Dallas Fort Worth Insurance Lawyer Blog

The above question could be asked by someone in Grand Prairie, Hurst, Euless, Bedford, Grapevine, Colleyville, Keller, Dallas, Fort Worth, or anywhere in Texas. So what is the answer? The answer is what all lawyers say in response to all questions put to them: It depends!
It depends on whether or not the insurance policy is ambiguous. If it is ambiguous, then it is open to more than one interpretation. Or if it is doubtful or uncertain, the court must find in favor of coverage.
Experienced Insurance Law Attorneys look at and rely on what courts have done in the past with similar cases when advising a client what may be the outcome to any particular set of facts in a case.
A Texas Supreme Court case decided in 1993, is a good case to look at for guidance in answering the question. The style of the case is, State Farm Fire & Casualty Company v. Joseph C. Reed, et al.
In this case, Frances Reed operated a registered family home for day care services at her home and was registered at the Texas Department of Human Resources as such. In 1987, an eighteen month old child drowned in a puddle of water that settled on a tarp covering a swimming pool at the Reed house. The child had climbed through a hole in the fence that separated a play area from the swimming pole.
The parents of the child sued Reed. Reed notified State Farm Fire & Casualty Company and sought coverage under their policy. State Farm denied coverage concluding that coverage was excluded under the Reed's policy because the death resulted from a business pursuit.
A Lets follows this again - In deciding the case the court found the phrase in the policy of insurance to be ambiguous because it could broadly exclude any loss associated with the activities of the for-profit day care, or it could be read narrowly to cover a loss that arose from an activity not ordinarily associated with the business.
Maintaining a fence, which had a hole in it, was not an activity normally incidental to the day care business. This court ruled there was an ambiguity, or uncertainty in the meaning of the insurance policy exclusion. Thus, the court ruled in favor of coverge.
There are cases after cases making it clear that ambiguities in insurance policies must be resolved by the courts in favor of finding coverage.

Someone in Dallas, Fort Worth, Grand Prairie, Arlington, Carrolton, Garland, Mesquite, De Soto,Duncanville, Burleson, Benbrook, or anywhere else in Texas may ask: How do I know what my insurance policy says?
Insurance companies spend lots of money paying lawyers to draft and write insurance policies that they issue to their insureds. And the insurance company knows what they are trying to write. The problem is, what they mean to write and what the insured person reads it to mean can often times be very different. So what happens?
What happens depends on whether or not the insurance policy is ambiguous.
Wikipedia defines ambiguity as a condition where information can be understood and interpreted in more than one way and is distinct from vagueness, which is a statement about the lack of precision contained or available in the information.
The context in which something is written can be important.
Speaking from a legal context: If an insurance policy is subject to more than one reasonable interpretation, it is ambiguous and the interpretation that most favors coverge for the insured will be adopted, as a matter of law. This was stated by the Texas Supreme Court in 1997, in the case styled, Grain Dealers Mutual Insurance Company v. McKee. This is still good law.
Here are rules that several courts have adopted for determining whether or not an insurance policy is ambiguous.
1. Whether a policy is ambiguous is a legal question to be decided by examining the entire contract in light of the circumstances present when the parties entered into the contract.
2. If a contract is worded so that it can be given a definite or certain legal meaning, then it is not amiguous.
3. An ambiguity does not arise merely because the parties offer different interpretations.
4. If after appling general rules of construction the policy is still subject to two or more reasonable interpretations, it is ambiguous.
5. When a policy is subject to more than one reasonable interpretation, the court must adopt the construction most favorable to the insured.
6. A court must adopt the construction urged by the insured, as long as that construction is not unreasonable.
7. The court must adopt the insured's reasonable interpretation, even if the construction urged by the insurer appears to be more reasonable or a more accurate reflection of the parties intent.
8. These rules are an outgrowth of the general principle that uncertain contractual language is construed against the drafter.
9. These rules are justified by the special relationship between the insurer and the insured arising from their unequal bargaining power.
As long ago as 1976, the Texas Supreme Court ruled in a case using some of the above guiding rules of interpretaion. The style of the case is Rotha Ramsay v. Maryland American General Insurance Company.
The issue for the court in the Ramsey case was, what does the term "commercial automobile" mean in the exclusionary clause of the policy issued by Maryland American General Insurance Company. The facts of what happened in this case were undisputed. Scott Ramsey was killed in an accident while driving a pickup truck owned by the United States Navy. He was an air-conditioning mechanic employed by the government. He had completed a job and was on the way back to his office to pick up a compressor to go to another job when the accident occurred. This pickup was used solely to transport employees, tools, and equipment.
The policy covering this pickup contained an exclusion clause which excluded commercial automobiles. The term "automobile" as used in the policy clearly included a pickup truck. It also had a $10,000 death benefit that was at issue.
The issue became; what does "commercial" mean? The term commercial is defined in dictionaries as "for profit" which the Ramsey attorney pointed out to the court. Maryland attorneys pointed out that the government was using the pickup in a "private" commercial way.
The court found both these interpretaions to be reasonable, so the policy was ambiguous and had to be construed in favor of coverage. This case serves as a good example for getting an experienced Insurance Law Attorney involved when an insurance contract can be read in more than one way. What the insured person needs to be aware of is that they may not know when a policy can be interpreted in more than one way and again illustrates why an attorney should be involved any time a claim is denied.

It just makes you mad! Most drivers in Dallas, Fort Worth, Grand Prairie, Arlington, Mansfield, De Soto, Duncanville, Weatherford, Azle, Aledo, and throughout Texas do the right thing by maintaining liability coverage on their automobiles. But, way too many drivers are on the road without insurance.
The Dallas Morning News ran an article on Saturday, July 17, 2010, addressing this subject. The article is written by Terrence Stutz. The title of the article is, TexasSure program finds about 25 percent of vehicles uninsured in Dallas County.
This article points to a scary statistic. This stastistic is that 25 percent of all vehicles in Dallas County, according to records, 429,478 cars and trucks, remain without liability insurance. This statistic comes from the Texas Department of Insurance.
Records of this type are availble because of a fairly new program in Texas called, TexasSure. This is a system to verify insurance coverage. When a driver is involved in an accident or stopped for an infraction, the law enforcement officer can enter the license plate number and vehicle identification number (VIN) into the TexasSure system to verify insurance coverage.
Those drivers identified without insurance are ticketed, subject to a fine of up to $350 on the first offense and up to $1,000 and posible suspension of their license on the second offense. Those who rack up multiple offenses and take no action are subject to arrest.
According to the Dallas Morning News article, Dallas County has the highest percentage of uninsured vehicles of the six largest urban counties in Texas. Tarrant County has about 21.6 percent of its vehicles uninsured.
As bad as the above numbers are, they have improved in recent years. Officials are unsure if the improvement is due to the TexasSure program. The program is funded by an annual $1 fee paid by all Texans when renewing vehicle registrations. Of course, drivers not having basic liability coverage is what forces responsible drivers to purchase uninsured motorist coverage to protect themselves against the unresponsible drivers on the roads and highways.
The article tells us that the south Texas counties are the ones with the highest percentages of uninsured vehicles, with almost 32 percent of vehicles uninsured in Cameron County. But this is down about 6 percentage points from less than a year ago.
A big stick the State hits people with is a surcharge for not having vehicles insured. The Public Safety Commission imposes surcharges on drivers of uninsured vehicles of up to $250 a year. There are also surcharges for driving violations and driving while intoxicated convictions, along with a whole bunch of other violations.
The TexasSure verification program relies on a massive database containing the names of all insured drivers and their insurance companies, matched to their license plates and VINs.
One problem the program has had is that such a large number of people have had these surcharges placed on them that they have simply refused to pay. This results in a license suspension and more surcharges and reinstatement fees that low income people cannot afford to pay. As a result, and in an effort to get people to be compliant, the Commission is adopting new rules lowering the costs to indigent people. Indigents would be those making less than $14,000 per year.

Homeowners in the Dallas, Fort Worth, Grand Prairie, Arlington, and Metroplex areas are not as affected by what appears to be a mass settlement for homeowners in the Gulf Coast area of Texas. But it is still a victory, and a victory for one should be considered a victory for all when the insurance company finally does the right thing by accepting responsibility for the homeowners policies it issues.
The Beaumont Enterprise, a newspaper published in Beaumont, Texas, recently ran an article disussing the above topic. The article is written by Mike D. Smith and was published on July 13, 2010. The title of the article is, Mass settlement offered in Ike windstorm cases.
The article tells how the wait could be over for countless Bolivar Peninsula property owners locked in a group stalemate with the Texas Windstorm Insurance Association over Hurricane Ike damages.
It is interesting to note that the Texas Windstorm Insurance Association has been in the news recently for wrongs and improper practices it has been caught commiting.
According to the article, within the next month, homeowners involved in the insurance fight should get notices from their respective attorneys about whether they want to accept a slice of a $189 million "mass settlement" with the state windstorm insurance pool.
One attorney involved in the litigation stated that the offer is substantially more than what was previously offered in these cases.
The settlement involves "slab" cases, or buildings where Ike's winds and storm surge left little behind. Another attorney said the settlement would be a triumph for "slab" owners and the Galveston County economy.
It appears attorneys for the homeowners were able to counter arguements by the insurance industry of whether damage was caused by water or wind by using weather modeling and weather experts. The result of this being that the insurance association agreed to pay full negotiated amounts to the property owners and to pay attorneys fees.
"These slab claims were very complicated and numerous, and they required a great deal of time and analysis in determining the impact from wind and storm surge damage since Texas Windstorm Insurance Association policies only cover direct loss caused by wind," insurance association general manager jim Oliver said in a released statement. "We hope that this global resolution will help those families rebuild their lives and homes. TWIA recognizes the important role that windstorm coverage and the recovery of policy benefits will have on economic development in Galveston County, and we are proud to help this vibrant community and help ensure its stability during future storms." It is kinda ironic for them to be saying this now, after fighting it for so long.
It is reported that one of the above attorneys is still working about 5,000 Ike lawsuits mainly in the Houston and Galveston areas. After about a year of fighting, mediation is speeding up settlements on about 98 percent of those cases and are moving much quicker that the Hurricane Rita cases.
The main difference between the two storms is that Ike hit more heavily in a much more populated area.

If someone in Dallas, Fort Worth, Arlington, Grand Prairie, Mansfield, Hurst, Euless, Bedford, Duncanville, or anywhere else in Texas gets involved in an accident and someone besides themselves are at fault, what happens when health insurance pays for the medical bills resulting from the accident? The answer is one you are going to hate. The answer is: It depends.
There are many variables that come into play, some of which have been discussed in previous blogs. Today we are going to discuss what happens when a person's own personal health insurance company pays for the medical bills incurred as the result of someone else causing injury to you.
Typical health insurance companies are Blue Cross / Blue Shield, Humana, and other names you have heard about and often times this health insurance is provided as a benefit by your employer. The significance of employer provided health insurance is that many times the health insurance provided through employment is a federally regulated plan called Employers Retirement Income Security Act, otherwise known as an ERISA plan.
ERISA plans are in a category all by themselves and are often times very difficult to deal with. Other plans, that are not ERISA are usually much easier to deal with but can still be challenging depending on the language in the plan.
The Texas Supreme Court has held, that when someone else causes one to incur medical expenses that get paid by the injured person's health insurer, that the health insurer may be entitled to "first money" from a settlement. This may be the case even where the injured party has not been made whole by the policy proceeds from the person's insurance company who caused the medical bills to be incurred. By not "made whole" meaning the injured person still is short money due to lost wages and other damages.
The most recent, significant case by the Texas Supreme Court, is a 2007 case styled, Fortis Benefits v. Vanessa Cantu and Ford Motor Company. This case is a must read to have an ideal of how subrogation sometimes works.
Keep in mind - when someone else, a third party, causes you to be injured and incur medical expenses and you have health insurance that pays those medical expenses, then, when you recover from the person who caused the injuries you have a responsibility to pay back your health insurance. When your health insurance pays, they have paid for bills that the third party should have paid for. If you do not pay them back then you are getting a "double recovery." However, it should be quickly pointed out that sometimes this is okay, it just depends on the circumstances and the writing in the health insurance policy.
It is vital to have an experienced Insurance Law Attorney involved in these situations. If it is not handled properly, the person receiving the "double recovery" could find themselves being sued by their health insurance company. This is not uncommon. An experienced attorney, using properly legal means, can often times make this "double recovery" legal. But it is a situation where the "i's have to be dotted and the t's crossed."
Health insurance companies generally include a subrogation clause in the insurance contracts and the wording will vary insurance company to insurance company and policy to policy. But these contractual provisions creating a right of subrogation are valid and should be honored. This has been made clear by the Texas Court of Appeals, Eastland, in 1974, in the case, Group Hospital Service, Inc. v. State Farm Insurance Co.
Worse, some policies have provisions written into them excusing the health insurer from paying altogether if there is a personal injury claim arising from an injury, so injury claims increasingly do not involve health insurance.
One thing to bear in mind and make clear. These policies vary widely with an ERISA plan being the hardest to deal with in these situations. And an experienced attorney can sometimes make even the worst plans deal fairly with the injured person.

Am I paying too much for my insurance? Whether you live in Cedar Hill, Mansfield, Benbrook, Saginaw, Keller, Fort Worth, Dallas, Grand Prairie, Arlington, or some other place in Texas, that would be a question most people would ask at one time or another when thinking about their finances.
For a California woman, the answer to the above question seems to be, yes. She has sued Blue Shield of California, accusing the nonprofit health plan of overcharging thousands of policyholders who bought safety net insurance for peole who were sick or jobless.
This was reported by the Los Angeles Times in an article written by Duke Hefland and published on July 8, 2010.
The title to the article is, "Blue Shield of California is accused of overcharging for safety-net insurance."
A 64 year old lady by the name of Amalia Lample said in her lawsuit that Blue Shield, the state's second largest not for profit insurer, knowingly exceeded maximum insurance rates set by the state and falsely reported to regulators that the charges stayed within official guidelines.
Lample is argueing that she is owed $4,475 in excess charges she paid from 2007 to 2009. She also claims that more than 6,000 Blue Shield policyholders with similar coverage also were overcharged since 2001.
"This is for justice. It's not only for the money," said Lample, who decided to file her lawsuit in Los Angeles County Superior Court after reading a story in The Times about Blue Shield's rates. "It's not right what they do."
The lawsuit seeks class- action status. There has been no comment from the San Francisco company.
Blue Shield denied two refund requests by Lample, who filed a complaint with the California Department of Managed Health Care. Regulators said they could not conclude that Blue Shield had violated state law.
On Wednesday a department spokeswoman said the law's definition for calculating maximum rates was ambiguous, making it difficult to determine whether health plans were charging too much. As a result, the department is sponsoring a bill in the Legislature to "eliminate any question" on rates insurers can charge.
At issue is health coverage available under the federal Health Insurance Portability and
Accountability Act (HIPAA). Insurers are required by the federal law to sell insurance to people who have lost their jobs or who would otherwise be ineligible because of preexisting medical conditions.
HIPAA policyholders maintain that Blue Shield and one of its chief competitors, Anthem Blue Cross, have substantially overcharged subscribers for several years. Blue Shield says that its HIPAA rates comply with state guidelines.
Anthem, on the other hand, determined that it had overcharged customers between 2006 and 2009, and agreed to issue refunds.
As it relates to Anthem, one policyholder, Culver City attorney Les Greenberg, accused Anthem of returning only a fraction of what was due. Anthem had given Greenberg a $12 refund. He took the company to Small Claims Court. A judge agreed with Greenberg in September, awarding Greenberg with more than $7,300.
Greenberg filed another lawsuit in December on behalf of another Anthem subscriber, saying the insurer owed additional refunds to more than 10,000 HIPPA policyholders. Anthem issued a statement Wednesday saying its refunds were "appropriate."
Greenberg is also representing Lample in the lawsuit filed against Blue Shield.
"They have gone off on a lark of their own to overcharge their subscribers," Greenberg said of the two insurers. "I would call it egregious behavior."

Let us say you are a guy in Dallas, Fort Worth, Grand Prairie, Arlington, Irving, De Soto, Duncanville, Lancaster, Rowlett, Aledo, or anywhere else in Texas and you see an advertisement. How do you know whether the advertisement is being deceptive or misleading? The answer: You probably don't know.
Travelers Insurance was recently running an advertisement that was deceptive. There was a story on this on Wednesday, July 7, 2010. The story ran in the Austin paper, American-Statesman and was written by Tim Eaton. The title of the story is, "Consumer group says Travelers ad is deceptive, wants it pulled."
The Texas consumer advocacy group, Texas Watch, claims a television ad run by Travelers Companys, Inc. is deceptive in its content. The Executive Director of Texas Watch, Alex Winslow, has written to the Texas Attorney General, Greg Abbott, and to the Texas Insurance Commissioner, Mike Geeslin, seeking a cease-and-desist order to keep the ad off the air in Texas.
The article by Eaton tells the reader about the content of the ad saying, "In the advertisement, titled "Driving Your House," a man is seen driving throught the desert in what appears to be a wall-less house on wheels. The man gets into an accident, which spreads the house's contents across the desert roadside. As the homeowner-driver flies through the air - along with furniture and a cat - a voiceover says: "Without the right auto insurance, a crash might impact more than your car. Make sure you're properly covered, so when you're driving your car, you're not risking your house."
Eaton writes that the advertisement ends with the tagline: "Travelers. Take the scary out of life."
Texas Watch says the message implies that if homeowners don't carry adequate automobile insurance, then they could lose their homes. But the Texas Constitution has homestead protections that prevent the forced sale of a home in most circumstances. The Texas Watch director, Winslow, says, "What's particularly troubling about this ad is that it is preying on the fears that many people have about losing their home in our current economic crisis," and that, "Insurance companies shouldn't be allowed to deceive their customers into buying more overpriced insurance."
The Texas Department of Insurance has confirmed receiving the complaint and according to a spokesman, they plan to act quickly.
Both the Texas Department of Insurance and the Texas Attorney General have the authority to demand that a company stop running an advertisement.
As a side note, it is reported in Eaton's article that in 2005, Attorney General, Greg Abbott issued a cease and desist order to Allstate Corp. after the company ran an ad that featured a family that lost its home and savings because it didn't carry enough auto insurance. In that case, Allstate was informed that they were in violation of the Texas Deceptive Trade Practices Act and the Texas Insurance Code. Allstate did stop the ad and a lawsuit was not necessary.

What is common to a lot of residents of Dallas, Fort Worth, Grand Prairie, Arlington, Mansfield, Benbrook, Burleson, Aledo, and other areas of Texas? One, there are a lot of veterans living in the state and two, there are a lot of people who are behind on their child support payments.
First of all, there is no correlation between the two, except they are easy and short discussions. Let's talk about VA subrogation first.
When someone is injured as the result of a third person's negligent activity and the Veterans Administration has paid benefits to the injured person, the VA is entitled to be repaid for the amount of money they spent on the veteran's behalf. The reimbursement rights of the VA are written into law and are set out in the 1990 case, United States v. Maryland. This is a United States 4th Circuit case and in part says:
Federal law pertaining to veterans benefits places the Unites States on an equal footing with private hospitals in its attempts to recover from third parties the cost of medical services provided veterans for non-service-related injuries. Such equity is ensured by 38 U.S.C., Section 629(a)(1), which provides:
In any case in which a veteran is furnished care or services under this chapter for a non-service-connected disability ... the United States has the right to recover or collect the reasonable cost of such care or services ... from a third party to the extent that the veteran (or the provider of the care or services) would be eligible to receive payment for such care or services from such third party if the care or services had not been furnished by a department or agency of the United States.
The above statute defines at 38 U.S.C., Section 629(i)(3), third parties to include health care providers, employers, automobile insurance carriers, and "a State or political subdivision of a State."
Bottom line - these Veterans Administration subrogation interests have to be protected and the failure to do so correctly could put someone in the position of being sued by the Veterans Administration.
So now, what about child support liens? What do they have to do with injury claims? Most important, Texas Family Code, Section 157.317(a), says a lien for unpaid child support attaches to the personal injury claim of a person owing the child support. The lien is enforced by the Texas Attorney General. This lien is inferior to that of a health care provider with a valid lien, which essentially means that health bills get paid before the child support lien. Also, a child support lien does not attach to the injured persons' attorneys fees in the personal injury case. Think about it this way. If the attorneys could not be paid out of the settlement, then there is no incentive to get an attorney involved and thus there is no recovery to assist with the back child support payments.
An important note on child support liens is that there must be actual notice of the lien before it attaches to settlement proceeds. Contrast this with the other government liens where there does not necessarily have to be actual notice of the lien. These child support liens arise by operation of law and attach to all of the obligor's property, as well as to an injury claim. Texas Family code, Section 157.261(a) and 157.312(d) make this clear. Child support liens may be filed with the County Clerk in the county where the injury suit is filed, the county where the divorce (or suit in the interest of the child) originated, or in the county of the child support obligor's residence. Child support is not just for the dad - it applies to moms and dads.
The above are just two more examples why an experienced Insurance Law Attorney needs to be consulted when dealing with insurance companies.

What do residents of Dallas, Fort Worth, Grand Prairie, Arlington, Mansfield, Weatherford, and other cities in Texas need to know about subrogation? The answer is, a lot, unless you get an experieinced Insurance Law Attorney helping you.
Another important and potentially risky area of subrogation is Medicaid. Medicaid is a Federal program which is administered by the State. For us Texans, the program is administered by the State of Texas. Anytime you are discussing Federal Government liens and subrogation claims, such as Medicaid, Medicare, Veterans Administration, and a laundry list of others, it is wise to assume that such liens attach to claims and are superior to other liens, even if you have no actual notice of their existence.
Having said the above, it is important to realize that Medicaid and Medicare liens are very different creatures. This is expecially true in light of a recent United States Supreme Court case appealed from the State of Arkansas. This 2006 case is styled, Arkansas Department of Health and Human Services v. Ahlborn. A copy of the July 3, 2006 memo setting forth the Federal Government's position on Ahlborn's impact on Medicaid reimbursement / subrogation is available to the public on the Internet at:
http://www.nasmd.org/issues/docs/CMS_Advisory_Ahlborn_Settlement_Options_July%202006.doc.
This memo includes the following language about the Ahlborn decision: "A State's lien laws may only operate to recover from that portion of a settlement that is allocated to healthcare items or services, even if it means that Medicaid must forego full recovery of its claim." The memo included the following section:
What This Means for Medicaid Third Party Liability Recovery Programs:
Prior to the Supreme Court's decision in Ahlborn, CMS had interpreted the Medicaid third party liability provisions to authorize States to pass laws permitting full recovery of Medicaid assistance payments from third party liability settlements, regardless of how the parties allocated the settlement. The Supreme Court rejected this interpretation of the Medicaid statute and held that to the extent State laws permit recovery over and above what the parties have appropriately designated as payment for medical items and services, the State was in violation of federal Medicaid laws.
For Texas, the Ahlborn decision means that insurance adjusters, individuals, or attorneys dealing with a Medicare or Medicaid lien have to familiarize themselves with the current interpretations of the Ahlborn decision under Texas law.
And finally, here is something very important to know: A Texas Medicaid recipient may commit a misdemeanor by failing to notify the Texas Department of Human Services of a tort claim or cause of action. This can be seen in the Texas Human Resources Code, Section 32.033(b) and the Texas Penal Code, Section 12.23. In other words, if you do not handle these federal benefits properly as it relates to their lien / subrogation interests, you may be guilty of a criminal offense.

No matter where you live - Grand Prairie, Dallas, Fort Worth, Arlington, Mansfield, De Soto, Duncanville, or anywhere else in Texas, you have to keep your eye on insurance companies. If you don't, they will cheat and try to get away with doing people wrong.
A few weeks ago on this blog there was an article talking about the Texas Windstorm Insurance Association. Well, they are back in the news.
One of our favorite reporters, Purva Patel, with the Houston Chronicle, did a follow up story on the Texas Windstorm Insurance Association. This article was published on July 7, 2010, and is titled, "State criticizes windstorm insurer." Purva Patel has had a number of articles describing wrongs committed by insurance companies. In the article published on July 7, about the Texas Windstorm Insurance Association, he writes about poor record keeping procedures that Texas Winstorm evidently does not have. Of course, this is wrong. The Texas Insurance Code, Section 542.005(b), says:
"An insurer shall maintain a complete record of all complaints received by the insurer during the preceding three years or since the date of the insurer's last examination by the department, whichever period is shorter. The record must indicate:
(1) the total number of complaints;
(2) the classification of complaints by line of insurance;
(3) the nature of each complaint;
(4) the disposition of the complaints; and
(5) the time spent processing each complaint."
According to Patel's article, the Texas Windstorm Insurance Association hasn't logged consumer complaints or complied with its own internal hiring procedures. This is from a report released by state regulators.
This is a Texas Department of Insurance report of TWIA's operations from January 2006 to December 2008.
The TWIA is a state-created insurance company that sells wind insurance coverage to coastal homeowners who can not buy it elsewhere. They have been the target of over 2,000 lawsuits over how it handled Hurricane Ike related claims.
Coupled with the above TWIA has been the subject of state investigations about allegedly deceptive claims handling practices.
TWIA is refusing to talk about the wrongs it is being accussed of.
Here are a couple of examples of complaints against TWIA:
Permitted conflicts of interest by hiring family members.
Did not have claims managers in the field to train adjusters and handle problems.
Did not update pricing guidelines.
This is one company with one little niche of the insurance market. There is no excuse for this behavior.
Any time someone is having to make a claim with an insurance company, it would be good advice to consult with an experienced Insurance Law Attorney. A little consultation can prevent a lot of heartache and trouble.

A large part of the population in Dallas, Fort Worth, Arlington, Grand Prairie, Weatherford, and most all other cities in Texas receive some form of government benefits. So what happens when someone receiving Medicare benefits gets a settlement in an injury case from an insurance company?
The answer to the above question is, "it depends."
It should be obvious that if the benefits received by someone on Medicare are unrelated to the claim being made, then there is nothing to worry about. However, if the person receives a settlement based on injuries and medical bills that were paid for by Medicare, then Medicare is entitled to be paid back for any monies they paid for the benefit of the person receiving the benefits.
The most typical scenario is: A person who receives Medicare benefits is involved in an auto accident where someone other than the person receiving the Medicare benefits is at fault. The Medicare recepient goes to the emergency room and receives care until they have recovered from the injuries that were incurrred. The bills incurred by the Medicare recepient are all paid for by Medicare.
When the above happens, Medicare has a lien for any monies paid to settle the claim against the insurance company that the Medicare recepient is entitled to.
Medicare liens are sometimes referred to as "super liens" and for good reason. A Medicare lien is superior to other types of liens and does not even require written or actual notice to the parties involved. They are just suppose to be paid back, period. Medicare can recover from either party or either party's attorney. There are several Federal laws saying so.
Texas Courts have sometimes upheld Medicare's "super lien," even in the case of uninsured motorist benefits. This was shown in the case, Lewis v. Allstate, where Allstate was held not to have breached its contract with its insured by including Medicare as a co-payee on the settlement check for uninsured motorist benefits when both parties knew Medicare had issued payments for the insured's medical treatment. This was a 2006 case. In the Lewis case, the insured person conceded that Medicare would have had the right to seek reimbursement from an insurance company that knew or should have known about payments made by Medicare but failed to protect Medicare's rights. In this case, the insured attempted to rely on a 2000 case decided by the Beaumont Court of Appeals, styled Texas Farmers Insurance Company v. Fruge, in which the Court held "that it is a breach of contract for an insurer to include Medicare on a benefit check where the insurer had no reason to suspect that Medicare had any entitlement to a portion of the benefits paid." The Court refused to hold that Texas Farmers Insurance Company had a duty to determine the amount paid by Medicare, and distinguished Fruge, wherein the insurer knew Medicare had made a very small payment, yet it included Medicare as a co-payee on checks totaling nearly ten times that amount.
When dealing with Medicare it is not just important, it is vital that an experienced Insurance Law Attorney be involved in the settlement to keep the Medicare recepient out of legal trouble.

What if someone in Fort Worth, Arlington, Mansfield, Mesquite, Garland, Irving, Grand Prairie, Dallas, or anywhere else in Texas, is involved in an accident and goes to the hospital for treatment? Are there any special laws that apply?
The answer is yes. It depends on the circumstances, but often times, what is called a "hospital lien" comes into play. If this hospital lien is not properly dealt with it could cost a lot of money and heartache.
Texas public policy strongly supports hospital liens, and it is important to understand that these liens are not just applicable to hospitals; they may also operate for the benefit of EMS providers and doctors at teaching hospitals whose bills are not already included in the bill. The rights of hospitals and certain other medical providers to be paid from settlement proceeds or a judgment begins with the Hospital Lien Statute. This is found in the Texas Property Code, Chapter 55. It says, in relevent part, that a lien attaches to "any cause of action, judgment, or settlement" received as a result of an accident for which the person was admitted to a hospital within 72 hours of the injury, as well as any hospital to which the injured person is subsequently transferred for the same injuries. This is found in Texas Property Code, Section 55.002. These hopital liens must be filed prior to settlement in order to be valid, and hospital liens are limited to "reasonable and regular" charges within the first 100 days following the injury. Even the attorney representing the injured person may have to wrestle with the hospital for first priority, as seen in the Texas Supreme Court case styled, Bashara v. Baptist Memorial Hospital System, decided in 1985.
The Dallas Court of Appeals in 1979, in the case styled, Baylor University Medical Center v. Travelers, said that the intent of the Hospital Lien statute was to save lives, by "...inducing hospitals to receive a patient, injured by the negligence of others, by giving the hospital a lien on the claims, suit or settlement of the patient."
An important exception to the hospital lien statute is stated in the case, Members Mutual Insurance Company v. Hermann Hospital, decided in 1984, by the Texas Supreme Court. It says that a hospital lien does not attach to uninsured/underinsured motorists benefits. The reasoning is that the statute is to apply to settlements recovered from third parties and not to underinsured/uninsured benefits.
Another situation that the hospital lien statute does not apply to is a wrongful death case. Atleast that was the decision by the Fort Worth Court of Appeals in the case styled, Tarrant County Hospital District v. Jones, decided in 1984.
Rather than getting some relief by settling a case with the person who caused injuries in an accident, the end result could find the injured person being sued by the hospital if the hospital lien statute applies and is not properly handled.

Most every person in Grand Prairie, Arlington, Mansfield, Fort Worth, Bedford, Mesquite, De Soto, Duncanville, Weatherford, or anywhere else in the State of Texas, has at one time or another purchased something on credit. Many times when a credit purchase is made a person will have the opportunity to purchase some sort of insurance that will pay the debt in the event that you become disabled or killed before the debt is repaid.
Almost all credit card companies will offer credit life and disability for a few extra dollars each month and charged a fee based on the total amount of the debt due on your credit card. The payment for this insurance is going to be charged and included in your credit card payment. Another place most people will see this type of insurance being offered is with a home purchase. If you do not purchase this option when you purchase the home, you will receive numerous solicitations in the mail offering this insurance to you. Another time a person is almost always requested to purchase this type of insurance is when an automobile purchase is made on credit. If this type of insurance is purchased in a car transaction it is going to be at the point of sale and is usually a lump sum and rolled into the loan for the vehicle.
Texas laws exist to regulate credit life and disability policies in Texas. The chapter of the law dealing with this is cited as the Act for the Regulation of Credit Life Insurance and Credit accident and Health Insurance.
Texas Insurance Code, Section 1153.003, defines "credit accident and health insurance" as insurance to provide indemnity for payments that become due on a specific credit transaction of a debtor when the debtor is disabled, as defined in the policy. It defines "credit life insurance" as insurance on the life of a debtor in connection with a specific credit transaction.
The above definitions are found in Chapter 1153 of the Insurance Code. The various subchapters define and describe how this type of insurance is regulated.
This is an area of insurance that is ripe for abuse. Too many times this insurance is needed most when the debtor dies. Usually it is only the debtor who knew the insurance existed. Good probate attorneys know to ask questions of survivors that will get them to search for this type of insurance to cover the debts of someone who has passed away, but too often people who die did not have estates left behind that the survivors feel it is worth getting a probate attorney to look into.
One area where people get abused quite a bit is when these policies are sold at the time of a vehicle purchase. The sales person is almost never qualified to sell this type of insurance and their motive is to just sell the policy in order to get a commission off the sale. As a result, the paperwork filled out for the purchase of this insurance is usually not completed properly with the debtor. In other words, the salesman fills out the paperwork without really going over important parts of the application. In fact the salesman will not even ask a lot of the relevent questions, rather the salesman will just fill out the paperwork in the manner they know will be acceptable for completing the sale without regard to the truthfulness or completeness of the answers to the questions. The result of doing it this way is that when a claim for benefits is made, the claim is denied because of untruthful or incomplete answers to the questions.
Experienced Insurance Law Attorney will be able to tell you plenty of "war stories" of examples where this credit life and disability insurance has been improperly handled by those selling the policies.

What is a lien? The person in Flower Mound, Haslet, Saginaw, Irving, Carrolton, De Soto, Grand Prairie, Arlington, Mansfield, Fort Worth, or anywhere else in Texas may ask that question.
Generally speaking, in the insurance context a lien is a right to money that a third person may eventually get. Others describe it as a property right which remains attached to an object tht has been sold, but not totally paid for, until complete payment has been made. Another way of putting it is, a hold or claim which one person has upon the property of another as a security for some debt or charge.
In the insurance world a lien normally arises where some person or business causes injury to someone. After the injury, the injured person seeks and receives medical care that his personal health insurance pays for. When this occurs the health insurance company will usually have a subrogation lien against the person or business that caused the injury.
A personal injury settlement or judgment may create tension between insured people and their health insurance company and their medical providers. The right of an insurer of a medical provider to be paid from the proceeds of a settlement falls under the general category of subrogation. Subrogation is defined as, "The substitution of one person for another, expecially the legal doctrine of substituting one creditor for another."
Both "subrogation" and "lien" are terms of art with specific meanings, and it is sometimes hard to be true to the meanings. Legally, this is a challenge, as the terms are often used interchangeably by legislatures and courts and Judges. In the insurance context, it generally means the right to money that a third party may eventually get. Liens are perfected (that is, made collectable) by filing them with the appropriate County Clerk. Subrogation, which again is a term sometimes used interchageably with "lien," and sometimes along with it, as in "subrogation lien," is a right of repayment that can be created by a statute or by contract.
Before going further, when talking about liens and subrogation, it is vital that an experienced Insurance Law Attorney be consulted. Otherwise, a person receiving money and benefits can find themselves being sued. Sometimes a criminal wrong is committed unknowingly when these issues are not handled properly.
Subrogation interests are created by contract, and a third party's liability for same can be extinguished by a release of the wrongdoer by the injured person.
One example is where a person's car is damaged in a wreck with another person and the other person was at fault. The person's car who was damaged makes a claim with the insurance of the atfault person but the insurance company is too slow to fix the damage so the person with the damaged car gets his own insurance company to fix his car. He gets his car fixed and goes on about his life when two weeks later the atfault driver's insurance company calls and concedes they are atfault and pays money for the damage to the car. If the person who has his car damaged accepts the money he can get in trouble. Why? Because when he got his own insurance company to fix his car, his insurance company became the one who had the right to receive the money from the atfault driver's insurance.
Another example is, same as above but the person was also injured and went to the hospital and had his health insurance pay for his medical bills. Later when the atfault driver's insurance admits fault and pays the injured person for his injuries, the injured person's health insurance company has a subrogation interest that must be satisfied to the extent of all monies paid to the injured person.
The confusing thing about the above is all the exceptions that can come into play.

Here is a question a resident of Mansfield, Grand Prairie, Arlington, De Soto, Hurst, Benbrook, Burleson, Fort Worth, or any other city in Texas might ask. What happens if my insurance company goes bankrupt?
First of all, insurance companies that have financial problems do not go into or declare bankruptcy. Financially insolvent insurance companies go into receivorship. The Texas Insurance Code, Section 443.004, defines receivorship as any liquidation, rehabilitation, or ancillary conservation.
Companies that write insurance policies in Texas are heavily regulated, and the Texas Legislature has provided numerous safeguards to protect the residents listed above against insurance company insolvency. The Texas Property and Casualty Insurance Guaranty Act is found in the Texas Insurance Code, Chapter 462. Also see, Texas Transportation Code, Section 643.105. (This section 643.105, deals with commercial carriers on the highway such as the companies that insure 18-wheelers) In connection with these statutory safeguards, Article 5.06-1 of the Texas Insurance Code requires the definition of "uninsured motorist" to include a vehicle for which the liability carrier is or becomes insolvent. Furthermore, the Texas Property and Casualty Insurance Act provides further protection for the public against failure of licensed insurance companies as a result of insolvency.
This Act creates a Guaranty Association for the purpose of paying unpaid claims, including those claims which are the fault of other people, known as third parties, that arise out of and are within their coverage. The liability of the Guarantee Association is still limited by the limits these third parties had on their insurance policys. This is addressed in Sections 462.002, 462.007, 462.008, and 462.305. Another limitation is found in Section 462.213. This section limits covered claims to $300,000.
While the Texas Property and Casualty Insurance Guaranty Act does provide the insurance policy holder with a source for recovering damages that would be assessed against an uninsured motorist, the Act does not alter a solvent insurance company's obligation to pay UM/UIM coverage, and, in fact, requires the insured to first exhaust UM/UIM coverage that may be available under his or her own policy. In this regard this is further discussed in Sections 462.251, 462.252, 462.253, and 462.254.
More information about situations where an insurance company is declared insolvent and goes into receivorship can be found with the Texas Department of Insurance or an experienced Insurance Law Attorney can be helpful in working through the situation.