Dallas Fort Worth Insurance Lawyer Blog

Facts Needed To Sue An Insurance Adjuster

August 28, 2018 | Mark S. Humphreys

When suing an insurance adjuster, it is necessary to articulate facts that show an adjuster did something wrong. This is illustrated in this 2018, U.S. District Court, Northern District, Dallas Division, opinion styled, Recovery Resource Counsel v. ACE American Insurance Company, et al.

Recovery Resource Counsel (RRC) alleges it suffered wind and hail damage to its insurer ACE. ACE hired Kirn to investigate the claim, who in turn hired Douglas Structure repair. Douglas Structure subsequently issued a report that RRC’s property had not sustained any damage and the claim was denied. RRC sued for breach of contract and various violations of the Texas Insurance Code.

The lawsuit was filed in State Court and ACE had the case removed to Federal Court where ACE claimed the case against Kirn was sued for the purposes of defeating diversity jurisdiction and was thus, an improper joinder.

Using Drones For Insurance Claims

August 26, 2018 | Mark S. Humphreys

The use of drones for evaluating insurance claims has become normal.

The Claims Journal published an article on July 19, 2018, titled, Insurers’ Drone Use Picks Up After 2017 Hurricane Season.

The article says that Insurers’ use of drones to inspect property claims came into full swing in 2017, after the FAA began issuing permission allowing commercial firms to operate unmanned aerial vehicles in designated U.S. airspace.

Life Insurance – Who Gets Paid

August 25, 2018 | Mark S. Humphreys

Here is an interesting case form the U.S. Northern District, Dallas Division, regarding payment on a life insurance policy. The case is styled, Metropolitan Life Insurance Company v. Michael Wayne Battle II.

Metlife offers life insurance to federal employees through a program referred to here as FEGLI. The Office of Personnel Management (OPM) administers the program. Metlife is required to pay FEGLI benefits when a beneficiary establishes a valid claim under FEGLI. FEGLI payments are prioritized thus: first, to the employee’s designated beneficiary; second, if there is no designated beneficiary, to the employee’s surviving spouse; and, third, if neither is present, to the employee’s child or children. This is pursuant to 5 U.S.C. Section 8705.

Battles’ father, Michael Battle (Michael), was covered under the plan and had coverage totaling $475,000 at the time of his death. Michael had not designated a beneficiary.

Direct Action Against Third Party Insurer

August 23, 2018 | Mark S. Humphreys

An insurance lawyer in Dallas or Fort Worth who understands insurance law will tell a client that when a car wreck occurs, the person or entity who caused the wreck is the proper party to sue, not the person or entity’s insurance company.

This is illustrated in this 2018, Eastland Court of Appeals opinion styled, Randy Durham v. Hallmark County Mutual Insurance Company.

Durham was injured in a wreck with Bobby Burl Straley and L&L Trucking. Durham sued Straley and L&L originally, then sued Hallmark, the alleged insurance company of Straley and L&L.

Bad Faith And Breach Of Contract

August 21, 2018 | Mark S. Humphreys

The general rule in first party insurance cases is that in order to recover for bad faith insurance causes of action and insured must first prove a breach of the insurance contract. There is an exception to this rule. The exception is discussed in this July, 2018, opinion from the United States 5th Circuit. The opinion is styled, Glen Moore v. Allstate Texas Lloyd’s.

This case is an appeal from a summary judgment granted in favor of Allstate. The case resulted from a lawsuit filed in State Court and the removed to Federal Court by Allstate. This court sustained the ruling in favor of Allstate.

Moore alleged his property “suffered incredible damage due to storm related conditions.” Moore alleged there were a “laundry list of perils, which Allstate would not cover under the claim.”

Getting Away With A Mis-Representation?

August 19, 2018 | Mark S. Humphreys

Insurance lawyers will testify that one of the biggest reasons they see for denial of coverage is the insurance company allegation that there was one or more misrepresentations in the policy application.

This issue is discussed in the 1969, San Antonio Court of Appeals opinion styled, The Prudential Insurance Company of America v. Ignacia Torres et ux.

This lawsuit, a declaratory judgment action, is asking the court to rescind and cancel a policy due to misrepresentations in the policy application.

Life Insurance Exclusions – Limits On Exclusions

August 18, 2018 | Mark S. Humphreys

Exclusions in life insurance policies are common. The Texas Insurance Code, Section 1101.055 limits the permissible life insurance exclusions to suicide, stated hazardous occupations, and aviation activities. Courts have construed this list to render void other exclusions, such as one excluding a loss caused by a preexisting condition.

A 1921, Texas Supreme Court case does a good job of explaining limits on exclusions. The opinion is styled, First Texas State Insurance Company v. Smalley.

As explained in Smalley: It was formerly usual for policies of life insurance to contain numerous conditions on which the amount or amounts promised to be paid on the death of the insured might be reduced or entirely defeated. Among common conditions were those relating to the insured’s occupation, habits, residence, and suicide. Not infrequently the amount of the insurance was stated in bold type, on the face of the policy, while the conditions were inconspicuously put on the back. Such policies could be used to lead the unwary into the belief that they held enforcible promises of real and substantial benefits, when the promises were so limited and conditioned as to have slight actual value. In this way premiums could be collected from the insured in exchange for apparent, rather than real, obligations on the part of the insurers.

Life Insurance Lawyers – Is The Person Dead?

August 16, 2018 | Mark S. Humphreys

This may seem strange but there are times an insurance company will deny a claim for life insurance benefits based on their assertion that the insured has not been proven to be dead. This is discussed in the 1987, Texas Supreme Court opinion styled, Davidson v. Great National Life Insurance Company.

Here are some interesting facts. In May 1980, a man identifying himself as Dauod Alquassab applied for a $1,000,000 life insurance policy with Great National. Alquassab had previously used the names of David Kassab and David Kay; was a convicted of felony fraud charges under a different name. Alquassab named Ilan Eiger, his partner in a real estate business, as the beneficiary when Great National issued the policy in June 1980. In September 1980, Alquassab changed the beneficiary designation from Eiger to Phyllis Davidson, his former wife from whom he was divorced in 1968. Alquassab then traveled to Tel Aviv, Israel, in February 1981. Prior to his departure, the record indicates that Alquassab allegedly defrauded First City Bank in Houston, of approximately $1.5 million dollars, and committed additional acts of fraud upon other banking institutions.

On Wednesday, February 11, 1981, a body was discovered approximately 100-200 yards from the hotel where Alquassab was registered. The body, which Davidson claims was Alquassab, had been struck by a car and then dragged face down. Great National was notified of Alquassab’s alleged death on February 12; the body was buried the following day, Friday, February 13. After Davidson made a formal claim under the policy to Great National on June 1, Great National rescinded the policy because of Alquassab’s alleged fraud in procuring the policy, and refused to pay any beneficiary proceeds to Davidson.

Insurance Policy – Statute Of Limitations

August 14, 2018 | Mark S. Humphreys

Knowing the statute of limitations on a case is vital. This is illustrated in a 2018, Southern District of Texas, Houston Division opinion styled, Lillian Smith v. Travelers Casualty Insurance Company of America.

Smith sued Travelers for violations of the Texas Deceptive Trade Practices Act (DTPS), Texas Insurance Code violations, and breach of contract. Travelers filed a motion for summary judgment based on the statute of limitations.

The allegations in the case are that a lightening strike caused damage to Smith’s home and air conditioner. The claim was reported on September 5, 2013, and acknowledged on September 7, 2013. An investigation was conducted in September and October of 2013. Travelers issued a denial letter on November 13, 2013.

Life Insurance And ERISA Ruling

August 12, 2018 | Mark S. Humphreys

Here is a case from the United States 7th Circuit that deals with life insurance when the policy is an Employee Retirement Income Security Act (ERISA) policy. The case is styled, Emma Cehovic-Dixneuf v. Lisa Wong.

Pursuant to 29 U.S.C., Section 1104(a)(1)(D), ERISA requires administrators of employee benefit plans to comply with documents that control the plans. In the case of life insurance policies, that means death benefits are paid to the beneficiary designated in the policy, notwithstanding equitable arguments or claims that others might assert.

In this case, the employee, Georges Cehovic, had two life insurance policies through his employer and the policies named his sister Emma as the sole and primary beneficiary. When Georges died, his ex-wife, Wong, claimed that she and the child she had with Georges were entitled to the policy benefits.