Employee Retirement Income Security Act (ERISA) cases have their own set of rules.  Two things stand out about ERISA cases.  One is that a person is not entitled to a jury trial in an ERISA case, rather a Judge reviews the administrative record in the case when deciding who is going to prevail in the case.  Two is that there is very little to no discovery in the case.

This is illustrated in the 1998, 5th Circuit Court of Appeals opinion, Vega v. National Life Ins. Services, Inc.

Vega is a summary judgement case where Vega is appealing the decision rendered against hit.  Part of his appeal addresses how the Court ruled as it relates to discovery in the case.

Insurance company unfair settlement practices is dealt with in a specific section of the Texas Insurance Code.  Look at Texas Insurance Code, Section 541.060.

The statute prohibits engaging in any of the following settlement practices with respect to a claim by an insured or beneficiary:

(1)  misrepresenting to a claimant a material fact or policy provision relating to coverage at issue;

Here is a life insurance case that involves a plan under the Employee Retirement Income Security Act (ERISA).  It is a 2018, 5th Circuit Court of Appeals case styled, Jason Crawford v. Metropolitan Life Insurance Company.

This is a summary judgment case granted in favor of MetLife.  This Court sustained the ruling in favor of MetLife.

The deceased, Tracy Crawford, worked as a flight attendant for Southwest Airlines.  Tracy enrolled in the company offered life insurance benefit plan in 2008, and submitted a paper document naming her great-nephew as the primary beneficiary.

A new law, Texas Insurance Code, Section 542A.006(a) matters in this case.

The case is from the Western District of Texas, Austin Division.  It is styled, Yan Qing Jiang v. The Travelers Home and Marine Insurance Company and Dana Ellen Pustka.

Jiang filed this action in state district court alleging her home was damaged in a storm and that Travelers is the insurer and the adjuster was Pustka.  Jiang asserted causes of action for violations of the Texas Insurance Code and the Texas Deceptive Trade Practices Act (DTPA).  Travelers and Pustka had the case removed to federal court based on diversity jurisdiction, 28 U.S.C., Section 1332(a), and argue that Pustka was improperly joined in an effort to defeat diversity jurisdiction.

Most people do not know what an anti-assignment clause in an insurance policy means.  This issue is discussed in a 2018, opinion from the 14th Court of Appeals.  The opinion is styled, Safeco Insurance Company of America v. Clear Vision Windshield Repair, LLC.

This case concerns anti-assignment clauses in insurance policies.  Clear Vision repaired chips in the windshields of Safeco’s insureds.  Safeco recently refused to pay invoices for the windshield repairs on four of Safeco’s insureds.  The insureds had assigned the claim to Clear Vision for payment and Safeco denied the payments relying on the anti-assignment clause in the policies at issue.

The trial court ruled in favor of Clear Vision and that ruing was upheld on appeal by this Court.

Life Insurance cases can have a surprising number of twists to them.  Readers of the DallasFortWorthInsuranceBlog have seen some of these various twists.

The U.S. District Court, Eastern District of Texas, Sherman Division, issued an opinion in a case styled, Reliastar Life Insurance v. Trina R. Wiemer, Laura R. Weimer, and Roderich W. Weimer, Jr., which is interesting.

This case is an interpleader action.  Reliastar issued a life insurance policy on the life of Vincent H. Weimer, who died on August 19, 2017.  The policy was for $3,000,000.00 and this amount is claimed by competing persons.  Because of these competing persons, Reliastar filed this interpleader action pursuant to Federal Rule of Civil Procedure 22 and 28 U.S.C. Section 1335.

The U.S. District Court, Western District, Austin Division, issued an opinion on November 16, 2018, that is worth reading.  It is styled, Thomas G. Kezar and Sylva Shroyer Kezar v. State Farm Lloyds.

This is an appeal from a partial motion for summary judgement as to one issue in the case.  The issue is whether Kezars still had a claim against State Farm for breach of contract and extra-contractual damages under the dwelling coverage aspect of the claim when State Farm had already properly and timely paid that aspect of the claim after an appraisal award.  This Court ruled in favor of State Farm.

The policy language at issue states:

The Fort Worth Court of Appeals issued an opinion on November 15, 2018, that is worthy reading for lawyers handling uninsured / underinsured motorist coverage (UIM).  The case is styled, William Blevins v. State Farm Mutual Automobile Insurance Company.

This case is an appeal from a trial by Blevins against State Farm wherein the jury ruled in favor of State Farm.  The opinion is lengthy and the majority of it deals with whether the decision by the jury was justified in light of the evidence.  What is dealt with here is the ruling by the court to not allow in evidence regarding the UIM coverage.

Blevins argued the trial Judge erred by declining to allow testimony about Blevin’s UIM coverage.

The Fifth Circuit Court of Appeals issued an opinion on November 14, 2018, in a situation which is going to be rarely seen, but is something for insurance lawyers to know exists.  The case is styled, Sentry Select Insurance Company v. Lorena Munoz, Individually and on behalf of the Estate of Lorenzo Munoz, and as Next Friend of L.M. and C.M., Minor Children; Virginia Munoz.

The Munoz’s were defendants in the case.  Sentry had been granted a summary judgment in the District Court.

On August 17, 2010, Lorenzo Munoz, was killed when the semi-truck in which he was traveling veered off the highway and crashed into a concrete drainage channel.  The semi-truck consisted of a tractor owned by Moore Freight Services and a trailer leased by Goal Transport.  Sentry issued a commercial auto insurance policy to Goal.

This 2018, Fort Worth Court of Appeals opinion is unique and involves a situation most life insurance lawyers will not ever see, however, it is worth knowing about due to some of the ruling by the appeals court.  The case is styled, Old American Insurance Company v. Lincoln Factoring, LLC.

Lincoln is an assignee of a portion of benefits under a life insurance policy.  Lincoln was assigned a portion of the benefits by the life insurance beneficiary for advancing costs of the burial of the insured.  The insured had a life insurance policy with Old American.

When the insured died, the beneficiary made a claim for benefits.  Instead of paying the benefits, Old American insisted they needed a copy of the death certificate.  When a copy of the death certificate was provided, Old American withheld payment because the death certificate stated that the manner of death of the insured was pending investigation.

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