Dallas Fort Worth Insurance Lawyer Blog

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.

No matter where you live, Grand Prairie, Arlington, Mansfield, Fort Worth, De Soto, Hurst, Duncanville, Weatherford, Aledo, Azle, or anywhere else in Texas, you like most anybody else, are always looking for ways to save a few dollars and hopefully make life a little easier to manage.
The Palm Beach Post ran an article on June 22, 2010, that showed how one business was taking unfair advantage of this desire to save a little money that most of us have. This article was written by Susan Salisbury. The title of the article is, "Lawsuit says Fort Lauderdale auto group engaged in deceptive practices."
She reported that, Auto Relief Group, a Fort Lauderdale based firm owned by a John J. Boyle, from Fort Lauderdale and his son John J. Boyle, from Boca Raton, are being sued for allegedly engaging in deceptive and unfair practices related to automobile loan modifications. These accusations are from the Florida Attorney General's Office.
In a civil complaint filed by the Florida Attorney General's Office, it is alleged that Auto Relief Group, its subsidiaries and owners falsely represented in national television and radio advertisements that they could reduce consumers' car payments by up to 50 percent. The Attorney General's Office was granted an injunction in Broward County Circuit Court to freeze the company's assets and appoint a receiver to take possession and control of the company.
Representatives of Auto Relief Group allegedly told undercover investigators that they qualified for loan modifications that would reduce their monthly auto loan payment up to 50 percent for up front payments ranging from $299 to $375.
It is reported that the Attorney General's Office is working to locate victims. The investigation indicates the company may have collected several hundred thousand dollars in up front fees from consumers each month.
The on-line posting of this article by The Palm Beach Post had many posts following the article, of victims who had been taken in by this scheme. The only comfort is knowing there are agencies who pursue these illegal activities. In Texas, the Texas Attorney General has essentially the same rules and laws under the Texas Deceptive Trade Practices Act, to pursue these wrongdoers. In addition to shutting these businesses down there are rules for pursuing the owners of these businesses in civil court and in the right situation to criminally prosecute the wrongdoers.

If you have an insurance agent in Grand Prairie, Arlington, Mansfield, De Soto, Aledo, Duncanville, Bedford, Fort Worth, Weatherford, or anywhere else in Texas, you might wonder if the guy was being completely honest with you when he sold you the insurance policy on your car or auto.
Lawyers.com defines false representation as an untrue or incorrect representation regarding a material fact that is made with knowledge or belief of its inaccuracy.
In the Texas Supreme Court case, DeSantis v. Wackenhut Corp., a 1990 case, the court said a false representation must involve an existing or past material fact, rather than a statement of opinion, judgment, probability, or expectation in order to constitute actionable fraud. Statements concerning future events, sales talk, "puffing," and other similar statements are not considered actionable misrepresentations. This was stated by the Texas Court of Appeals in Tyler, in 1978, in the case, Hicks v. Wright. Similarly, representations concerning future events are not actionable unless at the time the statement or promise was made, the person making it did not intend to perform. This was stated by the Dallas Court of Appeals in 1976, in the case, Stone v. Enstam.
The Texas Insurance Code has a statute dealing with misrepresentations of insurance policies. Texas Insurance Code, Section 541.061, is titled "Misrepresentation of Insurance Policy." It says:
It is an unfair method of competition or an unfair or deceptive act or practice in the business of insurance to misrepresent an insurance policy by:
(1) making an untrue statement of material fact;
(2) failing to state a material fact necessary to make other statements made not misleading, considering the circumstances under which the statements were made;
(3) making a statement in a manner that would mislead a reasonably prudent person to a false conclusion of a material fact;
(4) making a material misstatement of law; or
(5) failing to disclose a matter required by law to be disclosed, including failing to make a disclosure in accordance with another provision of this code.
So now, what happens if false representations are discovered?
The 1977, Corpus Christi Court of Appeals case, Neuhaus v. Kain, says, anyone may sue for damages who has suffered injury in reliance on a misrepresentation made to them.
Next, the Fort Worth Court of Appeals, in 1960, in R.O. McDonnell Dev. Co. v. Schlueter, said that all persons who commit fraud are liable for the consequences of such fraud.
With regard to a principle - agency relationship, a principle may be held liable for the fraudulent representations of an agent if an agency relationship existed and if the acts committed by the agent were within the scope of the agent's authority. This was spelled out in a 1970, Houston [14th] Court of Appeals case, Pasadena Assoc. v. Connor. This means that not only is an insurance agent liable for his misrepresentations but so is the insurance company.
The best thing to do is seek the assistance of an experienced Insurance Law Attorney when you feel like you have had false representations made to you. All these situations are fact specific in determining whether or not there is a case worth pursuing.

How does a person in Grand Prairie, Arlington, Mansfield, Aledo, Burleson, Bedford, Euless, Lancaster, Hurst, Fort Worth, or any other city in Texas know when their insurance company or agent is committing fraud? The problem with fraud is that a person usually does not know when it happens.
USLegal defines fraud as an intentional misrepresentation of material existing fact made by one person to another with knowledge of its falsity and for the purpose of inducing the other person to act, and upon which the other person relies with resulting injury or damage. Fraud may also be made by an omission or purposeful failure to state material facts, which nondisclosure makes other statements misleading.
The Texas Supreme Court, in 1977, defined fraud in the case, Stone v. Lawyers Title Insurance Corp., saying:
A fraud cause of action requires proof of the following elements:
(1) a material representation was made;
(2) the representation was false;
(3) the speaker knew it was false or made it recklessly without any knowledge of the truth and as a positive assertion;
(4) the speaker made it with the intention that it should be acted on by the party;
(5) the party acts in reliance upon it; and
(6) the party suffered injury.
In Stone, the purchaser of a tract of land sued Lawyers Title Insurance Corp. on an owner's policy covering the tract for damages sustained due to the failure of the policy to show pipeline easements as exceptions. The Court held the title-agency president's statement that "everything was squared away" constituted some evidence that he represented that there were no easements on the property. As a result, the Court found evidence of actionable fraud against the title agency and its president.
Another example of fraud is found in, Pankow v. Colonial Life Insurance Co. of Texas. This is a 1996, Amarillo Court of Appeals case.
In Pankow, Pankow sued Colonial Life Insurance Co. of Texas, a credit life insurer, after it failed to pay policy proceeds on grounds that the policy had not been reinstated before the insured's husband died. Pankow alleged that employees of Colonial misrepresented that the policy would be reinstated and that they would secure the transfer of monies from an escrow account to pay outstanding premiums. These were actionable representations, as they involved misrepresentations of a future act which could be performed in compliance with policy terms.
Celestino v. Mid-American Indemnity Co., is an example of a case where the court said there was not any fraud. This is a 1994, Corpus Christi Court of Appeals case.
In Celestino, an employer's excess policy contained an exclusion for punitive damages. The declaration page, which specified that the umbrella policy conferred one million dollars in excess employer's liabiity coverage, did not amount to a fraudulent misrepresentation merely because the Mid-American Indemnity Co. policy contained the punitive damages exclusion. Celestino alleged that, by virtue of the exclusion, the policy in essence provided no employer's liability coverage at all. But the court stated that it could not isolate a general provision within a contract and label it a misrepresentation merely because subsequent exceptions preclude the effect of that provision. Furthermore, the language of the exclusion was plain, and its placement was prominent.
With the examples given above, it can be seen that each case is fact specific and has to be looked at closely to see if the allegation of fraud applies.

Is a Grand Prairie resident who purchases an auto policy a person or a consumer for purposes of Texas law? What about residents of Arlington, Fort Worth, Weatherford, or Dallas? Why does it matter?
The Texas Insurance Code allows "persons" to bring claims against insurance companies and their agents. The Deceptive Trade Practices Act (DTPA) gives this power to "consumers". The DTPA, Section 17.45(4) defines consumer as one who seeks or acquires goods or services.
Someone suing under the Insurance Code does not have to prove he is a consumer. This is told to us in the 1987, Texas Supreme Court case, Aetna Casualty & Sur. Co. v. Marshall.
Insureds and beneficiaries of insurance policies meet both definitions. This is because of the direct relationship with the insurance company, and any misconduct by the insurance company affects them directly, plus they are the ones who sought or acquired the insurance services.
Other potential plaintiffs may be "persons" but not "consumers". An example of this is the insurance agent in Crown Life Ins. Co. v. Casteel, decided in 2000. The agent could sue under the Insurance Code as a person harmed by the insurance company conduct, but not as a consumer, because he did not seek or acquire the insurance coverage. He could not sue under the DTPA since it only applies to consumers.
In the 1995 case, Transport Insurance Company v. Faircloth, another Texas Supreme Court case, the court held that third parties negotiating a settlement with an insurance company do not seek to purchase or lease any of the services of the insurance company; they only seek proceeds of the policy. Thus, they are not consumers.
This restriction applies to the following DTPA sections that expressly include the word "consumer", and those that refer to "goods and services." Texas Business & Commerce Code, Section 17.46(b)(5), (7), (9), and (23).
It should be noted that for each of the DTPA sections that apply only to "consumers" there is a prohibition in the Insurance Code that can apply to the same conduct. As an example, DTPA Section 17.46(b)(24) prohibits nondisclosures to consumers. Looking at Insurance Code Sections 541.061(2) and (3), they prohibit failing to state information, and stating information in a misleading manner, both of which may address nondisclosures. Likewise, in place of the DTPA misrepresentation sections that apply only to consumers, a person may rely on Insurance Code Sections 541.060(a)(1) and 541.061(1).
An experienced Insurance Law Attorney will be able to know which sections of the DTPA and the Texas Insurance Code apply to any given situation.
The importance here is that suing under the wrong section will end up in getting a case thrown out of court. Also, the goal would be to maximize the recovery to be allowed and by filing a lawsuit under all applicable theories under the law helps achieve that result and discourages wrong conduct on the part of the insurance companies.

A few things for people in Dallas, Fort Worth, Grand Prairie, and Arlington to know. First, and most important would be to seek the help and advice of an experienced Insurance Law Attorney when having arguements with an insurance company. The second, is to use the Texas Department of Insurance web-site as a source of some information.
The Texas Insurance Code and the Deceptive Trade Practices Act (DTPA), which is found in the Texas Business & Commerce Code, were adopted together in 1973 by the Texas legislature as part of a package of reform legislation, are interrelated, and incorporate each other. Thus, as is stated by the Texas Supreme Court in the case, State Farm Life Insurance Company v. Beaston, in 1995, and in, Vail v. Texas Farm Bureau Mutual Insurance Company, in 1988; Courts construe the two statutes together.
Texas Insurance Code, Section 541.008, clearly states that the provisions of the code are to be liberally construed and applied to promote the underlying purposes which are to define and prohibit unfair and deceptive insurance practices.
In 1981, the Texas Supreme Court stated in, Cameron v. Terrell & Garrett, Inc., that the similar liberal construction mandate in the DTPA requires that the statute be given "its most comprehensive application possible without doing any violence to its terms." The Supreme Court has applied the same reasoning in insurance cases. This is stated in, Kennedy v. Sale, decided in 1985.
The statutory remedies found in the DTPA and the Insurance Code are cumulative of other remedies found in the law. Business & Commerce Code, Section 17.43, makes clear these cumulative remedies. Texas Insurance Code, Section 541.453, makes clear this principle also, citing, Waite Hill Services, Inc. v. World Class Metal Works, Inc., wherein the Supreme Court, disallowed double recovery of same damages for breach of contract and statutory violations.
An experienced attorney knows the proper way of seeking these damages. He will usually plead the case "in the alternative" listing all possible ways of recovery and seeking the highest amount legally possible, given the facts of the case.

Grand Prairie residents and residents of Arlington, Fort Worth, Dallas, Weatherford, and every other town in Texas should know a few things about holding insurance companies accountable. One is, they should always report wrongs to the Texas Department of Insurance. The other thing they should do is contact an experienced Insurance Law Attorney.
An attorney will discuss the fact that remedies for the wrongs committed by insurance companies are addressed in at least two areas of law in Texas; The Texas Insurance Code and the Texas Business & Comerce Code which contains the laws dealing with violations of the Deceptive Trade Practices Act (DTPA).
The Texas Insurance Code, Section 541.151(2) cross-references and prohibits conduct defined in The Business & Commerce Code, Section 17.46(b) of the DTPA. The latter statute applies to all types of consumer transactions, not just insurance, thus not all of the provisions are relevant to insurance issues. The sections that matter most in insurance cases are:
Section 17.46(b)(2) - causing confusion or misunderstanding as to the source, sponsorship, approval, or certification of goods or services.
Section 17.46(b)(5) - representing that goods or services have ... benefits, ... which they do not have or that a person has a sponsorship, approval, status, affiliation, or connection which he does not.
Section 17.46(b)(12) - representing that an agreement confers or involves rights, remedies, or obligations which it does not have or involve, or which are prohibited by law.
Section 17.46(b)(24) - the failure to disclose information concerning goods or services which was known at the time of the transaction if such failure to disclose such information was intended to induce the consumer into a transaction into which the consumer would not have entered had the information been disclosed.
The above Section 17.46 is known as the "laundry list" of claims by attorneys. Insurance business fits within these prohibitions because courts have held that insurance is a "service." The supporting law for this was declared in a 1984, Corpus Christi Courts of Appeals case, McCrann v. Klaneckey.
Insurance Code, Section 541.151(2), says that to sue for conduct in violation of one of the above provisions, the wronged person must show they relied on the act or practice to their detriment.
Here is a couple of examples:
The Texas Supreme Court case, Aetna Casualty & Surety Company v. Marshall, says "An insurer's breach of its contractual promise to pay future medical benefits was precisely the sort of conduct forbidden by Texas Business & Commerce Code, Section 17.46(b)(5), which prohibits misrepresenting "benefits." This case was decided in 1987.
Another Texas Supreme Court case, Royal Globe Insurance Company v. Bar Consultants, Inc., states, "Misrepresenting that the policy affords coverage it does not have violates Section 17.46(b)(12). This is a 1979 case.
It must be remembered that even though the Insurance Code and the DTPA both prohibit misrepresentations and nondisclosures, it can be important for a potential plaintiff to carefully choose the part of the statutes that best fit their exact situation and which is the easier to prove. This is where an attorney is most valuable.

Grand Prairie residents, residents of Arlington, Mansfield, Fort Worth, Dallas, Weatherford or anywhere else in Texas have the same insurance laws apply to each other. They all need to know there is a law that prohibits unfair settlement practices in the State of Texas.
Texas Insurance Code, Section 541.060, is titled "Unfair Settlement Practices". It is the law that prohibits these types of actions. The statute prohibits engaging in any of the following settlement practices with respect to a claim by an insured person or his beneficiary:
(1) misrepresenting to a claimant a material fact or policy provision relating to coverage at issue;
(2) failing to attempt in good faith to effectuate a prompt, fair, and equitable settlement of a claim:
(a) with respect to which the insurer's liability has become reasonably clear; or
(b) a claim under one portion of a policy of a claim with respect to which the insurer's
liability has become reasonably clear in order to influence the claimant to settle
an additional claim under another portion of the coverage, unless payment under
one portion of the coverage constitutes evience of liability under another portion of
the policy;
(3) failing to provide promptly to a policyholder a reasonable explanation of the basis in the policy, in relation to the facts or applicable law, for the insurer's denial of a claim or for the offer of a compromise settlement of a claim;
(4) failing within a reasonable time to:
(a) affirm or deny coverage of a claim to a policyholder; or
(b) submit a reservation of rights to a policyholder:
(5) refusing, failing, or unreasonably delaying an offer of settlement under applicable first-party coverage on the basis that other coverage may be available or that third parties are responsible for the damages suffered, except as may be specifically provided in the policy:
(6) undertaking to enforce a full and final release of a claim from a policyholder when only a partial payment has been made, unless the payment is a compromise settlement of a doubtful or disputed claim;
(7) refusing to pay a claim without conducting a reasonable investigation with respect to the claim;
(8) with respect to a Texas personal auto policy, delaying or refusing settlement of a claim solely because there is other insurance of a different type available to satisfy all or any part of the loss forming the basis of that claim; or
(9) requiring a claimant, as a condition of settling a claim, to produce the claimant's federal income tax returns for examination or investigation by the person unless:
(a) a court orders the claimant to produce those tax returns;
(b) the claim involves a fire loss; or
(c) the claim involves lost profits or income.
Here are a couple of examples where courts have held that the insurance company violated the above section of the Insurance Code. The first is a 1988, Texas Supreme Court case. The style is, Vail v. Texas Farm Bureau Mutual Insurance Company. In this case Texas Farm Bureau Mutual Insurance Company denied a fire loss claim, based on an arson defense that the jury rejected. The court found that Texas Farm committed an unfair insurance practice by failing to act in good faith to settle once its liability became reasonably clear.
The second case, is a 2000 case, decided by the Texas Court of Appeals in Corpus Christi. The style of this case is, Colonial County Mutual Insurance Company v. Valdez. Here, the court ruled that proving Colonial County Mutual Insurance Company did not meet the deadlines in the Prompt Payment of Claims statute, Texas Insurance Code, Section 542.051 thru 542.061, may be proof to show Colonial County committed an unfair settlement practice by not meeting the "reasonable time" requirements in the above statute.
Whenever a person gets the feeling they are not being treated right by an insurance, they should seek legal help with an experienced Insurance Law Attorney. In fact, they should talk to an attorney any time they are having to make a claim against an insurance company.

Grand Prairie residents and residents of Arlington, Dallas, Fort Worth, Mansfield, Weatherford, and any other town or city in Texas have a right to have their insurance company and agent be honest with them. Misrepresentation of an insurance policy in Texas is illegal under the Texas Insurance Code and Texas Deceptive Trade Practices Act.
The Texas Insurance Code, Section 541.061, states that misrepresentation of an insurance policy in Texas is an unfair method of competition or an unfair or deceptive act or practice in the business of insurance. The title of Section 541.061 is "Misrepresentation of Insurance Policy".
A violation of this section of the Texas Insurance Code is also a violation of the Texas Deceptive Trade Practices Act. As it relates to insurance misrepresentation, this section of the Insurance Code states that it is illegal to misrepresent features of an insurance policy by:
(1) making an untrue statement of material fact;
(2) failing to state a material fact necessary to make other statements made not misleading, considering the circumstances under which the statements were made;
(3) making a statement in a manner that would mislead a reasonably prudent person to a false conclusion of a material fact;
(4) making a material misstatement of law; or
(5) failing to disclose a matter required by law to be disclosed, including failing to make a disclosure in accordance with another provision of this code.
Some of this seems rather easy to understand and other parts of it can be quite confusing. One thing that should be obvious is that if you believe an agent or insurance company adjuster has mislead or misrepresented something about an insurance policy, you should contact an experienced Insurance Law Attorney. He would be able to discuss with you the representations made to you and your understanding of them and assist in seeing if you have a claim worth pursueing for violations of this section of the Insurance Code.
In 2003, the Court of Appeals of Texas, Austin, decided a case that discusses what constitutes "negligent misrepresentation". The style of the case is, New York Life Insurance Company; New York Life Insurance and Annuity Corporation and Michael Coffey v. Phillip M. Miller.
This case involves a life insurance policy issued by New York Life Insurance Company to the CEO of Mary Kay Cosmetics. The real dispute here was between the different agents who sold the policy. But what is important to the purpose of this article is that it set out the requirements for a claim for "negligent misrepresentation". The court said that what is needed to establish a claim for negligent misrepresentation is to prove that, without exercising reasonable care or competence, a representation was made in a transaction which contained "false information" for anothers guidance in his business affairs. That the misrepresentation caused the injured party to suffer a loss by relying on the information.
The biggest problem with the above New York Life case, is that it seems to make it much harder than it really is, to pursue a claim for a violation of Section 541.061. Of course this is another reason why legal counsel should be sought.

Regardless of what kind of insurance you have purchased or where in Texas the purchase occurred, the same law applies. So residents of Grand Prairie, Arlington, Mansfield, Dallas, Fort Worth, or Weatherford, all get treated the same.
This will be the first part of a several part writing on "unfair insurance practices".
Chapter 541 if the Texas Insurance Code, is where the definition and prohibition for unfair and deceptive insurance practices is found. These sections of the Insurance Code are Sections 541.001 thru 541.061, Section 541.151 thru 541.162, and 541.453.
Unfair insurance practices violations are also a violation of the Texas Deceptice Trade Practices Act (DTPA). DTPA violations are found in the Texas Business & Commerce Code, Section 17.46. This list is long and is also known as the "laundry list" of violations subject to civil prosecution.
The Insurance Code statutes listed above allow a private cause of action by a wronged person who has sustained actual damages caused by another's engaging in any act or practice that is defined as an unfair method of competition or unfair or deceptive act or practice in the business of insurance, or defined as an unlawful deceptive trade practice. This is set out in statute in Section 541.151. The usual violators or this section would be insurance agents and insurance adjusters.
The definitions of unfair and deceptive practices are found in two places: (1) Texas Insurance Code, Sections 541.051 to 541.061; and (2) Business & Commerce Code, Section 17.46(b), also known as the DTPA.
The Insurance Code sections prohibit the following:
1) misrepresentations and false advertising of policy contracts;
2) false information and advertising generally;
3) defamation of insurers or persons engaged in the business of insurance;
4) boycott, coercion, and intimidation in the business of insurance;
5) false financial statements;
6) stock operations and advisory board contracts;
7) unfair discrimination;
8) rebates;
9) deceptive names, words, symbols, devises, and slogans;
10) unfair settlement practices; and
11) misrepresentation of insurance policies.
Of these listed prohibitions, the most commonly used by experienced Insurance Law Attorneys are those related to unfair settlement practices and misrepresentations of insurance policies. Certainly the others apply in some situations and each case has to be looked at closely.

Grand Prairie residents beware; Weatherford residents beware; Arlington, Mansfield, Dallas, Fort Worth residents beware. Here is a case that makes you angry at the insurance company when you get into the details of how this person was treated by her insurance company and those associated with them.
The case is kinda old, decided in 2001. The style of the case is long, Lois Jones v. Ray Insurance Agency a/k/a Azteca Insurance and / or Alamo Insurance, and Collision Clinic, Inc., State & County Mutual Fire Insurance Company and Harbor Insurance Managers. It was decided by the Court of Appeals of Texas, Corpus Christi.
The facts of the case are long, but not really complicated. Lois Jones purchased a new 1998 Pontiac and purchased a State & County Mutual Fire Insurance Company insurance policy (State & County). This policy was purchased from the agent, Ray Insurance Agency a/k/a Azteca Insurance and / or Alamo Insurance (Ray). The policy administrator was Harbor Insurance Managers (Harbor). When purchasing the policy, Jones informed the agent that her sister lived with her, and was advised by the agent, that would not be a problem, and that as long as she paid her premiums on time she would have insurance. The policy with State & County excludes coverage for anyone residing with Jones age fourteen or over unless listed. Ms. Jones paid the November and December premium payments. The policy was to be effective from November 7, 1997 (the date of purchase) thru May 7, 1998.
On December 28, 1997, Jones Pontiac was severely damaged when hit by another auto driven by an uninsured drunk driver. Her Pontiac was towed to Collision Clinic, Inc. (Collision) The day after the accident, she was told she was fully covered for the accident. Less than thirty minutes later she was phoned and told the policy cancelled because she had not excluded her sister as a driver. Later she was told the cancellation was because she had not provided a copy of her driver's license. State & County and Harbor allege the cancellation was mailed on November 25, 1997, but Ms. Jones denies ever receiving the letter. The letter allegedly advised Ms. Jones that her policy would cancel on December 4, 1997. During this dispute, Collision foreclosed on the Pontiac for repairs that had been performed despite the fact that Jones had never been given a repair estimate. Collision's foreclosure caused Jones bank to foreclose and repossess the Pontiac even though she had continued to make her monthly payments. State & County never returned Jones December premium payment, which had been made on December 1, 1997, or any part thereof.
There are many issues presented in this case that are related to laws found in the Texas Insurance Code. Texas Insurance Code, Section 551.001, deals with how cancellations are to be handled with personal automobile insurance policies. In this case, the facts appear to be that the required ten day notice of cancellation was not properly handled in that the notice of cancellation was allegedly mailed at such a time that the earliest it could have been received by Ms. Jones was December 3 or 4. Yet, she had made a payment on December 1, 1997, which was accepted and never refunded in whole or in part. This failure to refund the premium became a big reason the court ruled in Jones favor. Plus the court found that as a matter of law the cancellation notice was void because it did not satisfy the requirement that there be a ten day notice prior to cancellation.
Other issues about her sister not being listed on the policy and the insurance company not having a copy of her drivers license were addressed as follows. The court pointed out that Jones had informed the agent about her sister and the agent said that Jones would be covered and the policy would stay in effect as long as she paid her premiums. So, atleast the agent knew of Jones sister and thus as an agent of the company this knowledge was imputed to the company. As for the license, the court pointed out that the insurance company had Jones drivers license information on the application, her name, address, date of birth, drivers license number, etc.
Going back to the failure of the insurance company to refund the premium payment, the court ruled that the insurance company's acceptance and processing of the check and refusal to refund the monies argueably prevents them from now asserting the policy was cancelled.
There are other insurance law issues in this case plus lots of issues falling under the Texas Deceptive Trade Practices Act. The case is a good and fairly easy read for someone trying to understand how atleast one of these insurance lawsuits was dealt with by the Texas courts.

The topic of this piece is a case that arose out of Mansfield, Texas. The case could have just as easily arisen in Arlington, Grand Prairie, Fort Worth, Dallas, or out in Weatherford.
The Fort Worth Star-Telegram published a story about a claim against a home builder for the builders faulty construction work.
Even when a claim is against a home builder for mistakes in the construction of the home, often times the same claim can be made against the insurance company that insures the home. The advantage of claiming against the home owners insurance is to, hopefully, get the matter resolved quickly rather than get involved in an extensive and long drawn-out court battle with the builder. Of course, sometimes it is just the opposite.
The title of the article is, "Jury Awards $58 Million to Mansfield Couple In Home Builder Lawsuit". The article tells that the lawsuit lasted almost a decade.
The Mansfield couple had purchased their home from their builder, Perry Homes, and also involved in the lawsuit was a home warranty company. They also included in the lawsuit, their insurance company, Warranty Underwriters Insurance Company, a Houston company.
The couple had paid nearly $234,000 and was the only new home the couple had ever had. They had bought it for their retirement after moving from a home in Arlington they had lived in for 25 years, and where they had raised their three children.
After moving into the home in 1996, problems became apparent by the following January. A representative for Perry Homes assured them that the home was just settling and that everything would be ok. However, cracks kept appearing in walls, and doors and windows jammed shut. They also discovered that a drainpipe that was punctured during construction had soaked a kitchen wall, requiring them to move out for several months while mold was removed.
This case was submitted to arbitration in 2001 where Perry Homes lost. They appealed and the case was again arbitrated in 2002, where Perry Homes lost again. Perry Homes then appealed to the Texas Supreme Court where the case was sent back to the trial court and the verdict resulted.
Home claims are in a classification to themselves. Home claims also involve insurance claims and claims against the builder for violations of the Texas Deceptive Trade Practices Act. It is important to get an attorney involved early when having disputes related to homes. This same advice applies to used / older homes the same as to new ones and also to major reconstruction, such as after a fire or flood.

The people living in Weatherford, Grand Prairie, Arlington, Dallas, or Fort Worth, is protected by the laws in Texas, against businesses that try to take advantage of them. These laws are found in the Texas Business & Commerce Code, Section 17.
To be eligible for protection under the DTPA, all you have do is prove your status as a consumer. Proving consumer status under the DTPA requires the plaintiff to prove it was a person or entity listed in Texas Business & Commerce Code, Section 17.45(4) that sought or acquired goods or services by purchase or lease. In determining the plaintiff's consumer status, the focus is on the plaintiff's relationship to the transaction, not on the plaintiff's contractual relationship with the defendant. Thus, the plaintiff does not need to prove it is in privity of contract with the defendant to have standing as a consumer. Instead of privity, the plaintiff is required to show that the defendant was "connected with" the transaction.
This Blog primarily deals with issues related to different forms of insurance issues. The importance of the DTPA is that most violations of the Texas Insurance Code are also violations of the DTPA and subject to the penalties of both sets of laws regulating the matters. Relevant Insurance Code Sections are, 541.003, and 541.051 thru 541.061.
Each state in the Union has its own sets of laws dealing with violations of the DTPA laws. But the laws between the states are very similar, as are the laws regarding insurance regulation in the various states.
The Miami Herald published an article on February 16, 2010, regarding a DTPA violation in Florida. The title of the article is "Thousands To Get Checks In Countrywide Settlement". In the article, it speaks of a lawsuit involving about 2,700 Floridians getting settlement checks from Countrywide Financial. In the lawsuit, the Florida Attorney General sued Countrywide under the Florida DTPA. Countrywide is alleged to have taken advantage of the Floridians in the way their home loans were handled. The 2,700 Floridians will be receiving checks from Countrywide for about $6,000 each.
Anytime a consumer believes they have been cheated or taken advantage of by a business the consumer should talk to an attorney who deals with DTPA claims. The consultation is usually free and the consumer has nothing to lose by talking with the attorney.