Dallas Fort Worth Insurance Lawyer Blog

ERISA Insurance And Administrative Review

April 20, 2019 | Mark S. Humphreys

Lawyers who handle ERISA cases always have to explain to their clients that in ERISA cases, the administrative process has to be completed before a lawsuit can be filed. This is illustrated in this 2019 opinion from the Southern District of Texas, Houston Division case styled, Lisa K. Bunner v. Dearborn National Life Insurance Company, et. al.

This case arises out of denial of long-term disability benefits to Lisa contained in her employee welfare benefit plan. This case is governed by the Employee Retirement Income Security Act of 1974 (ERISA).

The details of this case can be read in the opinion. What is relevant here is the Court stating / emphasizing the requirement that the administrative process be exhausted prior to filing a lawsuit.

Insurance – Amount In Controversy

April 17, 2019 | Mark S. Humphreys

Insurance companies prefer to litigate cases in Federal Court. Insurance lawyers representing insureds prefer to litigate their cases in State Court. In the appropriate situation, here is a way to stay in State Court.

This is from the Southern District of Texas, Houston Division, and the case is styled, WEN WIRELESS, INC. d/b/a Cell Spot, Kick Back Wireless v. Amguard Insurance Company.

Wen sued Amguard in County Court and Amguard timely removed the case to Federal Court based on diversity jurisdiction. Wen filed a Motion for Remand under 28 U.S.C., Section 1441(a) asserting that the Court did not have federal jurisdiction.

Press Release # 8

April 14, 2019 | Mark S. Humphreys

The Law Office of Mark S. Humphreys, P.C. is pleased to announce the settlement of a life insurance case wherein Mark was able to recover life insurance benefits for his client.

Mark’s client was the common-law wife of man who had a life insurance policy through his employer. Texas recognizes these informal marriages in the Texas Family Code, Section 2.401.

Upon the death of the man, Mark’s client made a claim for the life insurance proceeds. No one had been named as the beneficiary of the life insurance policy This claim was denied. The employer asserted there was no formal marriage and any life insurance proceeds went to the estate of the employee. This man did not have kids and his parents were deceased. If this man were married to Mark’s client, then all the proceeds would go to Mark’s client.

Insurance – Two Trials Or One?

April 14, 2019 | Mark S. Humphreys

The Southern District of Texas, Houston Division was presented with an issue that is not seen very often in insurance cases except cases involving uninsured motorist benefits. The case is styled Lamar Donald, Sr. and Diane Cottrell Donald v Metropolitan Lloyds Insurance Company of Texas.

Lloyds filed a Motion to Sever and Abate. This Court denied the motion. Here is why.

Plaintiff’s assert that Lloyds improperly denied or paid their claim for benefits after suffering damage from Hurricane Harvey. The Plaintiff’s sued sued for breach of the insurance contract and for extra-contractual claims based on the Texas Insurance Code.

Press Release #7

April 13, 2019 | Mark S. Humphreys

For attorneys handling life insurance cases here is news:

In early November, the Law Offices of Mark S. Humphreys, settled another life insurance case. The details are confidential as part of the agreement but here is what can be discussed.

The case involved a lady who had purchased coverage on herself years ago but when she moved from one state to another, she changed banks without forwarding the information to the insurance company and thus, the automatic bank drafts ceased and she had a lapse in coverage. She corrected the lapse within three months but as part of renewal of the policy she had to re-affirm her health conditions. In doing so, the insurance company claimed that her health condition had changed for the worse and that this change was not truthfully disclosed in the renewal application. When the lady died eight months later, her daughter, the beneficiary under the policy, made a claim for benefits. The life insurance company began an investigation and discovered the health conditions that had not disclosed in the renewal application and denied the daughter the life insurance benefits.

Insurance And Breach Of Contract

April 13, 2019 | Mark S. Humphreys

Not paying on an insurance claim is in simple terms, a breach of contract. The difference is that the contract breached is an insurance contract. The Texas Insurance Code provides for damages beyond the simple breach of contract damages. However, as is pointed out in the 2019, opinion from the Southern District of Texas, Victoria Division, you still have to prove the insurance contract was breached. The style of the case is, Deborah Gonzalez v. Allstate Vehicle and Property Insurance Company.

Deborah’s claim arose out of damage suffered in Hurricane Harvey in August of 2017. Deborah filed a claim against Allstate on August 28, 2017. Allstate’s adjuster reported damages totaling $8,596.63. After adjustments, Allstate paid Deborah $6,062.63.

Deborah did not agree with the amount paid and on August 13, 2018, Deborah and Allstate designated appraisers. The appraisers evaluated the loss at $23,822.72. After applying adjustments, Allstate paid the remainder of the claim.

Federal Court Jurisdictional Amount

April 10, 2019 | Mark S. Humphreys

The Southern District of Texas, Houston Division issued an opinion in an unusual case in February 2019. The case is styled, Patricio Delgado v. Allstate Texas Lloyds.

The case had been removed to federal court based on diversity jurisdiction. Four parties sued Allstate on four properties in four states. Allstate asked that the improperly joined parties by dismissed and the case severed into four separate lawsuits. The Judge has found that the four claims are “factually unrelated” and severed the claims. The Judge ordered that each plaintiff file an amended compliant related solely to his or her claims. The Judge also ordered that each of the cases be remanded.

Allstate argues that the remand is improper because of the amount in controversy exceeding $75,000, because the amount originally sought by Delgado and the others exceeded $200,000.

Portable Policy And ERISA

April 7, 2019 | Mark S. Humphreys

Here is another case for life insurance lawyers to read and make part of their knowledge of life insurance cases involving ERISA. The case is from the Northern District of Texas, Dallas Division. The case style is, Stephanie Taylor v. Metropolitan Life Insurance Company.

This ERISA life insurance case was decided on motions for summary judgment in favor of MetLife.

Stephanie is the beneficiary under a policy of life insurance insuring her husband, Jonathan. They had a policy of Basic Employee Life Insurance for $136,000 and $271,000 of Supplemental Employee Life Insurance.

Who Pays?

April 6, 2019 | Mark S. Humphreys

Here is a case from the San Antonio Court of Appeals to know and read. It is styled, MGR, Inc. and Miracle Body and Paint, Inc. v. Geico Casualty Company.

Miracle is appealing a summary judgment in favor of Geico.

Miracle is an independent auto body shop and has performed work on autos insured by Geico and Geico has paid Miracle according to labor rates disclosed in the Geico repair estimates. Miracle complains that after the work is completed, Geico has failed to pay the labor rates that Miracle charges and thus, sued Geico for breach of contract, among other causes of action.

Duty To Defend Insurance Case

April 3, 2019 | Mark S. Humphreys

Here is a type of case insurance lawyers do not see very often. It is from the Southern District of Texas, Corpus Christi Division. It is styled, Lamarr Womack & Associates, L.P.; dba LWA Architects, et al v. Lexington Insurance Company.

LWA filed a claim against Lexington seeking a defense and indemnity under the policy with Lexington. Lexington tendered a defense under a reservation of rights to dispute coverage, claiming LWA had notice of the claim prior to purchasing the insurance policy and failed to disclose it in their application. Lexington initiated arbitration seeking a declaration that it owes LWA neither a defense nor indemnity for the underlying claim.

LWA filed this declaratory judgment action, seeking a judicial determination of those issues and making a claim for breach of contract. Lexington filed for dismissal under Federal Rule 12(b)(6), arguing that LWA failed to state a claim on which relief may be granted because of the arbitration agreement.