Dallas Fort Worth Insurance Lawyer Blog

Jurisdiction And Insurance Cases

August 27, 2017 | Mark S. Humphreys

This is a case from the Northern District, Dallas Division, dealing with which court is proper to litigate the case. The case is styled, Hutchins Warehouse Limited Partners v. American Automobile Insurance Company et al.

A court may sua sponte raise the issue of its jurisdiction at any time during the course of litigation.

28 U.S.C. Section 1441(a) permits the removal of any civil action brought in a state court of which the Federal Courts have original jurisdiction. However, the removal statue must be strictly construed because removal jurisdiction raises significant federalism concerns. Therefore, any doubts concerning removal must be resolved against removal and in favor of remanding the case back to state court.

Life Insurance And ERISA

August 26, 2017 | Mark S. Humphreys

As any ERISA attorney can tell you, the rules surrounding ERISA are tough. This is illustrated in a Fifth Circuit opinion styled, Kimberly D. Hendrix v. Prudential Insurance Company of America, et al.

Hendrix appeals the summary judgment granted against her on her ERISA claims arising out of a life insurance policy issued to her husband Randy, by Prudential and the dismissal of her claims against her former employer, Wal-Mart.

Randy was employed by Wal-Mart until July 11, 2012. Prudential presented evidence that it sent a letter on July 23, 2012 , notifying Randy of his right to convert his Wal-Mart policy to an individual life insurance policy. Randy had until August 11, 2012, thirty-one days after he ceased to be insured under the Wal-Mart plan, to indicate whether he would convert to an individual policy. Randy passed on August 27, 2012. On September 4, 2012, because Prudential received no response to the notice of conversion and because Randy passed outside the thirty-one day conversion period, the claim for life insurance benefits was denied and Kimberly was so notified.

Suing The Engineer / Adjuster

August 24, 2017 | Mark S. Humphreys

A case from the Southern District, Laredo Division has an interesting twist for insurance lawyers to know about. The case is styled, Luis Gonzalez v. State Auto Property & Casualty Insurance Company, et al.

A hailstorm caused damage to the roof on Luis home and he submitted a claim to State Auto. State Auto hired Haag Engineering, one of the defendants in this case, to help inspect the roof damage. Haag prepared an engineering report that State Auto relied upon when it adjusted and allegedly undervalued Luis roof damage.

Luis filed suit in State Court. The defendants removed the case to Federal Court alleging that Haag was improperly joined for the purpose of defeating diversity jurisdiction under 28 U.S.C. Section 1441.

Suing A Lloyd’s Insurance Company

August 22, 2017 | Mark S. Humphreys

A lot of insurance policies written for commercial or business coverage are Lloyd’s insurance companies. Suing a Lloyd’s company and keeping it out of Federal Court is a little easier than if the company were not a Lloyd’s company. Though this did not happen in this case, it is explained in an Eastern District, Marshall Division opinion styled, North Dallas Lawn Care and Landscape Inc. et al. v. Hartford Lloyd’s Insurance Company.

Regardless of the parties’ agreement that this case should proceed before the Federal District Court, the court has an independent obligation to determine whether subject-matter jurisdiction exists. Hartford asserts that this Court has jurisdiction pursuant to 28 U.S.C. Section 1334(b).

Out of concern that jurisdiction may not exist in this case, the Court ordered Hartford to file a declaration of citizenship and the citizenship of its underwriters.

Events Insurance Lawyers

August 20, 2017 | Mark S. Humphreys

For people having events that can be large, such as wedding, big, family re-unions, company parties, and other types of celebrations, looking to purchase insurance for those events can be a smart thing to do. The Claims Journal published an article about events insurance that is good to read. The article is titled, Disastrous Fyre Festival Sheds Light On Events Insurance.

Already facing numerous lawsuits, Fyre Festival organizer Billy McFarland was arrested on federal charges last week. The government alleged he defrauded investors who bought into Fyre Media Inc., the company behind the music festival that collapsed so spectacularly in the Bahamas a few months back.

But the fiasco’s graduation to prosecution is almost beside the point as far as the festival industry is concerned. Events constructed to attract free-spending youth tend to include some who drink too much or take drugs and consequently do all the risky things that come with both. Organizers already had it tough when it came to getting insurance. Then Fyre Festival came apart, replete with tent cities, stranded teens, broken promises, and a global media spotlight covering it all.

ERISA – Some Legal Standards

August 19, 2017 | Mark S. Humphreys

Employee Retirement Income Security Act (ERISA). These types of plans are loved by insurers and not so much by the insured. The reason is that so often, the decisions of plan administrators are final in that the courts uphold their decisions. A Southern District, Galveston Division opinion is good reading to illustrate this favoring of the ERISA plan administrators. The opinion is styled, Kristin Walker v. Regency Blue Cross Blue Shield of Oregon.

After citing some lengthy and convoluted facts the court’s opinion read thus:

This Court had previously found the plan to be covered by ERISA. A claimant must exhaust all available administrative remedies before filing suit. An exception to this rule found in 29 C.F.R., Section 2560.503-1(g) wherein there is non-compliance with requirements.

ERISA And Administrator Conflict Of Interest

August 17, 2017 | Mark S. Humphreys

Here is an ERISA case from the United States Fifth Circuit Court of Appeals. It is styled, Lashondra Davis v. Aetna Life Insurance Company. It is an appeal from a summary judgment in favor of Aetna.

The facts can be read from the case. The important issue in this case, is how the Court analyzed the allegation that the plan administrator abused his discretion and there was a conflict of interest with the plan administrator being both who evaluates the claims for benefits and pays benefits claims.

The Court stated that in determining whether there was an abuse of discretion, we also consider whether the plan administrator had a conflict of interest. A plan administrator has a conflict of interest if it “both evaluates claims for benefits and pays benefits claims.” However, a conflict of interest is but one factor among many that a reviewing judge must take into account. A conflict of interest should prove more important where circumstances suggest a higher likelihood that it affected the benefits decision. A reviewing court may give more weight to a conflict of interest where the circumstances surrounding the plan administrator’s decision suggest procedural unreasonableness — that is, where the method by which the plan administrator made the decision was unreasonable.

ERISA And Fiduciary Status

August 15, 2017 | Mark S. Humphreys

Here is a read for lawyers handling ERISA cases. It is an opinion from the Southern District, Houston Division. The opinion is styled, Keith v. Metropolitan Life Insurance Company.

For the facts in this case, read the opinion. This writing is a discussion of the law as it relates to fiduciaries in ERISA cases.

The threshold question in an ERISA claim for breach of fiduciary duty is not whether the actions of some person employed to provide services under a plan adversely affected a plan beneficiary’s interest, but whether that person was acting as a fiduciary (that is, was performing a fiduciary function) when taking the action subject to complaint. The issue of ERISA fiduciary status is a mixed question of fact and law. Under ERISA, one is a fiduciary under 29 U.S.C., Section 1002(21)(A) to the extent that:

Hail Damage Lawsuit And Abatement

August 13, 2017 | Mark S. Humphreys

The Northern District of Texas, Dallas Division issued an opinion dealing with hail damage and abatement of the case to compel appraisal. This is becoming more and more common in hail damage claims. The case is Nabors v. American Reliable Insurance Company, et al.

This claim arises out of water and hail damage to Nabors home. The insurance company is American. It is a declaratory judgment action regarding the scope of the policy’s coverage as well as damages for breach of contract and violations of the Texas Insurance Code against American. American filed a motion to abate the proceeding and compel appraisal.

In this case, there was also a dispute over whether or not the adjuster assigned to the claim by American was properly joined as a defendant in this lawsuit or whether the joinder was merely an effort to defeat diversity jurisdiction in order to have the case remanded to State Court. As in other cases in this blog, the examination by the Court was in favor of American.

Uninsured Motorist Coverage And Full Trial

August 12, 2017 | Mark S. Humphreys

Lawyers handling insurance disputes involving uninsured motorist (UM) coverage should already know the law discussed in a recent case from the Southern District, Houston Division. The case is, Eleazar Cantu, Jr. v. State Farm Mutual Automobile Insurance Company.

Cantu was injured when he fell off a truck driven by an uninsured motorist. Cantu sued the driver, two other UM individuals, and State Farm and took a default judgment in the amount of $65,095.12. Cantu demanded State Farm pay $30,000, the policy limit, and when State Farm declined to pay, Cantu sued State Farm.

State Farm moved for partial summary judgment, arguing that it is not responsible for paying the default judgment in the uninsured-motorist lawsuit because it did not consent to be bound by that judgment. Mr. Cantu responded and cross-moved for partial summary judgment, arguing that State Farm’s knowledge of and participation in that lawsuit indicated its consent to be bound by the default judgment.