Articles Posted in Claims Refusal

Insurance lawyers should understand the interaction between the Texas Insurance Code and the Texas Deceptive Trade Practices Act (DTPA).

Texas Insurance Code, Section 541.151(2) cross references and prohibits conduct defined in Section 17.46(b) of the DTPA.  The DTPA statute applies to all types of consumer transactions, not just insurance, so many of the provisions are not directly relevant.  The most relevant subsections prohibit:

DTPA, Section 17.46(b)(2) –  causing confusion or misunderstanding as to the source , sponsorship, approval, or certification of goods or services,

There are deadlines for filing lawsuits and if those time limits are not honored, then there is no case.  This is illustrated in a Southern District, Houston Division, opinion released on July 2, 2019.  The case is styled, Nancy Roberson v. Allstate Vehicle and Property Insurance Company.

Roberson sued Allstate in state court asserting causes of action for breach of contract, violations of the Texas Insurance Code, violations of the Texas Deceptive Trade Practices Act, (DTPA) and common law fraud.  Allstate timely removed the case to federal court.  Allstate then filed a Rule 12(b)(6) Motion to Dismiss.

The background in this case is that Roberson had Allstate coverage for her home when in February 2016, she filed a claim for hail damage.  An adjuster determined that her roof was in great condition and that her loss was below her deductible.

Here is a case from the Northern District of Texas, Fort Worth Division, wherein the dates of the alleged damage incurred because of hail, is in dispute.  The style of the case is, LTG & Associates, Inc. v. Monroe Indemnity Insurance Company.

This is a summary judgment case granted in favor of Monroe.

LTG owns several properties that are insured by Monroe.  LTG alleges that on or about April 1, 2015, and March 23, 2016, the properties suffered damage due to a severe hail and windstorm.  The storm is alleged to  have caused incredible damage.  LTG further claims that Monroe hired adjustors for both storms to provide biased engineering reports so that it could deny coverage.  It is also alleged that on both occasions the adjustors wrongfully and intentionally ignored objective evidence of the wind and hail storm.

Renter’s insurance claims are not really much different than a homeowners claim.  But one distinction that sometimes appears is the language in a renter’s policy will often times shorten the statute of limitations.  This is seen in the 2018, San Antonio Court of Appeals opinion styled, Terry Granger v. The Travelers Home And Marine Insurance Co.

This is a summary judgment case rendered in favor of Travelers and affirmed on this appeal.  The relevant policy language reads:

9. Suit Against Us.  No suit or action can be brought against us unless there has been full compliance with all of the terms under Section I of this policy. Action

For Insurance Law Attorneys there are two other aspects that are important in the case. 1) opposing counsel and 2) your client.

The relationship with the insurance company lawyer makes a difference as far as how smoothly the case is processed.  Most of the lawyers involved on both sides in first-party insurance cases will have dealt with each other in other cases.

One way of making the case proceed more smoothly for both of you and your clients is getting on the phone and talking to the lawyer.   This happens less with the use of email communications but talking on the phone is much more productive and a good way to work out disputes without having a Judge work it out for you.  Getting in front of a Judge is going to cost more money and there is no assurance of the result.

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.

Knowing the statute of limitations on a case is vital.  This is illustrated in a 2018, Southern District of Texas, Houston Division opinion styled, Lillian Smith v. Travelers Casualty Insurance Company of America.

Smith sued Travelers for violations of the Texas Deceptive Trade Practices Act (DTPS), Texas Insurance Code violations, and breach of contract.  Travelers filed a motion for summary judgment based on the statute of limitations.

The allegations in the case are that a lightening strike caused damage to Smith’s home and air conditioner.  The claim was reported on September 5, 2013, and acknowledged on September 7, 2013.  An investigation was conducted in September and October of 2013.  Travelers issued a denial letter on November 13, 2013.

The wrongs committed by insurance companies would surprise most people.  A person pays his premiums and maybe has friendly conversation with their agent and they figure that when they make a claim, the claim will be properly paid.  While most insurance claims are handled without the need for lawyers to be involved, there are too many instances of the insurance company trying to work against they insured/customer.

This is illustrated in an article from Argus Leader.  The article is titled “Lawsuit Accuses Doctor Of Bias In Denying Injury Claim.”

The article tells us a woman who suffered a debilitating neck injury while at work has accused an insurance company who denied her benefits of hiring a doctor that it knew would dispute her injury claim.

Here is another case looking at experts in insurance cases.  The case is from the Eastern District, Sherman Division, and is styled, La Verdure & Associates v. Depositors Insurance Company.

Plaintiff, La Verdure filed suit against Depositors for alleged violations of the Texas Insurance Code, the DTPA, and breach of contract.  A Scheduling Order was entered into which set a deadline of March 24, 2017, for naming expert witnesses.

Plaintiff named its experts on April 7, 2017.  On May 19, Defendant filed its Motion to Strike or Limit Expert Testimony.  Plaintiff filed its Motion for Leave to Amend Designation of Expert Witnesses.

The above question is usually not easy to answer.  Aledo insurance lawyers need to read a 1976 case from the Waco Court of Appeals.  The opinion is styled, Westchester Fire Insurance Co. v. English.

Posing as husband and wife when in fact they were not married, a couple purchased a house and at closing, also purchased home owners insurance coverage.  The house burned down three months later.  After the fire, the Westchester learned for the first time that the couple were not married.

The policy provides in part that it ‘shall be void if, whether before or after a loss, the insured has willfully concealed or misrepresented any material fact or circumstance concerning this insurance, or the subject thereof, or the interest of the insured therein, or in case of any fraud or false swearing by the insured relating thereto.’

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