Dallas Fort Worth Insurance Lawyer Blog

ERISA Disability Claim Denied

June 16, 2019 | Mark S. Humphreys

Here is yet another ERISA claim being denied by the Federal Courts. This case is from the United States Fifth Circuit Court of Appeals and is styled, Deo G. Shanker v. United Omaha Life Insurance Company.

The District Court granted United’s summary judgment motion and this appeal followed.

Shanker was President of a company called Intracare and United was the insurer under an ERISA plan which provided for long-term-disability (LTD) benefits. To qualify for LTD benefits, Shanker had to become “Disabled due to an Injury or Sickness, while insured under the Policy.” Disabled is defined to mean: “Because of Injury or Sickness, a significant change in Your mental or physical functional capacity has occurred in which you are prevented from performing at least one of the Material Duties of Your Regular Occupation on a part-time or full-time basis ….” Material Duties is defined as “the essential tasks, functions, and operations relating to an occupation that cannot reasonably omitted or modified” and includes “the ability to work for an employer on a full-time bases.” Regular Occupation is defined as “the occupation You are routinely performing when Your Disability begins.” The definition in the policy also notes:

Insurance Claim And Allegations Of Arson

June 15, 2019 | Mark S. Humphreys

In situations where the insurance company is denying a claim based on their allegation that the claim involves arson, Insurance Lawyers would want to be aware of this decision from the Tyler Court of Appeals. The opinion is styled In Re: United Fire Lloyds, Relator. This is a writ of mandamus case.

The insured, Inner Pipe Pipeline, LLC, owned a Commercial Property, Commercial Auto, and Inland Marine policy issued by Lloyds. Inner Pipe’s property was damaged by fire and filed a claim with Lloyds.

Lloyds alleges that Inner Pipe’s owner, Edward Dailey, intentionally set the fire and had the motive, opportunity and means to set the fire, and there is substantial evidence linking Dailey to the fire, thus rendering coverage by Lloyds, void.

Insurance Claim Denial – Water Leak

June 15, 2019 | Mark S. Humphreys

For lawyers who handle claims against insurance companies, here is a case regarding a claim against a homeowners policy and a water leak. The case is from the Western District of Texas, San Antonio Division. The case is styled, William Burman v. State Farm Lloyds. It is a partial summary judgment case.

Burman had a homeowners policy of insurance with State Farm. Burman experienced a water leak and filed a claim. State Farm retained an engineer, Lara, to determine whether the leak caused the foundation to move. Lara’s report stated “that the observed foundation movements are primarily the result of seasonal moisture changes, and vegetation effects. Also, that a line identified by American Leak Detection was leaking and exacerbated the foundation movements in an isolated area of the residence.

The area effected by the leak was paid for by State Farm but the claim for other areas was denied asserting the foundation problems predated the leak and the leak damage did not warrant underpinning.

Damaged Property And Dates It Was Damaged

June 12, 2019 | Mark S. Humphreys

Here is a case from the Northern District of Texas, Fort Worth Division, wherein the dates of the alleged damage incurred because of hail, is in dispute. The style of the case is, LTG & Associates, Inc. v. Monroe Indemnity Insurance Company.

This is a summary judgment case granted in favor of Monroe.

LTG owns several properties that are insured by Monroe. LTG alleges that on or about April 1, 2015, and March 23, 2016, the properties suffered damage due to a severe hail and windstorm. The storm is alleged to have caused incredible damage. LTG further claims that Monroe hired adjustors for both storms to provide biased engineering reports so that it could deny coverage. It is also alleged that on both occasions the adjustors wrongfully and intentionally ignored objective evidence of the wind and hail storm.

ERISA And Discovery

June 9, 2019 | Mark S. Humphreys

ERISA lawyers are quick to tell potential clients the limitations of ERISA claims. One of those limitations is that little to no legal discovery is allowed in ERISA claims. This is discussed in an April 2019, opinion from the Northern District of Texas, Dallas Division. The case is styled, Jose Chavez v. Standard Insurance Company.

In this lawsuit, Chavez is seeking long term disability (LTD) benefits from Standard.

Chavez filed suit against Standard in sought to compel discovery of contractual and financial arrangements under which Standard’s medical consultants played their respective roles regarding Chavez’s LTD claim. Chavez also sought discovery of Standards internal claim procedures.

Insurance Claims – Personal Jurisdiction & Subject Matter Jurisdiction

June 8, 2019 | Mark S. Humphreys

Most insurance lawyers understand the distinction between “personal jurisdiction” and “subject matter jurisdiction”. A recent case from the Northern District of Texas, Dallas Division, explained the difference. The case is styled, Yakimas Payne, Carmenisha Payne, and Mar’Keyona Ford v. Government Employees Insurance Company.

The Plaintiffs sued GEICO in State Court for uninsured motorist benefits. GEICO removed the case to Federal Court and the Plaintiffs filed a motion to remand, arguing that diversity jurisdiction existed but that GEICO had “continuous and systematic contacts with the state of Texas sufficient to establish general jurisdiction.

GEICO argued that Plaintiffs have confused personal jurisdiction with diversity jurisdiction. The Court set forth standards for the two types of jurisdiction.

Suing That Insurance Adjuster In A Homeowners Claim

June 5, 2019 | Mark S. Humphreys

Insurance lawyers got good news about a month earlier, on April 8, 2019. The case they got good news out of was from the Western District of Texas, Austin Division. The style of the opinion was River Of Life Assembly Of God v. Church Mutual Insurance Company and Jim Turner Harris.

The style of this case is still the same but the Court amended its order and the language added to the opinion does a good job of articulating the reasoning in the opinion. This new language and amended order is helpful for insurance lawyers helping insureds in similar situations.

This was a lawsuit about insurance coverage for storm damage. River of Life had sued Church and the adjuster, Harris, for the way the claim was handled. The suit was filed in State Court because Church is diverse and Harris is not. Pursuant to Texas Insurance Code, Section 542A.006(c), Church elected to accept responsibility for Harris and removed the case to Federal Court. The statute requires River of Life to dismiss its claims against Harris after this election to accept responsibility for Harris. So the issue here was whether it was proper to remand the case back to the State Court or to keep it in this Federal Court.

How Does Insurance Work In A Divorce?

June 2, 2019 | Mark S. Humphreys

Unfortunately, this is an issue that has to be addressed too often. An article was written in April 2019, in Forbes, that addresses this issue. The title of the article is “Insurance Issues To Consider In A Divorce.”

Most of the time and fighting and arguing in divorce situations is directed toward emotional, financial, and child custody issues. What can be lost in the mix is, what is going to happen regarding insurance policies. Usually the law of the state where the divorce is taking place deals with all these issues.

This Blog deals with Texas and when it comes to divorces and the issues surrounding divorces, the Texas Family Code is the source of information for how Texas Courts address these issues and also, insurance policies.

Prompt Notice Must Be Given When Insurance Company Plans To Deny A Claim Based On A Misrepresentation

June 1, 2019 | Mark S. Humphreys

With regards to life insurance policies, what if the insurance company denies a claim for benefits based on their assertion that a misrepresentation was made in the policy application?

This is covered by the Texas Insurance Code, Sections 705.001 to 705.005 and 705.101 to 705.105. This is also addressed by a San Antonio Court of Appeals opinion from 1969. The style of the San Antonio case is, The Prudential Insurance Company of America v. Ignacio Torres et ux.

The facts in Torres are substantially undisputed. Torres was an employee of Gonzaba, who had six employees. Gonzaba was considering purchasing group life and health insurance for his employees and their families when he eventually purchased a policy through a new employee, Avalone, of Prudential.