Dallas Fort Worth Insurance Lawyer Blog

Life Insurance Claim Denial – Knowledge of Misrepresentation

August 3, 2019 | Mark S. Humphreys

Life insurance lawyers need to be know this 1990, opinion from the Texas Supreme Court. It is styled, Koral Industries v. Security-Connecticut Life Insurance Co.

It is not uncommon for a beneficiary of a life insurance policy to concede that misrepresentations regarding health were made on an application for life insurance. What they will contest is that the insurance company should have known of the misrepresentations.

In the Koral case, Koral sought insurance on one of its key employees, Lewis Lindsey. Lindsey did not disclose on the insurance application his medical history regarding treatment over the previous five years a history which included hospitalization in 1981, 1982, and 1983, and counseling and treatment for depression and excessive use of alcohol. Further, he had been treated for mental or nervous disorders from 1976-78, and his physician had treated him for anxiety.

Texas Prompt Payment Of Claims Act – Texas Supreme Court

July 31, 2019 | Mark S. Humphreys

The Texas Supreme Court has rendered an opinion which concerns the Texas Prompt Payment of Claims Act (TPPCA). The opinion issued on June 8, 2019, and is styled, Barbara Technologies Corporation v. State Farm Lloyds.

In this case, the Texas Supreme Court reversed the appeals court judgment, which had granted summary judgment in favor of State Farm, and remanded the case to the trial court for further proceedings.

This case arose out of a wind and hail storm that damaged Barbara Tech’s property on March 31, 2013. Tech filed a claim with State Farm on October 17, 2013, pursuant to the insurance policy, requesting coverage of the cost of repairs. State Farm promptly inspected the costs of repair and denied Tech’s claim based on the assertion that the damage totaled $3,153.75, which was less than Tech’s $5,000 deductible. Tech requested a second inspection and State Farm conducted another inspection finding no additional damage.

Texas Insurance Code, Section 542A Opinion

July 28, 2019 | Mark S. Humphreys

Here is another Federal opinion discussing Texas Insurance Code, Section 542A. The opinion is from the Eastern District of Texas and is styled, John McAdams v. Palomar Specialty Insurance Company, Wellington Claim Service, Inc. and Nicholas Abdallah.

McAdams had a homeowners insurance policy with Palomar when he suffered damages alleged to have been caused by Hurricane Harvey. Palomar assigned Wellington to investigate the claim and Wellington assigned adjuster Nicholas to inspect the claim.

The claim was not sufficiently covered according to McAdams and he eventually filed suit against Palomar, an out of state defendant, and against Wellington and Nicholas, both in-state defendants. McAdams alleged wrongs committed in the claims handling process.

Texas Insurance Code, Section 542A

July 27, 2019 | Mark S. Humphreys

Texas Insurance Code, Section 542A, is being used regularly now by insurance companies to prevent Plaintiffs from defeating diversity jurisdiction.

This Insurance Code Section was discussed by a court in the Southern District of Texas, Houston Division, in a case styled, Robert Ewell v. Centauri Specialty Insurance Company, et al.

Ewell filed a claim with Centauri, who insured Ewell’s home, for property damage alleged to have occurred during a severe storm on August 25, 2017. Steven Wiley is the adjuster assigned to investigate the claim. Centauri is alleged to have failed to pay the full amount of the claim.

Insurance Adjusters And Mediation

July 24, 2019 | Mark S. Humphreys

The vast majority of insurance cases are Ordered by a Court to participate in a mediation. There is good reason for this. Most cases, if they do not settle before mediation, will settle at mediation. The settlement brings an end to the litigation between the parties and saves court time and resources. For mediation to be successful, the parties with full settlement authority and the attorneys need to be present. So what if a particular person does not show up at the mediation? What is that person is the person most knowledgeable about the case?

The El Paso Court of Appeals issued an opinion in a mandamus case styled, In Re: Mary Anne Vinson. This case arises out of a car wreck between Jaime Soto and Stephanie Dutchover wherein Soto sued Dutchover for negligence in causing a car wreck and the resulting damages. Dutchover was insured by Allstate and Vinson was the adjuster assigned to handle the claim and the adjuster most familiar with the case.

The trial court signed an order appointing a mediator and further stated: “All Parties and their representatives with full settlement authority shall attend the mediation process, with their counsel of record.” Vinson did not attend the mediation but another adjuster did attend.

One Way To Stay Out Of Federal Court

July 21, 2019 | Mark S. Humphreys

Like it or not, an insured suing his insurance company has a much better chance of getting a favorable or more favorable result in State Court versus Federal Court. And, the insurance companies know this. As a result, an insurance company is always seeking to have a case heard / litigated in the Federal Court.

Here is a case wherein the insured was able to defeat the efforts of the insurance company to have the case heard in Federal Court. We don’t know whether this was the best way of doing it without knowing more about the Facts in the case but at the least the insured was successful in being able to litigate his case in State Court.

The case is from the Southern District of Texas, Galveston Division, and is styled, Ronald Mason v. Evanston Insurance Company.

Hail Damage Claims

July 20, 2019 | Mark S. Humphreys

Lawyers handling hail damage claims have to prove the claim. This is illustrated in a Southern District of Texas case styled, Faustina Ortiz v. United States Liability Insurance Group, et al.

Ortiz owns a restaurant in Conroe, Texas. He had a policy of insurance with United that provided coverage for windstorms and hailstorms wherein the policy period was from January 26, 2016, to January 26, 2017. On August 23, 2016, a claim was filed with United asserting that on May 26, 2016, a hailstorm caused extensive damage to the building and walls.

United’s adjuster inspected the building on September 6. He photographed and found (1) deterioration, (2) poor maintenance, (3) numerous gaps in the roof, and (4) earlier repairs.

Timing Of Removal

July 17, 2019 | Mark S. Humphreys

Insurance lawyers always want to remove cases filed by insured’s to the Federal Courts. In most instances they are successful in these efforts. Here is a situation where the insurance lawyers were too late in getting the case removed to Federal Court.

This case is from the Southern District of Texas, Houston Division. It is styled, Solaiha Enterprises LLC v. Amguard Insurance Company.

Amguard was the insurer for Solaiha when Solaiha made a claim for property damage. Amguard refused to pay the claim and Solaiha sued Amguard and Ronnie Patel, the agent who sold the policy. The lawsuit was filed on May 4, 2017, in State Court. Solaiha dismissed its claim against Patel in late February of 2019. Amguard filed a Notice of Removal on March 14, 2019, and Solaiha promptly filed this Motion to Remand arguing that Amguard was untimely in filing its Notice of Removal.

Timing Of Accepting Responsibility For Agent

July 14, 2019 | Mark S. Humphreys

Here is an opinion issued by a Magistrate Judge from the Western District, Austin Division, which says that the insurer was too late in accepting responsibility for the acts of its agent, the adjuster, when the company accepted responsibility the day before removal was filed. The case is styled, Robbins Place West Campus, LLC v. Mid-Century Ins. Co. and Jillian Meghan Sherman.

In this case, Robbins had commercial insurance coverage with Mid-Century when Robbins suffered wind and hail damage. Robbins was unhappy with the way the claim was handled by the adjuster, Sherman, and sued Sherman and Mid-Century in State District Court for various violations of the Texas Insurance Code and breach of contract.

Pursuant to Texas Insurance Code, Section 542A.006, Mid-Century made an election to legal responsibility for Sherman. The next day, Mid-Century removed the case to this Federal Court.

Segregating Damages

July 13, 2019 | Mark S. Humphreys

Lawyers handling insurance claims run into situations where damages that have occurred to property have to be segregated. This happens most often in the context of hail and wind damage to property. The U.S. District Court Northern District of Texas, Dallas Division, issued an opinion that does a good job of discussing how the courts are to look at these situations. The case is styled, Generation Trade, Inc. v. Ohio Security Insurance Company.

In this case, Generation bought the subject property in 2014, and had it covered by Ohio ever since. In July 2017, Simon, the owner of the property, observed hail damage and promptly reported the damage to Ohio. Ohio inspected the roof and acknowledged there was hail damage but after reviewing hail events over a period of time was unable to determine when the loss occurred.

This property was originally built in 1981 and was covered with a 24 gauge metal roof except for a small portion of the roof that was installed in May of 2016, that had 26 gauge roofing.