Dallas Fort Worth Insurance Lawyer Blog

House Fire – Arson?

April 26, 2018 | Mark S. Humphreys

Too many homeowner claims resulting from a fire get denied by the insurance company because the insurance company believes they can prove the fire was the result of arson. The Insurance Journal ran a story in March 2018, that illustrates that sometimes the insurance company is right. The story is titled “Two Plead Guilty To Insurance Fraud By Arson In West Virginia.”

The story tells us that two men pled guilty in federal court for their respective roles in a scheme to commit insurance fraud by arson.

Dudley Bledsoe, age 63, of Hanover in Wyoming County, West Virginia, and Ricky Dwayne Gleason, age 54, of Peach Creek in Logan County, West Virginia, both pleaded guilty to a charge of unlawful monetary transactions before Senior District Court Judge David A. Faber in Bluefield, West Virginia.

What Does PIP Cover And Not Cover?

April 24, 2018 | Mark S. Humphreys

Insurance lawyers in the Dallas and Fort Worth area need an understanding as to what Personal Injury Protection (PIP) benefits cover and do not cover.

PIP consists of reasonable expenses incurred for necessary medical and funeral services as well as replacement of 80% of income lost during the period of disability up to the amount of PIP policy limits. To receive the lost income benefits, the covered person must have been an income producer in an occupational status at the time of the accident. When an insured had not yet reported to a summer job that was to start two days after the accident and had not yet earned any wages, the court upheld a jury verdict that the insured was not an income producer. This was the result in the Houston Court of Appeals [1st Dist.] 1981, opinion styled, Slocum v. United Pacific Insurance Co. The court did point out that “one does not have to be at work at the time of the accident to be in an occupational status.” Thus, one simply needs to commence earning income before the accident to be considered an income producer in an occupational status.

If the covered person was not employed, PIP benefits include expenses incurred for obtaining services that the covered person would have performed had they not been injured. If should be noted that the covered person must make an election as to whether he or she wishes to recover for lost income or the costs incurred in obtaining substitute services. He or she cannot recover both.

Personal Injury Protection – Coverage Answers

April 22, 2018 | Mark S. Humphreys

Personal Injury Protection (PIP) coverage is different than other types of injury coverage.

PIP coverage exists if the insured or their family member is struck by a “motor vehicle” designed for use mainly on public roads or a trailer of any type according to the 1984, Houston Court of Appeals [1st Dist.] opinion styled, National County Mutual Fire Insurance Co. v. Wallace. In Wallace, the court upheld a jury verdict that a forklift was a “motor vehicle” for purposes of PIP. This holding was based mainly on the fact that the particular forklift in question had been used on a public road, as specifically required in the PIP language.

PIP benefits consist of reasonable expenses incurred for necessary medical and funeral services as well as replacement of 80% of income lost during the period of disability up to the amount of PIP policy limits. To receive the lost income benefits, the covered person must have been an income producer in an occupational status at the time of the accident. When an insured had not yer reported to a summer job that was to start two days after the accident and had not yet earned any wages, the court upheld a jury verdict that the insured was not an income producer. This occurred in the 1981, Houston Court of Appeals [1st Dist.] opinion styled, Slocum v. United Pacific Insurance Company. The court did point out that “one does not have to be at work at the time of the accident to be in an occupational status.” Thus, one simply needs to commence earning income before the accident to be considered an income producer in an occupational status.

Auto Insurance – PIP – What Does “Occupying” Mean?

April 21, 2018 | Mark S. Humphreys

To be covered under most auto insurance Personal Injury Protection (PIP) provisions, a person needs to be “occupying” a vehicle.

“Covered person” as used in PIP coverage means the named insured or any family member while occupying or when struck by a motor vehicle designed for use maily on public roads or a trailer of any type. “Covered person” also includes any person occupying the covered auto with the named insured’s permission.

Most PIP claims arise out of accidents when an insured, a family member, and/or a friend of the insured are “occupying” an insured vehicle. The policy contains a very broad definition of “occupying.” For example, when an insured injured himself in the act of getting out of the car, the Fort Worth Court of Appeals held that the insured was “occupying” the vehicle. This was decided in 1976, and the case was styled, Berry v. Dairyland County Mutual Insurance Co.

What Is A “Motor Vehicle Accident” For Purposes Of P.I.P.

April 19, 2018 | Mark S. Humphreys

Personal Injury Protection or PIP is insurance that can be purchased with auto insurance . It is unique in its coverage.

One Texas court has construed “motor vehicle accident” narrowly in the context of PIP coverage. Specifically, it held that “motor vehicle accident” does not include all accidents that occur in a motor vehicle.

In the 1996, Houston Court of Appeals [1st Dist.] opinion styled, Schulz v. State Farm Mutual Automobile Insurance Co., Schulz’s passenger ordered him out of the truck and fatally shot him. The appeals court upheld summary judgment in favor of State Farm, which had denied coverage because PIP benefits provide for payment of damages as a result of “a motor vehicle accident.” According to the court a motor vehicle accident does not include all accidents that occur in a motor vehicle. Because there was no casual relationship between the vehicle and the victim’s death, there was no “motor vehicle accident.” Therefore, Schulz was not entitled to recover PIP benefits simply because a covered vehicle may have been used in his demise.

Insurance Disputes And Arbitration

April 17, 2018 | Mark S. Humphreys

Insurance lawyers will be looking to see what happens in a case taken up by the Texas Supreme Court. The case is an appeal from the Amarillo Court of Appeals who had agreed with the trial court decision to compel arbitration.

This is a dispute between an insurance agency “The Altman” and Jody James Farms (JJF) and is a petition for review.

The conflict began in 2010 after JJF purchased a Crop Revenue Coverage Insurance Policy from Rain and Hail LLC. Altman Group was the insurance agency which sold the insurance to JJF through Rain & Hail LLC.

Auto Insurance Exclusions

April 15, 2018 | Mark S. Humphreys

Insurance lawyers can tell prospective clients that most pages in an insurance policy are pages explaining exclusions and limitations to what a policy will pay. This is no different when it comes to auto insurance.

The standard auto policy does not provide med pay coverage for any person for bodily injury occurring during the course of employment if worker’s compensation benefits are available for the bodily injury. This exclusion is discussed in the 1963, San Antonio Court of Appeals opinion styled, Williams v. Employers Mutual Casualty Co. Thus, med pay coverage will apply only if the insured does not have worker’s compensation benefits available to him or her.

Like the liability coverage, med pay coverage does not extend to the named insured while he or she is occupying a vehicle, other than his or her covered auto, which is owned by him or her or furnished or available for his or her regular use. This was discussed in the 1965, Tyler Court of Appeals opinion styled, Vaughn v. Atlantic Insurance Company. To extend such coverage would force the carrier to accept a greater risk without receiving a corresponding premium.

Automobile Insurance – Medical Payments Coverage

April 14, 2018 | Mark S. Humphreys

Medical Payments Coverage in an automobile policy is also known as Med-Pay coverage. Med-Pay is an optional coverage. Under this coverage, the insurance company agrees to pay “reasonable expenses incurred for necessary medical and funeral services because of bodily injury caused by accident and sustained by a covered person.” This insuring agreement uses the term “caused by accident” as opposed to the more specific phrase “auto accident” used in liability in the liability insuring agreement. This coverage defines “covered person” as the named insured or any family member while occupying or being struck by a motor vehicle. Also, any person occupying the named insured’s covered auto is entitled to med pay coverage. The coverage for those persons other than family members, however, is limited to occupancy in a covered auto.

According to the 1973, Waco Court of Appeals opinion, Dhane v. Trinity Univers. Ins. Co., med pay coverage is generally broader than PIP coverage.

Unlike any other provision in the Texas Auto Policy, Texas courts have ruled that med pay benefits can be “stacked.” These courts include the Austin Court of Appeals in the 1969, opinion styled, Harlow v. Southern Farm Bureau Cas. Ins. Co. and the Houston Court of Appeals in the 1961, opinion styled, Southwestern Fire & Cas. Co. v. Atkins. In other words, an insured may receive med pay benefits as if the benefits were being paid on two separate policies when a single policy covers two automobiles and the premium charged on the policy has been paid separately on each automobile. Stacking is only allowed with med pay benefits according to the 1978, Texas Supreme Court opinion styled, Holyfield v. Members Mut. Ins. Co.

Gun Owner Insurance

April 12, 2018 | Mark S. Humphreys

CNBC published an article in February 2018, titled, “Florida Shootings May Complicate Insurance For Gun Owners.”

To start with, gun owners need to know that most homeowner policies are not going to cover situations where a person has to use a gun. The policies will cover accidents but not other types of occurrences.

The insurance company Chubb has decided to stop underwriting an insurance policy for gun owners called NRA Carry Guard. This policy covers gun owners in the event they face legal repercussions following firearm incidents.

Ocean Marine Insurance

April 10, 2018 | Mark S. Humphreys

Most insurance lawyers don’t see this type of coverage, but for those who do, here is a little information.

Ocean marine insurance insures overseas shipments by vessel or aircraft. Ocean marine coverage can also be provided on a vessel to insure against any loss or destruction to the boat, barge, or other vessel. This is explained some in the 1965, Southern District of Texas opinion styled, Gulf Coast Trawlers, Inc. v. Resolute Insurance Co.

Coverage on the vessel usually insures against “perils of the sea” or any “marine peril.” The sinking of a vessel that occurred due to an open valve in calm waters while the vessel was docked was not a “peril of the sea” according to the 1972, Southern District of Texas opinion styled, Commercial Union Insurance of New York v. Daniels. One court explained the phrase “perils of the sea” within marine policy includes “all kinds of marine casualties” involving the sea and are distinguished from the mere act of being on the sea. This case was the 1963, Southern District of Texas opinion styled, U.S. National Bank of Galveston v. Maryland National Insurance Co.