Articles Posted in Claims Denial

Life insurance cases.  When is there a settlement?

Here is a 2024 opinion from the Western District of Texas, San Antonio Division that is worth reviewing.  The opinion is styled, Arch Insurance Company v. Rita Candelario.

The opinion does not deal with life insurance specifically, rather it deals with an insurance situation wherein the insurance company believed an agreement had been reached via a Rule 11 agreement.  A proper Texas Rule 11 of Civil Procedure Settlement Agreement is commonly used to memorialize that the respective parties have reached an agreement to settle a case.

Insurance claims usually don’t need an expert to testify but an attorney handling these types of claims needs to know when to hire an expert.  This is illustrated in a 2024 opinion from the Fort Worth Court of Appeals.  The opinion is styled State Farm Lloyds v. John Hilmi.

Hilmi had his home and contents insured by State Farm.  Helms asserts a lightening strike caused almost $200,000 of personal property at his home to be ‘fried”.   State Farm disagreed and this lawsuit was filed against State Farm for breach of contract and violations of the Texas Insurance Code.

A jury trial was conducted and resulted in a favorable verdict for Hilmi.  State Farm appealed and this Court reversed the judgment.  The opinion should be read to get an understanding of the facts and testimony at trial.  What follows is the legal logic.

A claim being denied doesn’t necessarily mean an expert has to be hired in the case.  But when an expert is needed the correct legal process must be followed.  This is illustrated in a 2024 opinion from the Southern District of Texas, Houston Division.  The opinion is styled, Dora Doss Thompson v. State Farm Lloyds.

Insurance usually covers accident that happen or acts of God, negligence, etc., things that are Unintentional.  Policies will rarely cover willful or intentional conduct that causes harm.

The above is illustrated in a 2024 opinion from the Eastern District of Texas, Sherman Division.  The opinion is styled, Jacksonville, Realty, LLC v. Certain Underwriters At Lloyds.

The Plaintiff, Jacksonville, filed a summary judgement seeks the Court to rule that the policy contract had been broken by the Defendant.  The policy at issue is an errors and omissions policy.  Miller Title acted as the escrow agent for a real estate transaction between Jacksonville and IBF Retail I, LLC.  As part of the transaction, IBF deposited $2,750,000 in earnest money with Miller Title.

Cooperating with the your own insurance company when making a claim for policy benefits is almost always a requirement in the policy.  An opinion discussing this was issued by the Tyler Court of Appeals in 2024.  The opinion is styled, Kenneth R. Cade v. State Farm Lloyds.

On April 18, 2019, a windstorm blew a large tree onto a portion of Cade’s house that was insured by State Farm.  Cade eventually made a claim for damage to the structure and contents.  Several inspections were made and payment was made totaling approximately $30,000.  The personal property claim was not made until about 18 months later, claiming several items of personal property were damaged or destroyed.  A lawsuit resulted after State Farm denied paying further damages citing a lack of cooperation by Cade with the claim.  State Farm filed a motion for summary judgement which was granted.

The opinion details many more of the facts and testimony in the case which should be read.  This article will cite the law related to this type of claim.

The duty to cooperate with the insurance company investigation of a claim is something a lot of people don’t realize.  When it is your own insurance company, the insurance contract requires the insured to cooperate with the insurance company investigation of the claim.

This issue was the point of contention in a 2024 opinion from the Southern District of Texas, Houston Division.  The opinion is styled, Raymond Funes v. Allstate Vehicle And Property Insurance Company.

In this case, the facts are generally undisputed.  Plaintiff filed a claim in or around February 2021 for broken pipes at his property that was insured by Defendant.  He withdrew the claim in March 2021, but then retained an attorney and pursued the claim with Defendant in February 2023.  Defendant inspected the property and found that the home had been re-piped.  It requested the plumbing report and or invoice for the re-piping, but Plaintiff failed to oblige.  As such, Defendant denied the request for appraisal for “lack of cooperation by the insured.”  Subsequently, Plaintiff brought this suit.

An insured under an insurance policy has a duty to cooperate with an insurance company investigation of a claim.  This issue is discussed in the 2024 opinion, Henry & Lydia Ansah v. Nationwide Property and Casualty Insurance Company.  The opinion is from the Southern District of Texas, Houston Division.

The Plaintiff’s allege that Nationwide underpaid their property insurance claim.  Nationwide ended up filing a motion for summary judgement arguing the Plaintiffs are not entitled to further coverage because they failed to make the damaged property available for inspection or to document the damages.

A misrepresentation in an insurance application is grounds for denial of a claim but it is not necessarily a win for the insurance company.  This issue is discussed in a recent opinion from the Texas 14th Court of Appeals.  The opinion is styled, Jose Palma v. Allied Trust Insurance Co.

This case was a summary judgment win for the insurance company but there is a clear distinction with this case and the vast majority of cases regarding misrepresentations.

Palma purchased an insurance policy for his home with appellee.  During the policy period, there was a fire at Palma’s home.  Palma submitted an insurance claim under the policy.  Allied investigated and found that Palma had a prior conviction for insurance fraud that was not disclosed on his application for