Dallas Fort Worth Insurance Lawyer Blog

Here is a situation for someone in Grand Prairie, Arlington, Fort Worth, Dallas, Irving, or anywhere else in the DFW area to think about. If a car has insurance and it gets sold, is the insurance on the car still valid?
This case was decided by the Houston Court of Appeals, First District, in 1986. The style of the case is Douglas W. Black v. BLC Insurance Company.
Black was appealing from a summary judgment that BLC had no duty to defend against his claim because BLC had no liability to him under its insurance policy.
On May 6, 1983, BLC issued an auto policy to Thomas Webster covering his 1972 Dodge. Webster sold the car to Robert Linville on September 9, 1983. A week later, Linville sold the car to Warren Sanchez. Sanchez took possession on September 17, 1983, paying $270 and promising to pay the balance by September 30, 1983. Linville gave Sanchez a bill of sale to evidence the transaction. On October 23, 1983, Sanchez, while driving the 1972 Dodge, was killed in a collision with a car driven by Black. Black, who was injured, sued Sanchez' estate for damages.
BLC sought a declaratory judgment that it had no duty to defend or indemnify Sanchez' estate under its insurance policy issued to Webster, because Webster had sold the insured auto before the accident. The court ruled in favor of BLC.
Black contended that the court erred because Webster's policy was not cancelled and still covered the 1972 Dodge on October 23, the date of the accident.
The pertinent portions of the policy provide:
DEFINITIONS
Throughout this policy, "you" and "your" refer to:
1. The "named insured" shown in the Declarations, and
2. The spouse if a resident of the same household.
***
"Your covered auto" means:
1. Any vehicle shown in the Declarations;
2. Any of the following types of vehicles on the date you became the owner:
a. a private passenger auto; or
b. a pickup, panel truck or van, not customarily used in any business or occupation other than farming or ranching.
This provision applies only if you:
a. acquire the vehicle during the policy period; and
b. notify us within 30 days after you become the owner.
If the vehicle you acquire replaces one shown in the Declarations, it will have the same coverage as the vehicle it replaced. You must notify us of a replacement vehicle within 30 days only if you wish to add or continue Coverage for Damage to Your Auto.
If the vehicle you acquire is in addition to any shown in the Declarations, it will have the broadest coverage we now provide for any vehicle shown in the Declarations.
***
PART A -- LIABILITY COVERAGE
INSURING AGREEMENT
We will pay damages for bodily injury or property damage for which any covered person becomes legally responsible because of an auto accident.
"Covered person" as used in this Part means:
1. You or any family member for the ownership, maintenance or use of any auto or trailer.
2. Any person using your covered auto.
3. For your covered auto, any person or organization but only with respect to legal responsibility for acts or omissions of a person for whom coverage is afforded under this Part.
4. For any auto or trailer, other than your covered auto, any person or organization but only with respect to legal responsibility for acts or omissions of you or any family member for whom coverage is afforded under this Part. This provision applies only if the person or organization does not own or hire the auto or trailer.
Black contended that "your covered auto" in the policy means "any vehicle shown in the Declaration," and the declaration named the 1972 Dodge; therefore, the car remained insured under Webster's policy, despite the two changes of ownership. Black charges that the trial court's judgment has improperly added to the policy a requirement that the named insured, Webster, own the "covered auto."
In explaining its ruling, this court said that Webster's ownership of the car was a prerequisite to coverage under this policy. The policy language is clear. A "covered person" is any person using "your covered auto." "Your covered auto" is defined in the policy as "any vehicle shown in the declarations. The word "your" is defined as referring to:
the "named insured" shown in the declarations ....
The use of the word "your" in this policy means that Webster had to own, possess, or at least control the use of the car in order for coverage to exist.
Other courts have reached the same result even though, as in the present case, the named insured remained the record owner on the certificate of title and despite laws providing that unrecorded sales are void.
In a concluding paragraph the court said:
"A finding of coverage under these facts would deprive an insurance company of the right to choose its customers and delegate that power to the insured when choosing a buyer. It would expose the insurer to a greater risk than it assumed by covering permissive users. This is because the insured will generally loan his car cautiously, in order to get it back whole. The insured will not be so careful, however, when selling. Then he will likely sell to the highest bidder, no matter how unskilled or uninsurable the person may be. That is a risk that neither party bargained for, and it is not one plainly included within the policy's language. The trial judge's decision was supported both by the policy language and by sound public policy.

Insureds in Weatherford, Mineral Wells, Aledo, Azle, Hudson Oaks, Willow Park, Brock, Millsap, Cool, Springtown, and other places in Parker County and Texas do not always understand what is covered by their policy and what is not. Here is a case that helps understand a little bit about coverage as it relates to auto policies.
In 2003, the Houston Court of Appeals, 14th Dist. issued an opinion in the case, Alejandro Armendariz and Alma Armendairz v. Progressive County Mutual Insurance Company. This case is an appeal from a Declaratory Judgment lawsuit where in Progressive won after filing a motion for Summary Judgment. Here is some background.
The Progressive automobile insurance policy in the case covered two cars, one owed by Alejandro and the other owned by his sister, Alma. Alejandro was the named insured on the policy. Additionally, Alejandro's parents, who lived with him, and Alma were named as "listed drivers" on the policy. When Alejandro first purchased insurance from Progressive, the policy covered his parents' van. However, Alejandro deleted the van from the policy because his parents wanted to sell it. Four months later, while driving her parents' then uninsured van, Alma, by accident, backed over and killed her father. Alma's mother then sued Alma for the father's wrongful death.
Contending that the van was not a covered auto and Alma was not an insured, Progressive denied the claim and filed this lawsuit. The language in the policy that Progressive relied upon said: "We do not provide liability coverage for the ownership, maintenance, or use of any vehicle other than your covered auto which is owned by a family member or furnished or available for the regular use of any family member."
The Armendarizes contended that the exclusion at issue violated public policy and the Texas Motor Vehicle Safety Responsibility Act. There were two pertinent portions of the Progressive policy in the case. The first was the exclusion:
"B. We do not provide Liability Coverage for the ownership, maintenance or use of:
...
3. I. Any vehicle, other than your covered auto, which is:
a. owned by any family member, or
b. furnished or available for the regular use of any family member.
II. However, this exclusion (B.3) does not apply to [the insured's] maintenance or use of any vehicle which is:
a. owned by a family member ...."
The second pertinent portion of the policy was the definition of "family member": "a person who is a resident of [the insured's] household and related to [the insured] by blood, marriage, or adoption." In this case, Alejandro's parents, who lived with him, owned the van. Further, the van was no longer a covered auto under the policy. Lastly, Alma was not an insured under the Progressive policy, but merely a listed driver for the two covered autos. Because Alma caused the accident while driving her father's uninsured van, the exclusion, if valid, precluded liability coverage.
The Armendarizes argued that the exclusion in the case was akin to the invalid "family member exclusion." The family member exclusion, also called Endorsement 575, reads, "We do not provide Liability Coverage for you or any family member for bodily injury to you or any family member."
In its analysis of this case the court looked at the above and stated, "However, there was no liability coverage here because the family member's vehicle was uninsured, not because a family member was the injured claimant. Even if an unrelated third party had been struck by the van, the exclusion would still apply because the van was owned by a family member but was not insured."
The decision in this case was consistent with the interpretation of owned-but-uninsured exclusionary language in other states. As this court noted, without the exclusion, an insurance company would be "required to insure against risks of which it is unaware, unable to underwrite and for which it is unable to charge a premium.
These cases are tough. An experienced Insurance Law Attorney needs to be involved early in these claims to establish facts that might be helpful to a recovery.

Policy purchasers in Grand Prairie, Arlington, Irving, Fort Worth, Crowley, Hurst, Euless, Bedford, Mansfield, Dallas, and other places in Texas would like to think they know who is covered under a policy they purchase. What is surprising is the difference between what the policy purchaser thinks and what the insurance company thinks.
A 1972, Texas Supreme Court case styled, Robert Snyder, et al. v. Allstate Insurance Company, is an interesting case. Here is a little bit about it.
The controversy is between Allstate, which issued an auto policy to J.B. Rhodes about whether or not they should pay damages arising out of a claim in the possession of and used by Darla Rhodes (minor daughter of J.B.) while being driven by Robert Snyder with Darla Rhodes as a passenger.
Allstate brought this declaratory judgment action seeking an affirmative determination that it had no obligation under its policy.
On June 1, 1968, J.B. purchased a 1962 Mercury auto and delivered it to his daughter Darla, a minor, who did not live in the same household with her father. Both the legal and equitable title to the car are disputed by the parties, but it is undisputed that J.B. purchased an automobile liability policy from Allstate and that the Mercury was specifically described in the policy and a premium was paid for that car. On January 18, 1969, Darla and Snyder were involved in a collision while Snyder was driving the Auto at Darla's request. Both suffered personal injuries, as did occupants of the other car.
Snyder and his father, John Snyder, and Darla and her father J.B., had requested Allstate to defend Snyder up to the limits of the Allstate policy.
At a trial in this matter, the trial court withdrew the case from the jury and entered a judgment that Allstate had an obligation to defend Snyder in all actions and to pay all claims up to its policy limits arising out of the collision.
Allstate appealed claiming that by its policy of liability insurance, Allstate contracted with J.B., the named insured, to pay all sums he should become legally obligated to pay as damages because of bodily injury or property damage "arising out of the ownership, maintenance or use of the owned automobile." The policy defines "insured," with respect to the owned automobile, as:
"(1) the named insured and any resident of the same household."
"(2) any other person using such automobile with the permission of the named insured, provided his actual operation or (if he is not operating) his other actual use thereof is within the scope of such permission, and"
"(3) any other person or organization but only with respect to his or its liability because of acts or omissions of an insured under (a)(1) or (2) above,"
"Owned automobile" is defined in the policy as:
"(a) a private passenger, a farm or utility automobile described in this policy for which a specific premium charge indicated that coverage is afforded, ..."
It was undisputed that a specific premium charge was paid on the specific automobile in question; therefore, the automobile was an "owned automobile." Allstate argued that in addition to the definition of "owned automobile" the policy required that actual ownership of the automobile be in the insureds' name. As the court pointed out, the policy did not so provide, and the court refused to compel such a requirement.
J.B. testified that he gave Darla the car for her general use and "left it up to her for her own judgment" as to how she used the car, warning not to let "every Tom, Dick, and Harry" to use it. Darla testified that she asked Robert to drive her from Stratford to Fritch because she did not have a jack in her car and did not want to drive alone in the dark. Allstate did not dispute these facts but relied on them in this appeal in making its argument that J.B. had no authority to give his permission as the named insured because he did not own the auto.
This appeals court recognized two fact questions; (1) authority for the permittee (Darla) to allow a third person (Robert) to drive or use the car, and (2) the original permittee's consent to such use by a third person. As indicated above, these facts were undisputed and thus the court ruled against Allstate.
The cases are often times difficult. Each depends on the facts of exactly what happened and the language in the policy at issue. This is why an experienced Insurance Law Attorney needs to be sought out early in a case where the insurance company denies coverage.

Insured's in Weatherford, Mineral Wells, Aledo, Willow Park, Hudson Oaks, Azle, Brock, Millsap, Springtown, Cool, Peaster, and other places in Parker County would be confused when trying to figure out some aspects of coverage as it relates to auto insurance policy's. The meaning of "Family Member" in a policy might sound pretty easy at first glance, but looking at individual situations makes it not so easy. What about when people just filed for divorce, are separated, not married but living together, away at college or trade school? Are they a "Family Member?" Here is a different look:
The Houston Court of Appeals, First District, issued an opinion in 1996, that is interesting. The style of the case is, State Farm Mutual Automobile Ins. Co. v. Ms. Hanh Thi Dinh Nguyen, and Dr. Bay Van Nguyen, Individually and as Next Friend of His Deceased Infant Daughter.
This appeal is from a summary judgment hearing wherein the court had to decide whether the child in the case, whose entire six-day life was spent in a hospital, was a "resident" of the insured's household.
State Farm had issued an auto liability policy to the Nguyen's with policy limits of $100,000. In 1992, Mrs. Nguyen, who was pregnant, was in a car accident. She sustained injuries that resulted in an emergency cesarean section. A daughter was born. She lived for six days but then died from her injuries in the accident. It is undisputed that the child spent her life in the hospital and never went home to her parents' house.
Dr. Nguyen sued his wife for the child's wrongful death caused by her negligent driving. State Farm defended the lawsuit. The trial court rendered a $100,000 judgment against Mrs. Nguyen. Dr. Nguyen, as third party beneficiary, and Mrs. Nguyen, as insured, sought insurance coverage from State Farm for the amount of judgment. State Farm denied coverage under the family member exclusion in the policy and filed a declaratory judgment action.
At a resulting summary judgment hearing, the Nguyens asserted that the family member exclusion in the policy did not apply to the facts of this case because their child never resided in Mrs. Nguyen's household. There were other legal issues asserted.
State Farm contended that, to the extent it is valid, the family member exclusion applies and precludes coverage because the infant was a resident of Mrs. Nguyen's household.
The policy excluded liability coverage "for [the insured] or any family member for bodily injury to [the insured] or any family member." "Family member" is defined as:
[A] person related to you [the insured] by blood, marriage or adoption who is a resident of your household. This includes a ward or foster child who is a resident of your household, and also includes your spouse even when not a resident of your household during a period of separation in contemplation of divorce.
The court said there were three possibilities here: 1) the child was a resident of the Nguyens' household; 2) the child was a resident of the hospital; or 3) the child established no residence before she died.
The controlling test of whether persons are residents of the same household at a particular time, within the meaning of the policy in question, is not solely whether they are then residing together under one roof. The real test is whether the absence of the party of interest from the household of the alleged insured is intended to be permanent or only temporary -- i.e., whether there is physical absence coupled with an intent not to return.
The case then discussed other cases and other cases from other states.
The court then said they agreed with a ruling which stated, "'resident' is an elastic and amorphous word having different shades of meaning depending upon the context in which it is employed." Moreover, the court considered two factors to be especially significant to the present case, the age and self-sufficiency of the injured person and the absence of another lodging. Both favor a finding that the child was a resident of Mrs. Nguyen's household.
"If we were to hold that the child was not a resident of the Nguyens' household, we would have to conclude that she had no residence. Clearly, she was not a resident of the hospital. While she was there for all six days of her short life, there was no intention that she remain there upon recovery; the intention was that she would reside with the Nguyens. Here, the child could have but one residence, that of her parents, the insureds, for the purpose of determining the application of the family member exclusion."
In this case, the court ruled that the family member exclusion applied. As a result, the Nguyen's were not able to recover the full $100,000 under the policy. Instead, they were limited to the state minimum at that time, of $20,000. To understand this part of the ruling, someone would need to consult with an experienced Insurance Law Attorney.

Someone in Grand Prairie, Weatherford, Arlington, Fort Worth, Dallas, Mineral Wells, Grapevine, Keller, Colleyville, or anywhere else in Texas should know that when it comes to suing an insurance company, there are things to know.
A 2007, San Antonio Court of Appeals case serves as a good example. The style of the case is, In re Terri Ann Garcia.
This is a writ of mandamus case. The person suing, Terri Ann Garcia, sought a writ of mandamus to vacate the trial court's order quashing the deposition of a State Farm Mutual Automobile Insurance Company representative. State Farm was trying to prevent the taking of the deposition of its representative.
Here is some background.
Garcia claimed injury when she was hit by another car. Garcia collected the full liability limits from the other car's insurance liability carrier. When she sought an under insured motorist claim against her own carrier, State Farm, they denied the claim and she filed a lawsuit. The claim was for her injuries and for bad faith and breach of contract. The trial court severed the injury claim from the bad faith claim and breach of contract claim.
Garcia subsequently informed State Farm of her intent to take the oral deposition of one or more of its representatives. State Farm moved to to quash the deposition and the trial judge granted State Farm's motion.
In the mandamus petition, Garcia asserted the trial court's order afforded State Farm "a special immunity from discovery not contemplated by the Texas Rules of Civil Procedure," emphasizing that State Farm "should not be permitted to conduct full and complete discovery of Garcia's case position on issues pertaining to the breach of contract allegations" while she is prevented from discovering similar information from State Farm.
In discussing this case the court pointed out that for Garcia to prevail in her breach of contract suit, she must prove both the liability of the third party and her actual damages. State Farm pled several defenses to Garcia's breach of contract claim, including disputing her actual damages. State Farm alleged Garcia failed to comply with all conditions precedent to recover under her insurance policy; Garcia suffered from pre-existing injuries and conditions; Garcia suffered from subsequent and intervening injuries and conditions not caused by the accident; and Garcia failed to mitigate her damages by ignoring her doctor's instructions and failing to seek appropriate treatment.
Garcia's deposition notice informed State Farm that the deposition would cover ten specific areas, including the occurrence or non-occurrence of all conditions precedent under the contract, any facts supporting State Farm's legal theories and defenses, and information regarding State Farm's experts. The court's review of the specific requests lead them to conclude that many of these matters correspond to the defenses and theories raised by State Farm or have a direct bearing on the damages in Garcia's breach of contract claim. Clearly, information about State Farm's defenses are relevant and properly discoverable, absent a showing of privilege or some other exemption authorized by the Texas Rules of Civil Procedure, Rule 192.3(a).
State Farm offered no evidence to substantiate their claim that the evidence could be obtained in other ways, nor did they produce any evidence showing a deposition of its representative constitutes harassment or is unduly burdensome or expensive as required by Rule 192.4(a). State Farm also contended it had stipulated to the insurance policy, the underlying liability policy limits, and the amount of any offsets or credits. At the hearing, State Farm's attorney represented to the trial court that in the future it would stipulate to the policy of insurance, the facts supporting its legal theories and defenses, its limitation of liability, and any offsets or credits to which it is entitled. However, nothing in the record showed State Farm stipulated to any of these matters. The court said, "We believe State Farm's assurances that it will stipulate to these matters in the future is not a proper substitute for discovery."
The court went on to say, "Without the opportunity to fully discover information about State Farm's multiple defenses, Garcia is effectively prevented from verifying and refuting those defenses. Moreover, as State Farm acknowledges in its brief, Garcia must establish at trial that 'her damages exceed the underlying liability insurance limits and any other offsets or credits State Farm may be entitled to.'"
Thus, this appeals court ordered the trial court to withdraw its order quashing the deposition of the State Farm representative.

Workers in Grand Prairie, Arlington, Irving, Fort Worth, Dallas, Mesquite, Garland, Richardson, Carrolton, Hurst, Euless, Bedford, or anywhere else in Texas may wonder about this situation. What if you are hurt at work while driving a company vehicle, your employer has workers compensation benefits you seek and obtain, and the vehicle has underinsured / uninsured (UM) benefits purchased by your employer? Can you obtain the UM benefits?
The Amarillo Court of Appeals had this issue come up in a case they issued an opinion in on September 26, 2011. The style of the case is, Robert Smith v. City of Lubbock and St. Paul Fire and Marine Insurance Company.
This case was an appeal from a summary judgment in favor of Lubbock and St. Paul. This court reversed as it relates to St. Paul but affirmed the decision as it relates to the employer, City of Lubbock.
The issue was whether or not the Texas workers compensation laws bar an employee from suing his employer upon an UM injury suffered by the employee while working. The damages at issue arose when Smith was struck by an intoxicated driver while Smith was working for Lubbock. The intoxicated driver was not an employee of Lubbock nor was he sufficiently insured. So, Smith made a claim for UM benefits under the policy purchased by Lubbock for its employees, even though he already received workers' compensation benefits. The claim was denied and this lawsuit resulted.
Lubbock argued that the state workers' compensation laws barred Smith from additional recovery. Smith claimed those statutes only precluded recovery for work-related injuries arising from common law torts as opposed to a contract and his claim arises from an insurance contract.
Here are some undisputed facts:
First, Lubbock acquired the policy from St. Paul on behalf of its employees.
Second, Smith was an employee of Lubbock at all times relevant.
Third, Smith suffered injuries at the hands of a drunk driver while Smith was within the course and scope of his employment.
Fourth, Lubbock paid for Smiths injuries through its workers compensation plan / insurance.
Pursuant to Texas Labor Code, Section 408.001(a), "Recovery of workers' compensation benefits is the exclusive remedy of an employee covered by workers' compensation insurance coverage or a legal beneficiary against the employer or an agent or employee of the employer for the death of or a work-related injury sustained by the employee."
Smith is asking the court to interpret the statute as simply referring to tort claims, not those arising from contract.
In discussing this case the court pointed out that the statute does not contain the words "tort" or "negligence." It does not mention a particular chose-in-action. Given that the common law choses-in-action of tort and contract have existed for more than a century, it is safe to presume that the legislators knew of them when enacting Section 408.001(a). Yet, they opted not to express them in the statute. Instead, they incorporated terms focusing upon a remedy for particular injuries, not a cause of action through which remedies are generally sought. Those terms were "workers' compensation benefits" being the "exclusive remedy" for "work-related injuries" encountered by employees "covered by workers' compensation insurance."
It cannot be doubted that breach of contract is a common law claim. So, it would seem that Smith's effort to categorize his claim upon the policy as one for breached contract to trump the exclusivity provision is of little value to him.
Simply put, if an employee suffers work-related injuries and seeks their redress from an employer that subscribes to a workers' compensation program, there is only one way to obtain them. It is through that compensation program. It does not matter if the employer provides those benefits from its own pocket or via a contract with a third party insurer; once it provides them, statute bars the employee from forcing the employer to redress the injuries through other means. For the court to rule otherwise would provide the employee a backdoor way of recovering more from his employer than the exclusive workers' compensation remedy.
This case was an attempt by Smiths' attorney to maximize a recovery for Smith that did not work out.

Insured's in Grand Prairie, Irving, Garland, Mesquite, Dallas, Carrolton, Richardson, Duncanville, De Soto, and other places in Dallas County might have a hard time believing some of the reasons an insurance company will use for denying a claim. Here is one they tried but it did not work regarding the child of divorced parents.
The case was decided by the Texarkana Court of Appeals in 1978. The style of the case is, Hartford Casualty Insurance Company v. Barbara Smith Phillips, Individually and as Personal Representative of the Estate of Jerry Glenn Phillips.
This case involves the question of coverage under the uninsured motorist provisions of a policy of automobile liability insurance. Barbara Phillips was the named insured and sought recovery of damages for bodily injuries sustained by her son, Jerry Glenn Phillips, as a result of an accident caused by an uninsured motorist. At trial, the jury found that Jerry was a "resident of the same household" as Barbara. Hartford contended that Jerry was not such a resident as a matter of law; that there is no evidence to support the jury finding; that there was insufficient evidence to support such finding; and that such finding was so against the great weight and preponderance of the evidence as to be manifestly wrong and unjust.
It should be noted that at the time of his death, Jerry Glenn Phillips was only fourteen years old.
Barbara was Jerry's mother. His father was Jerry Leon Phillips. The parents had divorced in 1964 and custody was placed with Barbara. However, in 1965, without a change in the custody order, Jerry Glenn, through an agreement by his parents, went to live with his father. It appears that Barbara had only a one bedroom apartment and the father had a two story home with ample space for a separate bedroom for Jerry Glenn, such home being located within twelve blocks of the school that Jerry Glenn attended. Barbara's apartment was not within the school district and the home address of Jerry Glenn for school purposes was that of his father. He had his meals and kept his clothes at his father's house except when visiting his mother. He also kept extra clothes at his mother's apartment. The father claimed Jerry Glenn as a dependent on his income tax returns. The school directory listed his address as that of his father. The medical, hospital, physician records and police report reflected that he resided with his father. His mother bought all of his clothing and provided his food when he was at her apartment. His father testified that he stayed with both him and his mother. The jury found as a fact that Jerry Glenn was a resident of his mother's household and the court entered a judgment reflecting that finding.
From a legal stand point, it should be noted that Barbara was the legal custodian of the child, that the child was only fourteen years of age and that a person, particularly a child, can have more than one "residence" as distinguished from a "domicile." A person may, and many do, have more than one residence. This is particularly true of a minor child of divorced or estranged parents.
In ruling for Barbara the court stated:
"It is quite evident that a finding by the court or jury that Jerry Glenn was a "resident" of his father's household would be adequately supported by the evidence. However, such a finding would not necessarily foreclose and prevent a finding that he was also a "resident" of his mother's household. The mother remained his legal custodian, contributed to his support, he regularly spent time with her in her apartment and kept some clothes there. Barbara as his legal custodian, had she so desired, could legally have required him to remain under her roof full time. The fact that for what apparently she and his father jointly felt would be for his best interest, would not within itself as a matter of law prevent him from being a "resident" of her household."

Insureds in Grand Prairie, Arlington, Fort Worth, North Richland Hills, Hurst, Euless, Bedford, Dalworthington Gardens, Lake Worth, Crowley, or anywhere else in Tarrant County may wonder when a person is determined to be a member of the household for insurance purposes under an insurance policy. Guidance to an answer of that question was provided in a case in 1977.
The style of the case is, Southern Farm Bureau Casualty Insurance Company v. Kenneth C. Kimball et al. The opinion was issued by the Waco Court of Appeals.
Kenneth Kimball was the named insured under a policy issued by Southern Farm Bureau Casualty Insurance Company. Kenneth's wife, Connie was killed in an automobile accident with an uninsured motorist when the policy was in force. At the time of her death, she and Kenneth were separated, living in separate residences, and a divorce action by her was pending. Farm bureau filed a declaratory judgment as to its responsibilities under the policy for uninsured motorist protection benefits, personal injury benefits, and death indemnity benefits. On the trial, under stipulated facts, the only issue raised by the parties was whether Connie and Kenneth were "residents of the same household," as that term is used in the policy, at the time of Connie's death.
The jury answered "yes" to that question and rendered judgment accordingly.
Farm Bureau argued that Connie and Kenneth must also "dwell together under the same roof" in order to be residents of the same household.
This appeals court upheld the jury decision. In doing so they looked at the following evidence and ruled that it was sufficient to satisfy the "residents of the same household" requirement of the insurance policy.
Here are those facts:
Kenneth and Connie, a couple in their 20's, were married in May, 1972. Their only child, a daughter, was born in September, 1973. Connie was killed on December 21, 1975. Before their separation, they resided in their mobile home in the City of Waco. Early in their marriage, they suffered substantial financial losses in the construction business. Thereafter, during the last two years of their marriage, Kenneth was a "long haul" truck driver, based in Waco. He would be on the road three or four weeks at a time, with no longer than three days home between trips. Sometimes he would get in at night and leave the next morning. On the trips, he virtually lived in his truck. It was arranged with his employer that Connie could draw on his earnings and pick up his paychecks. She cashed the checks, bought the family needs, and paid the bills, including payments on the mobile home and several department store accounts she maintained. Connie also held a job. During the day, she left their child with her mother who lives in the City of Lacy-Lakeview, near Waco. After work when Kenneth was gone, Connie would go home, clean up, carry her work clothes for the next day to her mother's house, and she and the child would spend the night there. Connie filed suit for divorce on November 5, 1975. Later, she separated from Kenneth and moved into her mother's house, taking all of her work clothes. After the separation, Connie still kept most of her things in the trailer home. One week before her death, Connie rented an apartment in the City of Bellmead, near Waco, and moved all of her belongings into it. She left a set of dishes in the mobile home for Kenneth. The divorce suit and the separation were precipitated by emotional stress suffered by Connie which was caused by Kenneth's long absences from home and by the dunning of creditors of their defunct construction business. During the separation, Connie would either meet Kenneth at the truck depot in Waco when he returned from a trip, or she would have their car there for his use and he would go to her. They would go out together for supper when he was home, and would visit into the evening with each other and other trucker-couples at local night spots. Neither was romantically interested in another person. They continued with the arrangement for Connie drawing on his pay, cashing checks, using the money as she saw fit, including her needs and those of the child, and paying the bills. He talked with her several times about reconciliation, but she had not agreed to it at the time of her death. On December 5, 1975, Kenneth returned home to attend his father's funeral. That night, he and Connie slept together in a room in his mother's house. Their child was with them. On December 20th, the night before Connie died, she fixed supper for Kenneth in her apartment. Their daughter was with them. They discussed plans for the child's Christmas. Kenneth had arranged his schedule to be home on Christmas.
An experienced Insurance Law Attorney needs to be consulted early in these situations. As can be seen from the above case, the facts of the case and the way they are presented are vital to the outcome of a case.

Whether you live in Weatherford, Mineral Wells, Aledo, Willow Park, Hudson Oaks, Peaster, Millsap, Brock, Springtown, Azle, Cool, or anywhere else in Parker County, there are odds that you may be subject to suffering a loss from flood damage. A natural question would be, "How does flood insurance work?"
Because most property insurance policies covering property at fixed locations exclude flooding, flood insurance must be purchased separately. In 1969, Congress created the National Flood Insurance Program to administer the sale of flood insurance. National flood insurance is available directly from the Federal Insurance Administration or through hundreds of private insurers who participate in federal flood insurance programs. The Federal Emergency Management Agency (FEMA) reinsures private companies against flood losses.
Flood insurance premiums are calculated based upon geographic maps setting forth the boundaries for various flood zones.
Contract claims must be filed in federal court, and are subject to the strict requirements of the policy and federal law. Insureds still have the right in the Fifth Circuit to bring suit on extracontractual claims under state law against a flood insurer. This per a 1993 case, Spence v. Omaha Indemnity Insurance Co., but it should be noted that there is disagreement in this area as to whether the National Flood Insurance Act of 1968, preempts state law in this area.
The standard flood policy is designed to insure against loss caused by an overflow of inland or tidal waters, unusual and rapid runoff of surface waters, and mud slides caused by flooding. All losses caused by perils other than flood are excluded. For example, the Standard Flood Policy excludes coverage for consequential damages resulting from the interruption of business activities following a flood. Also, case law tells us that water damage caused by heavy rains, does not constitute "flood damage." This is from a 1950, Fort Worth Court of Appeals case styled, "Sun Underwriters Insurance Company v. Bunkley."
An insured may not recover under a standard flood insurance policy unless the insured sends a proof of loss form to FEMA within sixty days of the loss. Failure to sign and swear to the completed proof of loss form enables the insurer to reject the claim.
The standard flood insurance policy contains a contractual one year limitations period. Extracontractual causes of action against flood insurers are subject to standard limitations periods under Texas law.
Flood claims need to be paid attention to immediately. Consulting with an experienced Insurance Law Attorney, early in the process is the best way to ensure you are going to maximize the coverage due because of the loss.

People in Grand Prairie, Arlington, Mansfield, Fort Worth, North Richland Hills, Saginaw, Keller, Roanoke, and other places in the Tarrant County area and Texas would want to know how their insurance policy pays for their property that is damaged in a loss that is covered by the policy.
A 1998, Austin Court of Appeals case helps us understand how some losses are calculated and paid. The case is styled, Great Texas County Mutual Insurance Co. v. Emmett C. Lewis. This is an appeal from the trial court finding in favor of Lewis.
The facts are undisputed. While covered by a policy issued by Great Texas, Lewis's 1989 Dodge Caravan car sustained damage to the engine. The car had 110,000 miles on it. Great Texas inspected the car and calculated the cost of repairs to be $3,608.27. which included the cost of a re-manufactured engine, replacement parts, and labor. From the $3,608.27, Great Texas subtracted the policy deductible of $527 and $2,031.72 for betterment or depreciation, leaving a net sum of $1,049.55. Great Texas offered Lewis that sum to discharge the obligation under the policy.
Lewis sued alleging the policy did not allow deduction for betterment or depreciation and seeking to recover the $3,608.27 estimated cost, less the deductible of $527, together with the other sums not in dispute. The trial court agreed with Lewis and rendered judgment accordingly. Great Texas's appeal was over the $2,031.72 claimed by Great Texas for betterment or depreciation.
The policy provided as follows under the heading "Limit of Liability."
Our Limit of Liability for loss will be the lesser of the:
1. Actual cash value of the ... damaged property;
2. Amount necessary to repair or replace the property with other of like kind and quality; or
3. Amount stated in the Declarations of this policy.
Number 3 above was not at issue in this case.
This court stated, "In arriving at the correct measure of damages in an action to recover under an automobile collision policy, it must be kept in mind that the action is not a suit for damages but one on the contract of insurance, and that therefore ... the language of the contract sued upon must prevail ...."
The contract provision quoted gave Great Texas an election. They could pay Lewis (1) the actual cash value of the damaged property or (2) the amount necessary to repair or replace the property with another of like kind and quality. After inspecting the engine, they elected to pay the "amount necessary to repair or replace the property with other of like kind and quality." Both sides agreed that the engine required repairs totaling $3,608.27 and that the car had been driven 110,000 miles when the engine -- original to the car -- was damaged.
The words betterment and appreciation were not in the policy. Great Texas argued that these words are implied because the replacement engine costing $3,608.27 is tantamount to a new engine -- it would carry a warranty. Thus the engine would have an expected useful life much longer than Lewis's used engine that has been driven 110,000 miles when it was damaged. Calculating that the 110,000 miles were equivalent to 3/4 of the useful life of the damaged engine, Great Texas argued that Lewis would receive an equivalent windfall unless Great Texas was allowed its claimed entitlement to a deduction for betterment or depreciation. As the court pointed out, for this interpretation to be sanctioned, there must be policy language to that effect. And as the court pointed out, there was no such language.
It is generally accepted that depreciation is a factor to be considered when an insurer elects to pay the "actual cash value" of damaged property, which Great Texas declined to do here. By electing to pay Lewis the "amount necessary to repair or replace" the engine with another "of like kind and quality," Great Texas elected a measure of loss that does not allow for depreciation.
The words "repair" and "replace" mean restoration to a condition substantially the same as that existing before the damage was sustained. Because Lewis's car was a functioning or operating car before the damage, Great Texas was required to pay an amount necessary for a repaired or replacement car of that character. The qualifying words "of like kind and quality" permit but do not require an engine of similar age, use, condition, or present cash value; they refer simply to repairing the damaged automobile so that it is suitable or fit for its intended purpose.
The law is clear, "when an insurer elects to repair, the insured is entitled to the amount required to repair the automobile." The insurer's obligation in such a case is not discharged until the insurer pays the cost of repair less any deductible specified in the policy. The only evidence in this case regarding the cost of repairing Lewis's car was the agreed sum of $3,608.27; the specified deductible was $527.
In conclusion the court said, "If the company may discharge its obligation by paying Lewis $1,049.55, he will not have, under the evidence, a sum sufficient to restore his engine and automobile to a functioning or operating state. He will be deprived of the protection ostensibly purchased in his policy -- protection against the risk of having to pay out of his own pocket to restore his motor car and its component parts to a functioning or operating state in the event they were damaged."
These disputes about the amount to be paid on a claim are not uncommon. When they arise an experience Insurance Law Attorney should be spoken with. A reading of the policy language and applying the language to the facts of the case will help in giving an opinion as to what should be done next.

What if someone in Weatherford, Mineral Wells, Aledo, Willow Park, Azle, Hudson Oaks, Millsap, Brock, Springtown, Cool, or anywhere else in Parker County has insurance on a house and the house burns down - do they automatically get paid the insurance on the house? The answer is - It depends.
To be able to recover on an insurance policy, the person suffering the loss must have an insurable interest in the property that is insured. The Dallas Court of Appeals issued an opinion in 1993, that is still good law. The style of the case is, William T. & Elaine Jones v. Texas Pacific Indemnity Company.
It is a summary judgment case. The Jones sued Texas Pacific on an insurance policy. The summary judgment was granted in favor of Texas Pacific because the court said the Joneses could not recover insurance proceeds on property which they did not have an insurable interest to.
As background, the Joneses owned their home subject to Henry and Diana Martin's mortgage interest. They insured their home with Texas Pacific. The policy listed the Joneses as the "Named Insureds" and the Martins as "Mortgagee[s]." When the Joneses defaulted on their mortgage payments, the mortgagees foreclosed. The Joneses remained in the home as tenants at sufferance. Eleven days after foreclosure, the home burned.
Texas Pacific paid the Joneses for content loss and additional living expenses. It reimbursed the Martins for the dwelling damage. The Joneses sued on the policy to collect on the dwelling damage.
Texas Pacific claimed the Joneses were not owners, thus could not collect.
The Joneses contended that although they no longer owned the property, they still had an insurable interest and were entitled to the insurance proceeds. Because the foreclosure divested the Joneses of right, title, and interest in the property, the Joneses could not show any loss.
In discussing this case, the court stated the law as it relates to this situation:
A party must have an insurable interest in the insured property to recover under an insurance policy. It is not necessary that the party own the property to have an insurable interest. An insurable interest exists when the insured derives pecuniary benefit or advantage by the preservation and continued existence of the property or would sustain pecuniary loss from its destruction. If a claimant cannot suffer any pecuniary loss or derive any benefit from the property, he has no insurable interest.
The claimant has the burden of proving an insurable interest.
Applying the law to the facts of the case, the court stated that, under the Jones-Martin deed of trust, the Joneses became tenants at sufferance after the foreclosure. As tenants at sufferance, the Joneses were subject to immediate eviction. They had no future legal interest in the dwelling, and diminished motive and opportunity to protect the property. The Joneses did not suffer any pecuniary loss in the dwelling from the fire or receive any benefit from the dwelling. They had no insurable interest in the dwelling.
This case is pretty clear cut. But that is not always the case. Whenever there is any doubt about the right to insurance proceeds, an experienced Insurance Law Attorney should be consulted.

Insurance Law Attorneys in Grand Prairie, Irving, Duncanville, De Soto, Lancaster, Mesquite, Garland, Richardson, Farmers Branch, or anywhere else in the state of Texas will usually want to sue the adjuster who handled the claim in addition to suing the insurance company when a claim is denied. There are reasons for this. But the insurance company will fight the issue.
The United States District Court, Southern District, Galveston Division, issued an opinion in a case on August 10, 2011, wherein the court allowed the adjuster to be sued over the objections of the insurance company. The style of the case is, Juan Jose Cruz, Lidia Cruz and Griselda Cruz v. Allstate Lloyds and Pilot Catastrophe Services, Inc. It is property damage claim following Hurricane Ike.
In this Federal Court case, the Cruz's filed a "Motion for Leave to File Amended Complaint" for the purpose of adding to the lawsuit the individual adjuster who handled the investigation of the claim. Of relevance to the court was that by adding the adjuster the case still remained in Federal Court whereas often times the addition of the adjuster causes the case to be remanded to State Court.
The insurance company position was that the adjuster should not be added to the lawsuit because the Cruz's amended complaint fails to state a claim under applicable state law. The insurance company stakes its position on a 2007, United States Supreme Court case, Bell Atlantic Corp. v. Twombly, wherein the Court set a very high standard for reviewing the pleading of plaintiffs, making sure that the pleading clearly stated a claim under applicable law.
In the Twombly case, the Supreme Court sought to ensure that in complex litigation the substantial burden of discovery would not be placed on a defendant based on implausible allegations. On controverting argument however is that the height of the pleading requirement should be relative to the circumstances of the case at hand. The court then said that this case, and the multitude of others like it are noncomplex, straight-forward property damage claims involving allegations of substandard adjustment practices; the cases are unique only because the properties differ. In such cases, all that need be alleged are "facts that, if proven, could make it reasonably possible for a Texas court to find" that a defendant violated certain provisions of the Texas Insurance Code. Allegations against an adjuster like failing to perform a thorough investigation; failing to include all damages pointed out by Plaintiffs; disregarding damages; undervaluing damages; underpricing the costs of repairs; misrepresenting to Plaintiffs that the damage to the property was not covered under the policy, even though the damage was caused by a covered occurrence; failing to make an attempt to settle Plaintiffs' claims in a fair manner, although aware of liability under the policy; failing to explain to Plaintiffs' the reason for the offer of an inadequate settlement; failing to affirm or deny coverage within a reasonable time; and performing an outcome oriented investigation of Plaintiffs' claim are sufficient.
Then this Court said that surely, the Defendants in this and similar cases can, without much intellectual effort, divine from Plaintiffs' allegations that the adjuster is being accused of intentionally or negligently cheating Plaintiffs out of legitimately owed insurance proceeds. If, through discovery, these "factual allegations" prove to be true, there is a reasonable possibility that the Plaintiffs could establish some violations of the Texas Insurance Code committed by the adjuster, if not, summary judgment would be the appropriate way to resolve the issue on the merits.
This case is a victory for people needing to sue an insurance company and its adjusters.

Adjusters in Grand Prairie, Dallas, Irving, Richardson, Garland, Mesquite, Carrolton, Farmers Branch, Duncanville, or anywhere else in Texas, who make a mistake in their job that costs an insurance customer money, can be sued for what he cost the insurance customer. The tricky thing is doing it in the most advantageous manner.
Usually the individual adjuster does not have to be sued. Suing his employer, the insurance company, is often times just as good. But sometimes there is a legal advantage to suing the adjuster and the company. Often times, if just the company is sued, the case can be removed from the State Court in which it was filed, to a Federal Court. There are advantages to the insurance company for doing a removal. That is why they do it.
One way of defeating the attempt at removal is by suing the insurance adjuster and not just the insurance company. However, doing it this way must be done correctly.
The United States District Court, Southern District, Houston Division, issued an opinion on July 25, 2011, dealing with this issue. The style of the case is Emma Gonzales v. Homeland Insurance Company of New York, et al.
In this case, the lawsuit was filed in State Court and then Homeland had the case removed to Federal Court. Here is some background:
This is an insurance case where Ms. Gonzales alleges her house sustained roof and water damage as a result of Hurricane Ike. Her house was covered by an insurance policy issued by Homeland. She submitted a claim and Homeland assigned its employee adjuster, defendant Ball, to adjust the claim. The adjuster then hired an adjusting firm, defendant Precise, who assigned defendant Murphy, to inspect the damage. Gonzales alleged in the lawsuit that:
Defendant Murphy conducted a substandard inspection of Plaintiff's property. Murphy spent a mere twenty minutes inspecting Plaintiff's entire property for hurricane damages. This is evident in his report, which failed to include all of Plaintiff's Hurricane Ike damages noted upon inspection. Moreover, the damages that defendant Murphy actually included in his report were grossly undervalued. Defendant Ball also actively participated in the investigation of Plaintiff's claim. Specifically, she corresponded with Plaintiff regarding her claim in a letter dated October 24, 2008. Ball's letter shows that she failed to thoroughly review Murphy's assessment of the claim and ultimately approved Murphy's inaccurate report of the damages. As a result of these defendants' unreasonable investigation, Plaintiff was considerably underpaid on her claim and has suffered damages.
In discussing this case, the court stated the law wherein, after removal a plaintiff may move to remand and, if "it appears that the district court lacks subject matter jurisdiction, the case shall be remanded." This is found at 28 U.S.C. Section 1447(c). But removal statutes are construed strictly against removal and for remand. All doubts regarding whether removal jurisdiction is proper should be resolved against federal jurisdiction. This means that once a motion to remand has been filed, the burden is on the removing party to establish that federal jurisdiction exists. This means that, "All factual allegations are evaluated in the light most favorable to the plaintiff."
The United State 5th Circuit Court of Appeals recognizes two ways to establish improper joinder when, as here, the defendant alleges that the adjuster was brought into the case for the sole purpose of defeating removal to federal court. First, that there is actual fraud in the pleading of jurisdictional facts, or second, the inability of the plaintiff to establish a cause of action against the non-diverse party in state court. Under the second test, the defendant prevails only when it establishes "that there is no reasonable basis for the district court to predict that the plaintiff might be able to recover against an in-state defendant." A reasonable basis for state liability requires that there be a reasonable possibility of recovery, not merely a theoretical one.
In ruling against the remand and allowing this case to be removed to Federal Court the court said:
"The question here is whether there is no reasonable basis for the district court to predict that the plaintiff might be able to recover against Precise or Murphy, the instate defendants. Defendants urge that Gonzales cannot recover from Precise or Murphy because she has failed to allege viable claims against the adjuster defendants .... Gonzales argues that defendant Murphy created a wholly deficient report as a result of his substandard inspection of the claim, which was in part, the cause of much of Plaintiff's damages complained about in this suit. Nowhere, however, does Gonzales plead any specific facts, or explain the what, where, when, and how, to support these allegations."
This writer believes the court made an incorrect ruling in this case. Maybe the decision will be reversed if it is appealed. One thing is certain. An experience Insurance Law Attorney should be consulted when contesting a denial of benefits on an insurance claim. There are many strategies to ponder in deciding the best way to proceed.

Anybody in Grand Prairie, Arlington, Fort Worth, Mansfield, Crowley, Burleson, Benbrook, Lake Worth, Azle, Saginaw, or anywhere else in Tarrant Count should be concerned about rising cost of insurance.
The Houston Chronicle published an article on September 20, 2011, dealing with auto insurance and rising rates. The author is Purva Patel who investigates and writes lots of articles concerning insurance in the state of Texas. The title of the article is, "Insurers Raising Auto Rates."
The article tells us that many of the state's larger auto insurers are raising rates across the state. These insurers include but are not limited to, Allstate Fire & Casualty, USAA, State Farm, and Farmers Insurance.
There appear to be two reasons claimed for the need to raise rates. One is the the new minimum liability rules in Texas that require drivers to have policies that cover a minimum of $30,000 per person for injuries and up to $60,000 for injuries per accident. Also the new minimum limit for property damage is $25,000 per accident.
Insurance Council of Texas, is an insurance industry trade group. According to them these rate increases are in part to reflect the changes in Texas law raising the minimum coverage amounts to the amounts mentioned in the prior paragraph.
Another insurance trade group, Southwestern Insurance Information Service, also cited rising fees for hospital and physician services related to automobile accidents. In support of their position, they cite U.S. Department of Labor statistics showing medical costs increasing 3.3 percent over last year.
The article points out that some insurers are lowering rates and points to some State Farm policy holders decreases. This means that consumers can benefit by shopping around and asking about discounts.
Allstate has raised its rates 3 percent for some of its insureds but points out that it is their first rate increase in three years.
USAA has filed notice of its intent to raise auto rates an average of 8 percent statewide. It pointed out that this increase does not effect all of their policy holders.
Farmers increase averaged about 3 percent for new customers and for renewals starting in July.
There are breakdowns by counties available on the amount of increases.
State Farm Mutual Automobile Insurance Co., the state's largest auto insurer, plans to raise rates on renewals starting October 3, 2011. Many areas are not seeing increases but some, such as Harris County, where Houston is located, are seeing rate increases as much as 1.9 percent.
No one denies the need for these companies to be able to make a profit, otherwise they would not exist. The concern to an experienced Insurance Law Attorney is that in the insurance company's desires to make profits, they deny legitimate claims that have been bargained for as part of the insurance policy contract. Of course when this happens, the insurance company may be breaking the law and advice needs to be sought as soon as possible.

When an adjuster in Grand Prairie, Arlington, Fort Worth, Burleson, Crowley, Lake Worth, Grandview, Benbrook, Britton, Joshua, or anywhere else in Texas commits a wrong, can the insurance company be held responsible?
That question was answered in 1936, by the Beaumont Court of Appeals in the case, Love et al. v. Aetna Casualty & Surety Co. et al. Here are some facts in the case.
Tom Love, Victoria Houston, and Cora Davis were a brother and sisters of Orange Love, deceased. They brought this lawsuit to recover damages for the mutilation and unlawful dissection and autopsy performed without there knowledge or consent in and upon the dead body of their brother, Orange Love.
When Orange Love died, his sister Cora Davis sent his body to Carter & Sutton, undertakers, for burial. While the body was in the possession and charge of Carter & Sutton, it was taken possession of by Drs. Goodson and Stout and an autopsy was performed upon the corpse in which the body was thoroughly explored by opening same and taking out the heart, kidneys, liver, spleen, and bowels, and these were cut into, portions denuded therefrom and never returned, but carried off for chemical investigation. All this without the permission of his relatives, and without their knowledge and consent. After learning of he autopsy, the body was buried and this suit followed.
Prior to his death, Orange Love had been an employee of and worked for the San Antonio Compress Company, which carried compensation insurance covering its employees with Aetna Insurance Company. Love had complained that he had suffered an injury to his abdomen while handling a bale of cotton, and had made claim to the compensation board for compensation under the insurance carried by Aetna. Pending his claim before the board, he died. His relatives continued the claim. Aetna filed notice of denial of the claim and filed with the board a copy of the report on the autopsy held on the body of Love.
C. E. Klein, with an office in San Antonio, was the claim adjuster for Aetna, and received and handled the claim of Love for compensation because of his alleged injury. Klein, as the claim adjuster, went to the local Justice of the Peace to get the authority to conduct the autopsy.
Klein testified to the actions he took in investigating the claim of Love. He testified that he was taking his actions in the course of his work. That he gave the Judge the information needed to sign off on the autopsy. He arranged for payment of the bills for the autopsy by Aetna.
In this appeal, Aetna insisted that if the autopsy was illegally performed, that Klein was operating outside his scope of authority, was not within his scope of employment, and had neither express or implied authority to seek a wrongful autopsy.
Further testimony by Klein revealed that he had complete authority to make complete settlements in a case. That he was in charge of the Adjustment Department, and that his adjustments are final, unless they were submitted to the Home Office. He also testified that Aetna gave him no instructions in this case.
At the trial court level, the trial Judge allowed Aetna to get out of the case. This appeals court said that was wrong and reversed that opinion and put Aetna back in the case and remanded this case to the trial court for further disposition with Aetna.
In its ruling the court stated, "We think it plainly appears that Klein in procuring the autopsy was acting as the fully authorized agent of [Aetna], within the scope of his employment, and in the exercise of his discretion given him in the investigation of and approval or rejection of claims against his company. But if not, still [Aetna] is liable because after the autopsy was had, it approved Klein's acts and paid the doctors for their services in performing the autopsy, and accepted the benefits of same by receiving the report of the autopsy from the doctors and filing a copy of same with the Industrial Accident Board where the claim for compensation for the death of Orange Love was then pending, and which was later refused."
In this case, the autopsy had been illegally obtained and Aetna tried to distance itself from the illegal acts of their adjuster. They were unsuccessful. It is vital to get with an experienced Insurance Law Attorney when an adjuster does an act in investigating a claim that is illegal or improper.

The liability of an insurance agent for his actions in selling an insurance policy to someone in Grand Prairie, Arlington, Mansfield, Fort Worth, Hurst, Euless, Bedford, or anywhere else in Texas should be of interest to the person buying the insurance. Especially so if the agent does something wrong and as a result the insurance company denies a claim made by the customer.
That is what happened in the 1989, case, "Paramount National Life Insurance Company v. Frankie Williams." This opinion was issued by the Houston, 14th District, Court of Appeals. Here are some of the facts.
Frankie Williams sued Paramount after the denial of two claims and the cancellation of her medical insurance policy. The jury found in her favor and Paramount appealed the decision.
On March 5, 1981, insurance agent, Cliff Cox, met with Frankie Williams and her husband Willie and took an application for a hospital insurance policy to be issued by Paramount. She was 64 years old and had a long history of medical problems which were described to Cox. Cox told the Williames he needed to know only about the preceding five years. He filled out the application and had them read and sign it. Paramount approved the application and issued the policy on March 20, 1981. She was hospitalized twice and filed claims totaling over $40,000 in connection with the hospitalizations. Paramount denied the claims and cancelled the policy on the grounds that Mrs. Williams had failed to disclose her full medical history on the insurance application and that the conditions for which she was treated were preexisting conditions.
The primary issue here was what occurred when agent Cox took the application for the policy. Williams did not contest Paramount's description of her medical history. She contended she disclosed it all to Cox but he told her he needed to know only about the preceding five years. He then filled out the application and had Williams initial the answers and sign the application.
Mrs. Williams did sign a document, the Confirmation of Presentation, which was a representation by her to Paramount acknowledging the terms of the contract and limitations on Cox's authority. Paramount maintained that Cox acted for Paramount in delivering the policy and collecting the premium but that he acted for Mrs. Williams and on her behalf when making the application for the insurance and in processing the policy and thus they are not liable for Cox.
As this court pointed out, and is now codified in the Texas Insurance Code, Section 4001.051, an agent binds an insurance company in any number of ways, several of which were present here.
Absent actual authority, liability may still arise if the agent had apparent authority to act for the carrier. Cox used Paramount forms when he took the application from Mrs. Williams. He signed the Confirmation of Presentation document as "Agent." The document itself, which purported to ensure that there is a "complete and clear understanding between the parties," was signed following the application visit, and refers to Cox's relationship to Paramount as "your agent." For example, one paragraph read, "Upon my request, your agent, whose signature appears below, visited with me to determine my interest in applying for insurance with your company." the receipt for the initial premium was signed for Paramount by Cox as "Duly Licensed Representative."
A statement in the Confirmation of Presentation that the company "is not bound by any knowledge of or statements made by or to the agent" does little to negate the apparent authority with which the company had clothed the agent.
The jury found that Paramount had breached its contract with Mrs. Williams by not paying her claim. Had the Williames not believed she was insured, they could have made different arrangements for her treatment.
This court upheld the ruling in favor of Frankie Williams.
The normal practice for an insurance company when denying a claim is to send a letter to their customer stating the reason for the denial. They normally will point to specific policy language or facts for the basis of their denial. Whenever this happens an experienced Insurance Law Attorney should be shown the letter. Often times the insurance company is wrong in their denial of the claim and you can get advice on the best next steps to take in favorably resolving the issue.

Residents in Weatherford, Mineral Wells, Millsap, Hudson Oaks, Aledo, Willow Park, Brock, Cool, Springtown, and other places in Parker County might wonder if what their insurance agent tells them is true. Or, if what the agent says is not true?
Most insurance agents are honest. However, there are a few that are not completely honest because they want to sell you a policy in order to make their commission on the sell. Others are confused or do not completely understand the insurance product they are selling. The question becomes; what can be done when the agent makes a mistake in what he tells someone when he sells the policy?
The answer often times depends on the authority of the agent.
There are two types of authority -- actual and apparent. In turn, actual authority can be expressed or implied. An Agent's authority can be actual authority expressly conferred by the insurance company, or it can be actual authority implicit in the agent's duties. The authority also can be apparent authority arising from acts by the insurer that give the agent the appearance of having authority.
In Texas, courts have described actual authority this way:
"Actual" authority, which includes both express and implied authority, usually denotes that authority a principle: (1) intentionally confers upon an agent; (2) intentionally allows the agent to believe that he possesses; or (3) allows the agent to believe that he possesses by want of due care ... "Implied" actual authority exists only as an adjunct to express actual authority ... because implied authority is that which is proper, usual, and necessary to the exercise of the authority that the principle expressly delegates .... This was stated in 1994, by the Houston [1st Dist.] Court of Appeals in the case, Spring Garden 79U, Inc. v. Stewart Title Co.
An example of the above is found in the 1979, Texas Supreme Court case, Royal Globe Insurance Company v. Bar Consultants, Inc., wherein they said, an agent may be given express authority to sell policies. That express grant of authority would carry with it implied authority to explain the policy benefits. A misrepresentation about the policy would be within the scope of the agent's actual authority.
Also, the Texas Supreme Court in 1994, in the case, Celtic Life Insurance Company v. Coats, said that where an insurer authorized the agent to explain its policy, the insurer was liable for the agent's misrepresentation that the policy provided a greater amount of mental health benefits than it actually did.
As for "apparent authority" an insurance company may also be liable for unauthorized acts by an agent, if the agent is acting within the scope of his "apparent authority." Actual authority is not required. The insurer will be liable when by its conduct it has given the agent the appearance of having authority, so that a reasonable person would suppose the agent had authority.
Apparent authority is an estoppel theory that holds the insurer liable because the insurer has clothed the agent with indicia of authority that would lead a reasonable person to believe the agent had authority. If the agent is acting within the scope of his apparent authority, not even instructions not to mislead, nor diligence in preventing misrepresentations, will shield the insurer from liability.
So what are examples of apparent authority?
Evidence of apparent authority may include:
1) application forms referring to the individual as the company's agent.
2) forms signed by the agent as "authorized representative,"
3) corroborating statements by the agent.
The three examples above were cases where this evidence allowed the court to find apparent authority.
An example where is was not found is in the 5th Circuit, Federal Court case, TIG Insurance Co. v. Sedgwick James. In this 2002 case, the court said that the only indicia of the agent's authority was a certificate of insurance provided by the insurer. The certificate disclaimed that the agent had the power to name additional insureds. The agent did not have apparent authority to modify the policy.
There are many cases where it is beneficial to make the agent and the company, both, part of the lawsuit. An experienced Insurance Law Attorney can explain these strategy considerations when an agent misrepresents a policy that ends up causing harm to one of his customers.

For sure, anybody in Grand Prairie, Arlington, Fort Worth, Hurst, Euless, Bedford, or anywhere else in North Texas wants to get rates as cheaply as they can on their homeowners insurance policy, but they would like to thing their coverage is staying the same. Well that may not be the case.
The Houston Chronicle published a story On September 12, 2011, which most homeowners would be interested to know. The author is Purva Patel, who has written on the topic of insurance before. The title of the article is, "State Farm Move Could Mean Less Homeowner Coverage."
The article tells us that State Farm has proposed changing home insurance deductibles. Most anybody who has tried to get their rates lowered knows that buy raising the deductible, the yearly cost for the insurance goes down. What is different here is that State Farm is trying to make the new coverage mandatory. Consumer advocates warn this would hurt some.
It does not sound like a lot, but the proposal is to move all current customers to a minimum 1 percent deductible starting in December. That means deductibles would be charged as a percentage of the home's insured value rather than a flat dollar amount.
For example, the owner of a house insured for $200,000 with a flat $1,000 deductible and a $10,000 claim would collect $9,000 from his insurance company. With a 1 percent deductible, the homeowner would only recover $8,000 because the 1 percent deductible translates to $2,000.
With a 5 percent deductible, the amount recovered would be $0.
State Farm is asking the Texas Department of Insurance, to allow this in order to keep from raising premiums.
Right now, consumers have an option. They can take a flat dollar amount deductible, such as $500 or $1,000, or they can get a percentage deductible. The effort here is to make the percentage deductible mandatory, with 1 percent being the lowest.
The consumer group, Texas Watch, says this simply means higher costs for consumers and is against it.
In addition to this change, State Farm is also asking for an overall increase in rates.
They say the increases are necessary because the company paid out more than $350 million in catastrophe claims in 2011 to date, mainly "due to spring hail storms and wildfires."
State Farm is also, on a positive note, intending to increase a discount for customers who have both cars and homes insured with the company to 25 percent from 20 percent.