Claims Denial

The Insurance Policy Definitions

May 18, 2024 | Mark S. Humphreys

Here is a 2024 opinion from the Northern District of Texas, Dallas Division, that deals with an insurance policy. Specifically, the wording of an insurance policy. The opinion is styled, Johnetta Askew Hunt v. Meridian Security Insurance Company State Auto Insurance Companies.

This is a summary judgment opinion regarding “residing” at a premises. The case deals with the coverage provided by a policy and where an insured, Hunt, tries to get more coverage than the policy provides.

In Texas, interpretation of an insurance policy begins with its actual words, because it is presumed parties intend what the words of their contract say.

Insurance Claims And Statute Of Limitations

May 11, 2024 | Mark S. Humphreys

Insurance lawyers need to read this November 2023, opinion from the Southern District of Texas, McAllen Division. It is styled, Bertha Salinas v. State Farm Lloyds.

The relevant facts are undisputed, Bertha sued State Farm for denying her claim against her homeowners policy due to a weather event on July 26, 2020. State Farm paid some sums of money on the claim but did not pay what Bertha alleges she was owed. On April 16, 2021, State Farm sent a letter explaining it was denying further payment on the claim. Upon receipt of the letter, Bertha invoked the appraisal provision under the policy. State Farm participated in the appraisal but did so under a reservation of rights. In the appraisal process an umpire ultimately ruled against State Farm on March 30, 2023. The attorney for Bertha sent a written inquiry about payment of the appraisal. On June 30, 2023, State Farm stated they would not be paying the appraisal award. State Farm argued about problems with the appraisal. Bertha filed suit on July 18, 2023.

State Farm moved for summary judgment on the case due to the statute of limitations having run on two years after their April 16, 2021, thus, the filing date of July 18, 2023, was too late.

Attorney Fees In Insurance Lawsuits

May 4, 2024 | Mark S. Humphreys

When can a person recover attorney fees in an insurance lawsuit? There is not an easy answer to that question. It is dependent on the facts of the case and the theories of law being alleged against the insurance company.

A 2024 opinion from the Southern District of Texas, Houston Division, addresses this issue when the claim is filed invoking Texas Insurance Code, Section 542A.003(a) and 542A.007(d). The style of this opinion is, Ashley and Walter Burke v. Liberty Mutual Insurance Company.

The Burks (Plaintiffs) filed this action against Liberty for breach of contract, common law bad faith, violations sections 541 of the Texas Insurance Code, and violations of the Texas DTPA. Plaintiffs allege that they sent a presuit letter to Liberty on January 24, 2022, outlining Plaintiffs’ alleged damages and expenses pursuant to Section 542A.003.

Insurance Claims Denial And Statute Of Limitations

November 6, 2023 | Mark S. Humphreys

When is the deadline for filing a law suit against an insurance company that refuses to fully pay on a claim?

This is usually a simple answer. It was the main issue in a 2023 opinion issued by the Fort

Worth Court of Appeals in a case styled, Kenneth Kessler v. Allstate Fire And Casualty Insurance Company.

Bad Faith Lawyer – Statute Of Limitations

July 29, 2023 | Mark S. Humphreys

Insurance lawyers have to understand how the statute of limitations is looked at by the courts. Here is a 2023 opinion from the Fort Worth Court of Appeals. The opinion is styled, Erica Quinn v. State farm Lloyds, et al.

A statute of limitations establishes a time limit for suing in a civil case. A statute of limitations operates as an affirmative defense to a cause of action.

A statute of limitations begins to run on the accrual date, which is the date that the cause of action accrues. Generally, a cause of action accrues when facts giving rise to the cause of action come into existence, even if those facts are not discovered, or the resulting injuries do not occur, until later.

Bad Faith Lawyers – Was There A Settlement Agreement

June 5, 2023 | Mark S. Humphreys

Here is a 2023 opinion from the Northern District of Texas, Dallas Division worth reading when it comes to determining whether the insurer and the insured have reached a settlement agreement. The opinion is styled, Brenda Kirby and Gary Kirby v. State Farm Lloyds’, Evan Kingery, and Kimberly Scholes. The opinion deals with other issues and the facts make a good read along with the legal history. We will focus on whether or not there was a settlement agreement.

After the lawsuit was filed, Defendant’s filed a motion to enforce a settlement agreement. For support, State Farm submitted copies of the above referenced e-mail correspondence exchanged by counsel for the parties on January 18, 21, 24, and February 2, 2022. Defendant contends that this correspondence clearly establishes the formation of a binding agreement to settle the claims asserted in this lawsuit under Texas law.

A district court has inherent power to recognize, encourage, and when necessary enforce settlement agreements reached by the parties. That one party to a suit initially agrees to a settlement but later refuses to execute a formal agreement that recites the terms of the settlement does not preclude a district court from exercising such discretion to enforce a settlement agreement. Further, the issue of whether such withdrawal by one party is allowed under Texas law is irrelevant to whether a settlement is enforceable. Unless the party seeking to withdraw can demonstrate that the agreement is invalid under state law at the time it was made or differs materially from any judgment entered enforcing the agreement, a federal court may hold them to their word by incorporating the terms of their agreement into a final judgment.

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.

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.

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.