Dallas Fort Worth Insurance Lawyer Blog

ERISA Claim – 5th Circuit

May 11, 2019 | Mark S. Humphreys

After reporting just a few days ago about a significant victory on an ERISA case, today we are reporting on a loss from the 5th Circuit. This case is from Eastern District of Lousiana but the appeals court is the 5th Circuit which is the same appeals court for cases out of Texas and the court that Texas courts are to look to in rendering their decisions. The case is styled, Amanda C. Foster v. Principal Life Insurance Company.

Amanda worked as an attorney when she started experiencing intractable migraine headaches that made work impossible. Amanda applied to Principal for long term disability (LTD) benefits. After multiple reviews by various healthcare providers Principal denied her claim, concluding Amanda was not disabled within the meaning of the policy.

As in most disability claims, the reports from various medical providers for the claimant are voluminous and lengthy, as are the reviews by the doctors hired by the insurer to review the claim.

Press Release Number 10

May 8, 2019 | Mark S. Humphreys

The law office of Mark S. Humphreys, P.C. is pleased to announce a settlement in a case involving a disability policy.

In this case the insured lady had purchased a disability policy through an advertisement she had received in the mail. The lady paid on the policy for a number of years when one day she was involved in a one vehicle automobile accident. This lady was severely injured and was in a hospital for about a week. Her injuries among other things included paralysis to one side of her body. This paralysis to one side of the body is called hemiplegia. Another term used to describe this condition is hemiparesis. However, from a medical perspective, these two terms have distinct meanings.

Hemiplegia is total paralysis to one side of the body, while hemiparesis is a partial paralysis to one side of the body.

ERISA – A Win!

May 8, 2019 | Mark S. Humphreys

Insurance attorney who handle denied claims and in particular insurance attorneys who are willing to take on an insurance claim governed by ERISA claim which has been denied, needs to read this opinion from the Eastern District of Texas, Sherman Division. The case is styled, Gina Pike v. Hartford Life And Accident Insurance Company.

Pike had received long term disability (LTD) benefits from Hartford from April 24, 2008 through December 14, 2016, the period of time when Hartford determined Pike met the definition of disability in the LTD policy. Later, after determining Pike was unable to prove she continued to be disabled under the policy, the benefits ceased on December 15, 2016.

This case resulted in a 51 page opinion which is not going to be discussed at any length here. What is relevant is that it is rare for beneficiaries of these employer sponsored benefit plans and as a result needs to be carefully read to determine what the Court saw that separated this case from other ERISA cases.

Experts And Insurance Claims

May 5, 2019 | Mark S. Humphreys

Insurance lawyers need to read this recent opinion from the Southern District of Texas, McAllen Division. It is styled, Federico Flores Cazares, et al v. Allstate Vehicle And Property Insurance Company.

This case / claim arises out of a claim for property damage made by plaintiffs against Allstate. Allstate sent an adjuster who concluded the property damage was not storm related which would be covered by the policy, rather the damage was wear/tear, and deterioration that occurred over a period of time and not covered by the policy.

Plaintiff’s filed suit in State Court and Allstate had the case removed to Federal Court.

Liability Insurance Dispute

May 4, 2019 | Mark S. Humphreys

The Penn Record published an article on March 18, 2019, discussing changes in insurance law in Texas. The article is titled “Texas Lawmakers Say The ALI’s Insurance Law Project Not Worthy Of Recognition By The Courts“.

Legislation has recently been filed by Texas legislators to discourage Texas courts from relying on the controversial passage of the American Law Institute’s Restatement of the Law of Liability Insurance.

Philadelphia based, ALI has a history of publishing Restatements with the goal of providing summaries to judges who deal with these types of legal issues. People question whether the group has started proposing new laws rather than restating existing ones. As a result the Texas legislature has filed three measures this year in response.

Reading The Insurance Policy

May 1, 2019 | Mark S. Humphreys

Insurance policies need to be read carefully and complied with. The reason is that most times the courts are going to enforce the insurance policy provisions. This is illustrated in a 2019 opinion from the Southern District of Texas, Galveston Division. The case is styled, Benjamin Ford, et al v. United Property & Casualty Insurance Company, et al.

The Fords had a homeowners policy with United. The Fords filed a claim with United for damage to their home resulting from a hurricane. United inspected the claim and offered a cash settlement of $7,105.74. The Fords rejected the offer and sought another inspection, after which, United made a “supplemental payment of $31,053.89. This payment was also rejected causing United to invoke the appraisal provision in the homeowner’s policy on January 18, 2018.

Two months later, the Fords sent a pre-suit demand letter to United. United responded by invoking the appraisal right again. The Fords then filed this lawsuit. United filed a motion with the court seeking an Order that appraisal be compelled.

Prompt Reporting Of A Claim

April 28, 2019 | Mark S. Humphreys

One of the responsibilities for an insured who has a claim is to promptly report the claim to his insurance company. This is illustrated in this 2019, Southern District of Texas, Houston Division, opinion styled, Bobwhite Rentals, LLC v. National Liability & Fire Insurance Company.

This is a summary judgment case in favor of National.

One of Bobwhite’s customers had property destroyed by a fire on March 6, 2015, while the property was on Bobwhite’s premises. Bobwhite reported the fire to its insurance broker the same day.On April 30, 2015, Bobwhite paid $50,000 to settle the customer’s claim. Over a year later, the fire and the damage to the customer’s property was reported to National. National issued a reservation of rights letter on July 14, 2016 and began its investigation of the claim and on November 1, 2017, denied the claim saying:

Insurance – Proof Of Loss

April 27, 2019 | Mark S. Humphreys

Filing a proof of loss as part of a claim is very basic to all insurance claims. This issue was a topic in a recent Fifth Circuit opinion styled, Andre Yanez v. American Strategic Insurance Coporation; E-Ins., L.L.C.; FKS Insurance Services, L.L.C.

The lower court granted the insurers motion for summary judgment based on Yanez not submitting a proof-of loss form as required by the federal flood program policy.

This claim arose out of storm in 2016, causing flood damage to Yanez’s property. Yanez filed a claim and adjusters were assigned to the claim. Yanez completed a flood field survey and filed a proof-of-loss and was paid for the 2016 flood consistent with the proof-of-loss that was filed.

Press Release # 9

April 26, 2019 | Mark S. Humphreys

The Law Office of Mark S. Humphreys, P.C. was able to get a settlement in a life insurance case recently that was not a normal situation.

Texas has a law referred to as the “Slayer Statute.” This law which is found in the Texas Insurance Code, Section 1103.151, states that if a person named as the beneficiary in a life insurance policy intentionally causes the death of the insured, then that beneficiary is excluded from recovery of the life insurance benefits. If this happens then according to Texas Insurance Code, Section 1103.152, the life insurance benefits then go to the next person entitled to the proceeds of the policy.

Mark represented the daughter of the insured.

Life Insurance Claim And Who Caused Death

April 24, 2019 | Mark S. Humphreys

The law in Texas regarding who is excluded from receiving life insurance benefits when the insured has been killed is clear. Texas Insurance Code, Section 1103.151, says that the named beneficiary forfeits their rights in the life insurance proceeds if the beneficiary is a principal or accomplice in willfully bringing about the death of the insured.

This issue is discussed in this 2019, Southern District of Texas, Houston Division opinion styled, Reliastar Life Insurance Company, P.T., a minor, and D.T., a minor v. Itani Milleni f/k/a Trang Vu.

This is an interpleader case filed by Reliastar, who insured the life of Tuyet Tran. Reliastar needed this Court to decide whether Trang Vu, Tuyet’s husband and primary beneficiary, or P.T. and D.T., Tuyet’s children and contingent beneficiaries, are entitled to the proceeds. This suit was instigated because Vu was suspected of murdering Tuyet, which if true, would disqualify him from receiving the insurance proceeds. Vu was never prosecuted for the death of Tuyet, but a criminal conviction is not a prerequisite for forfeiting the insurance proceeds.