Insurance policies have to be read carefully by an insured and by the insurance law lawyers who want to help the insured. This is illustrated in an Austin Court of Appeals case styled, Progressive County Mutual Insurance Company v. Edwin Emenike.
This is a summary judgment case granted in favor of Edwin. Progressive filed an appeal and this Court then reversed and rendered in favor of Progressive.
The facts are undisputed.
Here is a case where an insurance law lawyer sued an agent and was able to prevent the case from being held in Federal Court. The case is from the Southern District of Texas, Houston Division, and is styled, Mary’z Mediterranean Cuisine, Inc. v. Blackboard Insurance Company f/k/a Hamilton Insurance Company, Texas General Insurance, and Mir Khan.
This lawsuit was filed in State District Court and the defendants removed it to Federal Court based on their assertion that Texas General and Khan were improperly joined in an effort to defeat diversity jurisdiction. Mary’z filed a motion to remand to State Court which the Court granted. Here is why:
Mary’z alleges that Khan and Texas General sold a commercial policy to Mary’z with full knowledge of Mary’z business operations, building design, and Mary’z lack of an internal fire alarm by falsely representing to Mary’z that damages caused by a fire would be covered by the policy. A fire occurred and Blackboard denied the claim based on Mary’z not having an internal fire alarm.
In places like Weatherford, Texas and Mineral Wells, Texas, knowing about animal exclusions in insurance policies is important. Areas that are rural are usually more inclined to have people who own animals of one type or another. Dogs may be particular to more urban areas but in the rural areas there is greater likelihood of persons owning bigger dogs plus, horses and cows.
Animal exclusions become important in these more rural areas and animal exclusions is discussed in a Western District of Texas, Austin Division opinion styled, Colony Insurance Company v. Burleson County Saddle Club, Inc.
Colony filed a declaratory judgment action seeking to have the Court declare that there is no coverage in this case. A person was injured while riding a horse at a sporting event at the Burleson County Saddle Club. Burleson sought coverage from Colony.
Here is an opinion from the 14th Court of Appeals that concerns the Prompt Payment of Claims Act. The opinion is styled, William Marchbanks v. Liberty Insurance Corporation.
This is an appeal from the trial court granting summary judgment in favor of Liberty. This appeals court affirmed the trial court.
Marchbanks reported a hail damage claim to Liberty and the same day Liberty acknowledged the claim and sent an adjuster to the property the next day. The adjuster determined that any roof damage was not storm related and Liberty sent a denial letter explaining no storm related damaged was found.
Here is a Dallas, Texas opinion that insurance lawyers need to read. It is from the Dallas Court of Appeals and is styled, American National County Mutual Insurance Company v. Jonathan A. Medina.
On October 30, 2009, Angel Freeman ran a stop sign and crashed into Medina who was riding a motorcycle. The cycle was totaled and Medina was injured. Angel had a 1998 Dodge Ram that was listed as a covered vehicle on an ANPAC policy belonging to Paul and Katie Freeman. Angel is Paul’s sister.
After the wreck, a question arose as to who owned the Ram. and whether it was insured by Paul’s policy. If the truck was not owned by Paul, it could not be covered by the policy. Paul and Angel both told ANPAC that Paul sold the vehicle to Angel for cash four weeks before the accident, on October 1, 2009, and both gave written statements to ANPAC to that effect. Angel never put the title into his name. ANPAC cancelled the policy effective October 1, and refunded premiums paid. On December 8, 2009, ANPAC notified Medina of the decision and closed the file.
Most of the time, Courts are happy to have a case dismissed from their docket. An Eastern District of Texas, Sherman Division, opinion is an exception to that general situation. The opinion is styled, Mike And Jacqueline Sanchez v. Safeco Insurance Company of Indiana.
The Sanchez’s filed a Motion to Dismiss Without Prejudice and the Court denied the motion. Here is why.
The Fifth Circuit recognizes that as a general rule, motions for voluntary dismissal should be freely granted unless the non-moving party will suffer some plain legal prejudice other than the mere prospect of a second lawsuit. The primary purpose of Rule 41(a)(2) is to prevent voluntary dismissals which unfairly affect the other side, and to permit the imposition of curative conditions.
The papers filed in Court have to be proper when suing an insurance company. A Southern District of Texas, McAllen Division opinion illustrates this rule. The opinion is styled, Alfredo Murillo Jr., et al v. Allstate Vehicle and Property Insurance Company.
Alfredo suffered damage after a hail and or windstorm and sued Allstate alleging Allstate failed to “cover the true costs of repairs … including but not limited to, repair and/or replacement of the roof and any exterior damage,” and that Allstate “failed to properly adjust the claim and summarily improperly paid the claim.” Alfredo’s complaint contains no other specific factual allegations beyond general allegations that Allstate’s investigation of the claims was “unreasonable,” and that Allstate “failed to properly scope” Alfredo’s damages, and that Allstate delayed in the payment of the true cost of damages. In all other respects, Alfredo’s complaint is a form petition that merely restates the legal elements of his claims.
Allstate filed this motion for partial dismissal pursuant to Federal Rule 12(b)(6) for failure to state a claim for which relief can be granted and Rule 9(b) for failure to plead with particularity.
The statute of limitations is a legal issue that must be taken into account in every case. This case from the Southern District of Texas, Laredo Division,does a good job of discussing the statute of limitations in insurance cases. The case is styled, Gilberto Rodriguez v. State Farm Lloyds.
This is an insurance coverage dispute that arose out of a water pipe bursting in Gilberto’s home. State Farm filed a motion for summary judgement, part of which dealt with the limitations issue. The Court granted State Farm’s motion.
Here are relevant facts and discussion:
Whether you are talking about life insurance claims, homeowners claims, disability claims, auto claims, or other types of first party claims, policy benefits are the basic recovery allowed for an insurance company breach of the contractual obligations. An insurer’s refusal to pay the insured’s claim causes damages in at least the amount of the policy benefits wrongfully withheld. This is supported in the Texas Supreme Court cases, Vail v. Texas Farm Bureau Mutual Insurance Co. and Transportation Insurance Co. v. Moriel.
In addition, the same court stated in Hernandez v. Gulf Group Lloyds, an insured should be able to recover consequential damages that are the foreseeable result of the insurer’s breach of contract. Numerous cases hold that insurance policies are subject to the same rules as other contracts. One of the best established rules is that:
Where two parties have made a contract which one of them has broken, the damages which the other party ought to receive in respect of such breach of contract should be such as may fairly and reasonably be considered either arising naturally; i.e., according to the usual course of things, from such breach of contract itself, or such as may reasonably be supposed to have been in the contemplation of both parties at the time they made the contract as the probable result of the breach.
Here is a rare win in an ERISA case. Unfortunately the win is the the 7th Circuit Court of Appeals rather than the 5th Circuit which controls most ERISA plans for readers of this blog.
The ERISA case is styled, Susan Hennen v. Metropolitan Life Insurance Company. The case does illustrate how to win an ERISA case.
Hennen had received short term disability (STD) benefits for two years as the result of a back injury. Hennen then applied for long term disability (LTD) benefits. The disability plan that Hennen had contained a two year limit for neuromusculoskeletal disorder, subject to exceptions, including one for radiculopathy, a “Desease of the peripheral nerve roots supported by objective clinical findings of nerve pathology.” After Metlife terminated Hennen’s benefits, she sued under ERISA, arguing that Metlife’s determination that she did not have radiculopathy was arbitrary and capricious. The court hearing the case had granted summary judgment in favor or Metlife. This appeals court reversed the ruling saying Metlife acted arbitrarily when it discounted the opinions of four doctors who diagnosed Hennen with radiculopathy in favor of one physician who ultimately disagreed, but only while recommending additional testing that Metlife declined to pursue.
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