pulley on some property he owed. The District Court granted summary judgment in favor of Safeco and this appeal followed.

Pulley argues that summary judgment for Safeco was improper because, in Pulley’s view, by initially sending him a check in response to his insurance claim, Safeco conceded liability. Since the check was insufficient to offset his repair costs, Pulley argues that the only remaining issue in the case is the amount of damages. Pulley cites neither the terms of the policy nor any legal authority for the proposition that Safeco’s partial payment of his claim is an admission of liability. As a result, and because Pulley fails to address the District Court’s basis for dismissing his claims, the summary judgment was affirmed.

Pre-Suit Notice In Insurance Cases

May 17, 2020 | Mark S. Humphreys

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.

ERISA And How It Works

May 16, 2020 | Mark S. Humphreys

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.

Homeowners Claim And Breach Of Contract

May 13, 2020 | Mark S. Humphreys

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) Benefits

May 10, 2020 | Mark S. Humphreys

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.

Suing The Insurance Adjuster And Insurer Accepting Responsibility

May 9, 2020 | Mark S. Humphreys

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.

Uninsured/Underinsured Issue

May 6, 2020 | Mark S. Humphreys

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.

Exemplary Damages And Coverage

May 3, 2020 | Mark S. Humphreys

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.

Totaled Vehicles And Insurance Compensation

May 1, 2020 | Mark S. Humphreys

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.

Concurrent-Cause Doctrine

April 29, 2020 | Mark S. Humphreys

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.