Dallas Fort Worth Insurance Lawyer Blog

Anticipatory Breach Of Insurance Contract – Disability Claims

November 28, 2017 | Mark S. Humphreys

Weatherford insurance lawyers who handle insurance related matters need to understand that an anticipatory breach of the insurance contract has remedies under the law. This is best illustrated in disability policies where the insurance company is obligated to make monthly payments to the insured.

According to the 1937, Texas Supreme Court opinion styled, Universal Life & Accident Insurance Co. v. Sanders, when an insurance company is obligated by contract to make monthly payments of money to another absolutely repudiates the obligation without just excuse, the obligee is “entitled to maintain his action in damages at once for the entire breach, and is entitled in one suit to receive in damages the present value of all that he would have received if the contract had been performed, and he is not compelled to resort to repeated suits to recover the monthly payments.” Repudiation is conduct that shows a fixed intention to abandon, renounce, and refuse to perform the contract.

Another Texas Supreme Court is opinion is from 1976, and styled, Republic Bankers Life Insurance Company v. B.L. Jaeger.

Insurance And Oral Contract

November 26, 2017 | Mark S. Humphreys

Here’s something a lot of insurance attorneys may not realize.

An oral contract to insure is valid and enforceable. This is confirmed in the 1949, Texas Supreme Court opinion styled, Pacific Fire Insurance Company v. Donald. The oral agreement “is presumed to be made in contemplation of a policy containing the terms and conditions in customary use, and impliedly to adopt the same, and it is on this ground that such agreements are sustained as complete and binding contracts.”

Donald brought this suit against four insurance companies, one of which is Pacific to recover for the loss of 5500 bales of hay which were destroyed by fire while stored in a building. Donald based his action on an alleged oral contract between himself and Henry Moore, agent of Pacific. Donald prevailed at trial and this appeal followed.

Insurance And Contract Law

November 25, 2017 | Mark S. Humphreys

What all insurance lawyers know: Insurance policies are contracts, and as such are subject to rules applicable to contracts generally. This was stated in the 1994, Texas Supreme Court case, Hernandez v. Gulf Group Lloyds, and is still good law.

A party seeking to recover on an insurance contract must prove that the contract was in force at the time of the loss. Also, a party who claims under a policy is required to produce the insurance contract upon which he sues or to prove its terms. This was stated in the 1975, Tyler Court of Appeals opinion, Hartford Accident & Indemnity Co. v. Spain. This also, is still good law. To prove a breach off contract, the insured has to establish:

the existence of the contract sued upon;

Insurance – Theories Of Recovery

November 23, 2017 | Mark S. Humphreys

Insurance lawyers want to pursue the best theories of recovery when a client has a claim wrongfully denied. Some people just want to file a complaint with the Texas Department of Insurance. But, there are better ways to improve the situation.

Recovery based on theories of misrepresentation were discussed in the last posting.

Another way of recovery is based on “non-disclosures.” Closely related to misrepresentation is the theory that the insurance company, agent, or insured failed to disclose information. For example, if an exclusion is not adequately disclosed, the insurance company may be liable for breach of contract by relying on the exclusion to deny a claim. Failing to adequately disclose limitations or exception to coverage may also make the insurance company or agent liable for unfair insurance practices or deceptive trade practices.

Things Insurance Companies Do Wrong

November 21, 2017 | Mark S. Humphreys

Insurance transactions tend to resemble one another, so disputes arising from them tend to resemble one another. There are only so many ways that an insurance company and an insured can get crossways. Most cases present recurring problems that can be grouped into several categories. Insurance law is even more precedent driven than other areas, as courts try to construe similar policy language consistently. It is not surprising that cases start to look alike.

The key is find good authorities that match your facts, or to emphasize the facts that match good authorities.

Of course, the starting point is the contract itself. The initial inquiry almost always begins with the language of the contract to determine what is covered and what is not. Other tort and statutory theories may logically depend on the existence of coverage, or may exist independent of coverage. The interplay between recovery for breach of contract and recovery under other theories is discussed in numerous areas in this blog. Beyond suit for breach of contract, most insurance cases can be grouped into these categories – misrepresentations – non-disclosures – unfair settlement practices – and other misconduct.

Accidental Death And Dismemberment Policy

November 19, 2017 | Mark S. Humphreys

Abilene Texas lawyers who handle accidental death and dismemberment policy claims that are governed by ERISA, need to read this 2017, 5th Circuit Court of Appeals opinion. It is styled, Robert Ramirez v. United Of Omaha Life Insurance Company.

Ramirez traveled to West Texas and contracted a fungal infection that resulted in the removal of one of his eyes. He made a claim through the accidental death and dismemberment plan he had through his employer. The plan is governed as an ERISA plan. United of Omaha denied the claim, stating the infection that caused the removal of Ramirez’s eye was not the result of an “Accident” as that term is defined in the policy. United of Omaha was granted summary judgment by the District Court and this appeal followed.

The facts are undisputed. Following a trip to West Texas, Ramirez came in contact with a fungus and eventually was diagnosed with a condition known as coccidioidomycosis.

Elements Of An Insurance Transaction

November 18, 2017 | Mark S. Humphreys

Here is some very basic information that every insurance lawyer should be aware of. It is also information that every insurance consumer should know.

To understand the different ways disputes can arise, it is helpful to consider the sequence of events that is likely to occur involving an insurance issue. At its very simplest, the insurance transaction can be divided into the initial sale of the policy, and subsequent handling of claims. These can be broken down further to include:

(1) The sale of the policy: Initially, the consumer and insurance company or insurance company’s agent must communicate to establish a contractual relationship. Disputes may arise over what was asked for by the applicant, what was represented by the insurance company or agent, or the timeliness of the insurance company or agent in providing coverage. Issues may also arise about the truthfulness of the applicant or agent in disclosing information requested by the insurer;

Disability Claims – Illness Versus Accident

November 16, 2017 | Mark S. Humphreys

Lawyers who handle disability insurance claims know that the policy has to be read.

In a definition of “total disability” in an individual accident and sickness policy or hospital, medical, and dental service corporation subscriber contract, the inability to perform duties may not be based solely on an individual’s inability to perform “any occupational duty,” but the insurer may specify the requirement of the inability of the insured to perform all of the substantial and material duties pertaining to his or her regular occupation, or words of similar import, according to the Texas Administrative Code, Section 3.3012(b)

The policy may further provide coverage for “partial disability,” which is typically defined as the insured’s inability to perform one or more but not all of the essential duties of his or her employment or occupation.

Fort Worth Claims

November 14, 2017 | Mark S. Humphreys

Fort Worth lawyers who end up in Federal Court need to read this opinion from the Northern District, Fort Worth Division, Judge McBride. The opinion is styled, Antonio Perez v. Allstate Vehicle and Property Insurance Company, et al.

Perez initiated this action by filing a lawsuit in State District Court. Allstate removed the action to Federal Court, alleging diversity of citizenship and the required amount in controversy. This Court Ordered Perez to replead so that his pleadings complied Federal Court pleading standards found in Rule 8(a) and 9(b) of the Federal Rules of Civil Procedure, and directed Perez to file an amended complaint that complied with those requirements.

Perez filed his amended complaint. Despite the warning provided in the order for repleading, Perez’s complaint as amended was, with few exceptions, basically a repeat of his state court pleadings, alleging, in a conclusory way, violations of sections of the Texas Insurance Code, fraud, and conspiracy to commit fraud, breach of contract, and breach of the duty of good faith and fair dealing.

Underinsured Motorist Coverage Issues

November 12, 2017 | Mark S. Humphreys

Lawyers in the Dallas and Fort worth areas who handle underinsured motorist (UIM) cases need to read this 2017 opinion from the Texas Supreme Court. It is styled, Okelberry v. Farmers Texas County Mutual Insurance Co.

Steven Okelberry and his wife, Patricia, had an auto policy with Farmers that provided $500,000.00 in UIM coverage.

Steven and his two sons were injured in an 18-wheeler accident insured by Home State. Steven suffered a neck injury requiring surgery and the possibility of additional surgeries.