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Insurance lawyers need a good process for taking on a case.  This includes a good intake sheet and a thorough discussion about the case.

I.  One issue to discuss is the number or prior claims that the client has had in the past.  What repairs were competed?  An insurance company adjuster will use prior claims or lack of repairs to their advantage if possible.  Adjusters have access to this information and will use it fruitfully for themselves.  Having copies of repair receipts and photos are very helpful for the claimant.  Sometimes an expert is needed.

II.  Inspection tends to be the part of a case that has the most varied, and often polarized account of what exactly happened to cause the claim.  The attorney needs to know if the client was present when the property was inspected.  Too many times, the adjuster acted on his own without the claimant being present.  Knowing what the adjuster did can often times help the claim.  It may increase the value of the claim or lessen it.  The insured needs to be sure and point out all the damage the insured is aware of and know whether or not the adjuster looked for other damage

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Attorneys handling insurance claim denials and their clients, need to understand some basics about what needs to be done when a claim is denied.

Before reaching the court house steps, in most cases, the parties should consider possible resolutions to avoid trial.  The client may not always have the best facts, or the upper hand in negotiations, but counsel should advise the client of the potential risks and rewards of proceeding toward trial.  Ethically, lawyers have a duty to convey all offers made by the insurance company, and clients should be advised on any potential counterclaim risk, if applicable.  Texas Rule of Civil Procedure 167 may severely affect the way a judgement is handled in the event the case goes to trial and the plaintiff obtains less than what was offered.  The client must understand the risk involved.  In the end, he or she should be comfortable with any decision that is made after receiving full counseling and advice.

There is one of two things that have happened when the parties find themselves at the courthouse ready to pick a jury and present their case.  It is because 1) the plaintiff has overvalued the case, or 2) the defendant has undervalued it.  Preparation in the initial stages of the case can be just as valuable as what you do in the courtroom during trial.

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Insurance lawyers know there are time limits upon which lawsuits for bad faith insurance claims must be filed.

These limitations are illustrated in the 2018, U.S. Fifth circuit Court of Appeals opinion styled, Susan Sideman; Mark Sideman v. Farmers Group, Incorporated.

The Sidemans sued Farmers for breach of the Texas Insurance Code, Section 541.  In June 2013, Farmers mailed the Sidemans an offer package including (1) notice that Farmers was  not renewing the policy; (2) an offer for a new policy; (3) a summary comparison of the old policy and the new policy; and (4) a new endorsement, prominently titled “Exclusion of Marring of Metal Roof Materials” that limited coverage to situations where a covered peril such as hail punctures a roof or renders it functionless, and explicitly excluded coverage for mere marring like denting or scratching.

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Having an experienced insurance law attorney is vital.  Otherwise you can end up with a situation that occurred in the Eastern District of Texas, Sherman Division.  The case is styled, Mike and Jacqueline Sanchez v. Safeco Insurance of Indiana.

The Sanchez’s filed a Motion to Dismiss Without Prejudice.  In other words, the Sanchez wished to dismiss their lawsuit against Safeco.  However, by filing the motion “without prejudice” would allow them to refiled the lawsuit against Safeco.  For this reason, Safeco contested the motion.

The United States Fifth Circuit Court of Appeals recognizes that as a general rule, motions for voluntary dismissal should be freely granted unless the non-moving party will suffer some plain legal prejudice other than the mere prospect of a second lawsuit.  The primary purpose of Rule 41(a)(2) is to prevent voluntary dismissals which unfairly affect the other side, and to permit the imposition of curative conditions.

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In cases involving insurance, an experienced insurance lawyer needs to be hired.  This is illustrated in an Austin Court of Appeals opinion styled, Jessica Dennis and Douglas Dennis v. GEICO.

In August 2016, GEICO sued the Dennises, alleging that a “motor vehicle owned by Plaintiff’s insured Rene Zavala … was damaged by a vehicle negligently operated by Douglas Dennis, whose negligence proximately caused the collision and damages in the amount of $10,417.28.  Plaintiff compensated its insured for the loss, thereby becoming subrogated in the amount of $10,417.28.”  The petition further alleged that, “at the time of the collision, Jessica Dennis was the owner of the motor vehicle driven by Douglas Dennis, and the vehicle was operated with Jessica’s consent and knowledge.  Upon information and belief, Jessica wrongfully and / or negligently entrusted his/her motor vehicle to an incompetent, reckless, unlicensed and uninsured driver”

The Dennises filed an answer and counterclaim asserting that it was Zavala, not the Dennises, who negligently caused the collision.  The Dennises later filed with the Court a number of documents purporting to demonstrate the damages they incurred as a result of the collision.  Douglas also filed an affidavit alleging that Zavala’s negligence caused the collision.

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Bad Faith insurance claims require specific pleading in Federal Court.  This is illustrated in the Northern District of Texas, Fort Worth Division, opinion styled, Charlotte R. Carroll v. State Farm Mutual Automobile Insurance Company.

Carroll alleges:

The plaintiff filed a claim with the defendant under her insurance policy after a severe blow out on the expressway.  After several weeks of getting the run  around, the defendant deceived the plaintiff into believing a check they mailed to her in the amount of $3496.94 would completely pay for all covered repairs to the plaintiffs vehicle.  Which was more than far from the truth.

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Insurance policies have to be read carefully by an insured and by the insurance law lawyers who want to help the insured.  This is illustrated in an Austin Court of Appeals case styled, Progressive County Mutual Insurance Company v. Edwin Emenike.

This is a summary judgment case granted in favor of Edwin.  Progressive filed an appeal and this Court then reversed and rendered in favor of Progressive.

The facts are undisputed.

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Here is a case where an insurance law lawyer sued an agent and was able to prevent the case from being held in Federal Court.  The case is from the Southern District of Texas, Houston Division, and is styled, Mary’z Mediterranean Cuisine, Inc. v. Blackboard Insurance Company f/k/a Hamilton Insurance  Company, Texas General Insurance, and Mir Khan.

This lawsuit was filed in State District Court and the defendants removed it to Federal Court based on their assertion that Texas General and Khan were improperly joined in an effort to defeat diversity jurisdiction.  Mary’z filed a motion to remand to State Court which the Court granted.   Here is why:

Mary’z alleges that Khan and Texas General sold a commercial policy to Mary’z with full knowledge of Mary’z business operations, building design, and Mary’z lack of an internal fire alarm by falsely representing to Mary’z that damages caused by a fire would be covered by the policy.  A fire occurred and Blackboard denied the claim based on Mary’z not having an internal fire alarm.

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In places like Weatherford, Texas and Mineral Wells, Texas, knowing about animal exclusions in insurance policies is important.  Areas that are rural are usually more inclined to have people who own animals of one type or another.  Dogs may be particular to more urban areas but in the rural areas there is greater likelihood of persons owning bigger dogs plus, horses and cows.

Animal exclusions become important in these more rural areas and animal exclusions is discussed in a Western District of Texas, Austin Division opinion styled, Colony Insurance Company v. Burleson County Saddle Club, Inc.

Colony filed a declaratory judgment action seeking to have the Court declare that there is no coverage in this case.  A person was injured while riding a horse at a sporting event at the Burleson County Saddle Club.  Burleson sought coverage from Colony.

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Here is an opinion from the 14th Court of Appeals that concerns the Prompt Payment of Claims Act.  The opinion is styled, William Marchbanks v. Liberty Insurance Corporation.

This is an appeal from the trial court granting summary judgment in favor of Liberty.  This appeals court affirmed the trial court.

Marchbanks reported a hail damage claim to Liberty and the same day Liberty acknowledged the claim and sent an adjuster to the property the next day.  The adjuster determined that any roof damage was not storm related and Liberty sent a denial letter explaining no storm related damaged was found.

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