Dallas Fort Worth Insurance Lawyer Blog

Life Insurance Claim – ERISA – 2

February 22, 2021 | Mark S. Humphreys

Repeating what was stated in the post immediate to this one, “It is important to understand how difficult claims that are governed by the Employee Retirement Income Security Act (ERISA) can be. The law in this area of law is very tough for claimants.” This is illustrated again in a December 2020, opinion styled, Erica Talasek v. Unum Life Insurance Company of America, et al. The opinion is from the Southern District of Texas, Houston Division.

The insured, Ben Talasek, had life insurance through a Plan his employer, NOV, offered. NOV delegated authority and discretion to UNUM to handle claims and made benefit determinations.

Ben was covered by basic life insurance coverage and Ben also enrolled in a voluntary supplemental plan during November 2013. Unlike the basic life insurance, which did not require medical underwriting, the supplemental life insurance required an employee to submit evidence of insurability and obtain approval for coverage by Unum. On January 18, 2014, Unum sent Ben a letter informing him of an error in his application and the need for additional information. Around this time, Ben was diagnosed with pancreatic cancer. Ben called Unum on January 21, 2014 to check on the status of his application and was told about the January 18 letter. Ben corrected the error on the Evidence of Insurability Form and supplied additional information. Ben called Unum again on February 12, 2014 to check on the status of the application and was told that the standard turnaround time for a coverage decision was 4-6 weeks. On March 3, 2014,several weeks after receiving his cancer diagnosis, Ben provided blood and urine samples and basic health history as part of Unum’s requirement that he prove insurability prior to approval of coverage. He did not mention the cancer diagnosis.

Life Insurance Claim Denial – ERISA

February 20, 2021 | Mark S. Humphreys

It is important to understand how difficult claims that are governed by the Employee Retirement Income Security Act (ERISA) can be. The law in this area of law is very tough for claimants. This is illustrated again in a December 2020, opinion styled, Erica Talasek v. Unum Life Insurance Company of America, et al. The opinion is from the Southern District of Texas, Houston Division.

The insured, Ben Talasek, had life insurance through a Plan his employer, NOV, offered. NOV delegated authority and discretion to UNUM to handle claims and made benefit determinations.

Ben was covered by basic life insurance coverage and Ben also enrolled in a voluntary supplemental plan during November 2013. Unlike the basic life insurance, which did not require medical underwriting, the supplemental life insurance required an employee to submit evidence of insurability and obtain approval for coverage by Unum. On January 18, 2014, Unum sent Ben a letter informing him of an error in his application and the need for additional information. Around this time, Ben was diagnosed with pancreatic cancer. Ben called Unum on January 21, 2014 to check on the status of his application and was told about the January 18 letter. Ben corrected the error on the Evidence of Insurability Form and supplied additional information. Ben called Unum again on February 12, 2014 to check on the status of the application and was told that the standard turnaround time for a coverage decision was 4-6 weeks. On March 3, 2014,several weeks after receiving his cancer diagnosis, Ben provided blood and urine samples and basic health history as part of Unum’s requirement that he prove insurability prior to approval of coverage. He did not mention the cancer diagnosis.

Insurance Claims Denial Law Firms – Hail Damage Claims

February 15, 2021 | Mark S. Humphreys

Insurance lawyers who handle hail damage claims will need to read this opinion from the Western District of Texas, San Antonio Division. It is styled, Mazhar Footsteps, LLC v. Amguard Insurance Company and Michael Clayton Hepburn.

This lawsuit arises from damages incurred by a hailstorm. Based on the way the claim was handled, Mazhar sued Amguard and the adjuster, Hepburn. The lawsuit was filed in State District Court. Amguard timely removed the case to Federal District Court based on diversity jurisdiction and in its notice of removal, Amguard elected under Texas Insurance Code, Section 542A.006, to accept whatever responsibility Hepburn might have to Mazhar for Hepburn’s acts or omissions related to the claim.

Mazhar timely filed this Motion To Remand.

Insurance Claims Denial Law Firm – Federal Court Motions

February 13, 2021 | Mark S. Humphreys

Insurance companies always want to litigate cases in Federal Court. The Judges and rules related to proceedings tend to skew in favor of insurance companies. Here is a 2020 opinion where the insured actually got a favorable ruling. The opinion is from the Southern District of Texas, Houston Division, and is styled, Caramba, Inc. v. Nationwide Mutual Fire Insurance Company.

Caramba is the named insured under a Nationwide policy.

Caramba filed a claim for damages after Hurricane Harvey in August 2017. On August 27, 2020, Nationwide filed a Motion for Judgment on the Pleadings pursuant to Federal Rule of Civil Procedure 12(c).

Insurance Claim Denial Lawyers – Mechanical Breakdown

February 8, 2021 | Mark S. Humphreys

Here is an interesting case from the San Antonio Court of Appeals. The opinion is styled, Infinity County Mutual Insurance Company v. Michael Tatsch.

Tatsch had auto insurance with Infinity. Tatsch made a claim for engine damage. Infinity denied the claim and sent Tatsch a letter explaining its decision. The letter read:

The vehicle damage occurred due to poor quality fuel being added to the vehicle which caused mechanical failure to your insured vehicle. There is an applicable exclusion in Your Texas Commercial Auto Policy that states we do not provide comprehensive coverage for damages resulting from mechanical failure.

Insurance Claim Denial Lawyer – Reading The Policy

February 6, 2021 | Mark S. Humphreys

Insurance Policy interpretation is something the Courts are often called upon to do. Here is a twist to that. A 2020, case from the Southern District of Texas, Houston Division, was asked to require appraisers to use a specific format for an appraisal. The Court refused this request.

The case is styled, Mt. Hawley Insurance Company, et al. v. Harrod’s Eastbelt, Ltd.

Harrod’s had invoked the appraisal provision in the policy issued by the insurer. Mt. Hawley, requested the Court to require the appraisers to use a specific format for the appraisal and to select an umpire.

Insurance Claim Denial Law Firms – The Ways Insurance Companies Look At Lawsuits

February 1, 2021 | Mark S. Humphreys

In order to successfully pursue lawsuits against insurance companies, an insurance attorney must understand how the insurance company looks at their case.

A big part of a lawsuit is deposition witnesses who are controlled by the insurance company. These people are usually the corporate representative, the adjuster, and experts. Hear is a perspective that is primarily from the viewpoint of the insurance company lawyer.

Corporate representative depositions are make-or-break propositions. Sometimes, that choice is out of the hands of the insurance company lawyer but many insurance carriers have identified particular employees for whom giving testimony on behalf of the company is part of their job description. An ideal corporate representative will be someone with general knowledge of the case and the willingness to become a case expert. He or she should also have an unflappable demeanor.

Insurance Claim Denial Law Firm – First Party Property Insurance Case

January 30, 2021 | Mark S. Humphreys

First Party Property Insurance Cases are handled by insurance defense firms in certain ways. Here is a look at how most are handled, starting with answering the lawsuit.

If the attorney for the plaintiff/insured has not sent a proper notice, the insurance lawyer may want to file a verified answer seeking an abatement until such notice has been properly received. Although proper notices do not have to be detailed, they do need to comply with all the elements set forth in Chapter 542 of the Texas Insurance Code. Once the defense firm is armed with a specific number that the claimant is seeking, the defense attorney can better evaluate the potential range of damages the insurance company is having to deal with.

Because insurance carriers are among the least popular defendants in courts across the country, it is important to take advantage of any rules to ensure a favorable forum. Cases that are originally filed in state court may be removed to federal court where there is diversity of citizenship and an amount in controversy of more than $75,000. In Texas, where state trial court judges are selected through partisan elections, federal forums will often be more favorable. Federal judges with lifetime appointments often have more time and staff available to consider dispositive motions. In addition, jurors are drawn from a broader area, which generally results in more rural, conservative jurors. For these reasons, attorneys for plaintiffs may include a Texas-resident adjuster as a defendant to defeat diversity. It is important to consider whether the case can still be removed by arguing that the adjuster was improperly joined and her citizenship should be disregarded. For cases governed by Section 542A of the Texas Insurance Code (which applies to weather-related claims), the carrier has the option to elect to assume the liability for acts of its individual adjusters. Such an election may or may not mean that the individual adjuster is not properly named as a defendant. This election must occur prior to suit being filed to render the lawsuit removable, so the window to elect liability is short.

Claims Denial Attorneys – Attorney Misrepresentations

January 25, 2021 | Mark S. Humphreys

Here is a strange case from the Southern District of Texas, Houston Division. It is a 2020 opinion styled, Pruco Life Insurance Company v. Blanca Monica Villarreal, Transamerica Life Insurance Company v. Blanca Monica Villarreal.

This is a hard fought dispute over a large life insurance policy and discovery being conducted in two countries. Many accusations of misconduct are being hurled by both sides.

The two life insurance companies were trying to depose Villarreal’s investigator. Villarreal’s attorney objected to the questions based on it protected by attorney work-product rules.

Claim Denial Lawyer – Segregating Damages

January 23, 2021 | Mark S. Humphreys

Here is an opinion from the Northern District of Texas, Dallas Division, that concerns hail damage and segregating damages. The opinion is styled, Frymire Home Services, Inc. and Whitfield Capital, LLC v. Ohio Security Insurance Co.

This is a summary judgement opinion in filed by Ohio and the Court granted the summary judgment in favor of Ohio.

This is a hail damage insurance dispute. Ohio insured Property owed by Plaintiffs. The policy was in effect from March 23, 2018, until March 23, 2019.