Dallas Fort Worth Insurance Lawyer Blog

Claim Denial Attorney – Accidental Death

December 10, 2022 | Mark S. Humphreys

Attorneys who handle claim denials in accidental death cases need to know the opinions handed down by the courts on these types of claim. Here is a 1997, opinion from the Dallas Court of Appeals. The opinion is styled, Grant v. Group Life & Health Insurance Company.

Grant used a pry bar to break into the residence of Stokes. When grant entered the residence, Stokes shot him five times, killing him. Grant’s wife sued Group Life to recover benefits under an accident policy for the death of her husband. Group Life moved for summary judgement on the basis that Grant died while committing a burglary and, therefore, his death was not accidental. The trial court granted the summary judgment and Grant appealed.

The Court held that because Grant’s death was not accidental, the trial court correctly granted Group Life’s Motion for Summary Judgement. Grant argues that because Group Life did not furnish her with a certificate of insurance, it is estopped from relying on undisclosed exclusions. Because the policy in question does not provide coverage for Grant’s death the policy’s exclusions are irrelevant.

Claim Denial Attorney – You Have To Plead Your Case With Specificity

December 5, 2022 | Mark S. Humphreys

Here is a 2022, opinion from the Northern District of Texas, Dallas Division. It is styled, Pasha & Sina, Inc. V. The Travelers Home And Marine Insurance Company, And Doug Salsbury.

This is a commercial policy case.

Plaintiff purchased the policy from Travelers. Plaintiff attempted to recover from Travelers for damage to the property for roof leaks. A dispute arose and Plaintiff sued Travelers and Salsbury in State Court alleging causes of action for negligence, negligent misrepresentation, common-law fraud, fraud by nondisclosure, violation of the duty of good faith and fair dealing, and violation of Chapter 542 of the Texas Insurance Code.

Homeowners Insurance Claim – 3

December 3, 2022 | Mark S. Humphreys

This is a 2022, homeowners claim from the Eastern District of Texas, Tyler Division. The opinion is styled, Meridian Security Insurance Company v. Curtis Murphy.

In this case, Meridian seeks a declaratory judgment that it is not liable for damage caused by by a fire at Murphy’s home. Murphy asserted counter claims. Meridian now moves for summary judgment.

Murphy’s counter claims were dismissed by the Court.

Homeowners Insurance Claim – 2

November 28, 2022 | Mark S. Humphreys

This is a 2022, homeowners claim from the Eastern District of Texas, Tyler Division. The opinion is styled, Meridian Security Insurance Company v. Curtis Murphy.

In this case, Meridian seeks a declaratory judgment that it is not liable for damage caused by by a fire at Murphy’s home. Murphy asserted counter claims. Meridian now moves for summary judgment.

Murphy’s counter claims were dismissed by the Court.

Homeowners Insurance Claims

November 26, 2022 | Mark S. Humphreys

This is a 2022, homeowners claim from the Eastern District of Texas, Tyler Division. The opinion is styled, Meridian Security Insurance Company v. Curtis Murphy.

In this case, Meridian seeks a declaratory judgment that it is not liable for damage caused by by a fire at Murphy’s home. Murphy asserted counter claims. Meridian now moves for summary judgment.

Murphy’s counter claims were dismissed by the Court.

Segregating Damages Case – 5th Circuit

November 21, 2022 | Mark S. Humphreys

Insurance lawyers in the Dallas and Fort Worth need to read this 2022, United States 5th Circuit opinion. It is styled, Advanced Indicator And Manufacturing, Incorporated v. Acadia Insurance Company; Nicolas Warren.

Advanced asserts it suffered damage to the roof of its building as the result of the storm, Hurricane Harvey. Advanced submitted a claim to Acadia and Acadia assigned Warren to adjust the claim. Warren inspected the building and determined that the damage was pre-existing and leaks resulted from deterioration and poor workmanship. Based on Warren’s report, Acadia denied the claim.

On August 7, 2018, Advanced sued Acadia and Warren in state court, alleging various claims, including breach of contract, common law bad faith, and violations of the Texas Prompt Payment of Claims Act.

Dallas Fort Worth Insurance Lawyers – 5th Circuit Opinion

November 19, 2022 | Mark S. Humphreys

Insurance lawyers in the Dallas and Fort Worth, plus other parts of the state, need to read this 2022, United States 5th Circuit opinion. It is styled, Advanced Indicator And Manufacturing, Incorporated v. Acadia Insurance Company; Nicolas Warren.

Advanced asserts it suffered damage to the roof of its building as the result of the storm, Hurricane Harvey. Advanced submitted a claim to Acadia and Acadia assigned Warren to adjust the claim. Warren inspected the building and determined that the damage was pre-existing and leaks resulted from deterioration and poor workmanship. Based on Warren’s report, Acadia denied the claim.

On August 7, 2018, Advanced sued Acadia and Warren in state court, alleging various claims, including breach of contract, common law bad faith, and violations of the Texas Prompt Payment of Claims Act. On August 30, 2018, Acadia elected to accept responsibility for Warren under Section 542A.006 of the Texas Insurance Code, which provides that an insurer may accept liability for its agents. The next day, Acadia removed the case to federal court. One week later, Warren filed a motion to dismiss, arguing in part that Advanced could no longer state a claim against him. Advanced filed a motion to remand the case to state court, arguing that Warren was not improperly joined notwithstanding Acadia’s Section 542A.006 election. The remand was denied without reason by the District Court except to say that Warren was improperly joined.

Hail Damage Claims And Insurance Code Section 542A

November 14, 2022 | Mark S. Humphreys

Here is a 2022, opinion from the Northern District of Texas, Lubbock Division, that deals with recovery of attorney fees under Section 542A of the Texas Insurance Code. The opinion is styled, Mario Rodriguez v. Safeco Insurance Company of Indiana.

This is a decision based on Safeco’s motion for summary judgment.

At issue is whether payment of an appraisal award, plus payment of estimated interest due under the Prompt Payment Act, entitle an insurer to summary judgment on an insured’s claim
under the Prompt Payment Act. If so, then the insurer is absolved from paying attorney’s fees
that otherwise would be due under the Prompt Payment Act. No issue of material fact is present to prevent the entry of summary judgment. As the Parties have recognized, this is purely a matter of law. After careful review of the arguments and authority cited by the Parties, the Court finds that Defendant’s position is meritorious. Although the issue presents policy factors that weigh in favor of each possible outcome, the Court finds that pursuant to 542A.007(a), the legislature’s intent appears clear when enacting Chapter 542A of the Texas Insurance Code to limit attorney’s fees. It must be presumed that the legislature was aware of the conflict Chapter 542A would have with the Prompt Payment Act and chose to limit attorney’s fees anyway. It is logical that attorney’s fees are not recoverable when the computation of fees as set forth in Chapter 542A.007(a) lead to zero because the apparent purpose is to curb abusive hailstorm claims.

Bad Faith Insurance Lawyers And Insurance Company Removal To Federal Court

November 12, 2022 | Mark S. Humphreys

As has been discussed at this site many times, insurance companies prefer to litigate insurance claims in the Federal Court system rather than the State or County courts. However, they have standards they must meet to be able to get a case to Federal Court. This is discussed in a 2022 opinion from the Northern District of Texas, Dallas Division. The opinion is styled, Robert Stricklin v. State Farm Lloyds And Angel Hernandez.

This case concerns a dispute over residential property insurance coverage between Stricklin and State Farm. Plaintiff claims to have suffered damage to his home as the result of a hail and windstorm. State Farm assigned Hernandez to adjust the claim. A dispute arose over the extent of covered damage to the property. Stricklin filed suit in State Court for various violations of law in the Texas Insurance Code and for breach of contract. State Farm removed the case to Federal Court arguing Hernandez was improperly joined in the lawsuit.

Federal courts are courts of limited jurisdiction. Thus, courts must presume that a suit lies outside this limited jurisdiction, and the burden of establishing federal jurisdiction rests on the party seeking the federal forum. And if the record does not contain sufficient evidence to show that subject matter jurisdiction exists, a federal court does not have jurisdiction over the case. A defendant may remove a case from state to federal court based on diversity jurisdiction pursuant to 28 U.S.C., Sections 1332(a) and 1441(a). The party seeking to assert federal jurisdiction has the burden of proving the facts establishing subject-matter jurisdiction by a preponderance of the evidence. Thus, when a suit is removed based on diversity jurisdiction, the removing party must establish by a preponderance of the evidence that: (1) the amount in controversy exceeds $75,000; and (2) all person on one side of the controversy are citizens of different states than all persons on the other side of the controversy.

Hail Claims – Separating Covered And Non-Covered Damages

November 7, 2022 | Mark S. Humphreys

Hail damage claims have few unique aspects to themselves. One of those unique aspects is that an insurance company claims the damage to a roof is the result of something other than the recent hail storm a homeowner is claiming, then the homeowner has to properly present the claim to be able to make a recovery. The most common reason an insurance company denies the claim is that their position that the damage to the roof is the result of wear and tear.

Here is a 2022 opinion from the Northern District of Texas, Dallas Division, that deals with this issue. The opinion is styled, John Garcia v. State Farm Lloyds.

Garcia had a homeowners policy with State Farm. After a hail storm Garcia made a claim for hail damage to his roof. State Farm sent out an adjuster who asserted the damage was mainly due to wear and tear and that the damage from the hail was minimal to the extent that it did not meet Garcia’s deductible. Garcia hired an expert that said the damage was in excess of $70,000 and was solely the result of the hail.