Articles Posted in Intentional Acts

Garland insurance attorneys need to understand when coverage under an insurance policy is going to be provided and when it is not, due to the intent of the policyholder. A 1998, Amarillo Court of Appeals case is a good case to examine in helping to determine this issue. The style of the case is, Spruiell v. Lincoln Insurance Company. Here is some of the relevant information from that opinion.

McKean was a business person who leased a premises from Smith in which McKean operated the Tumbleweed Cafe. Spruiell’s Automotive shared an adjoining firewall with the cafe. Fire destroyed the cafe, heavily damaged Spruiell’s Automotive, severely burned McKean and killed McKean’s brother-in-law. McKean pleaded guilty to first degree arson and was sentenced to sixteen years in prison.

Spruiell subsequently filed a lawsuit against McKean and Smith alleging negligence in causing the fire and res ipsa loquitur, and seeking damages for the loss of personal property and equipment as a result of the fire.

Dallas insurance attorneys look for cases where they can be a “knowing” violation has been committed by an insurance agent or adjuster. A 1998, Texas Supreme Court opinion helps an attorney understand some of the ways courts look at “knowingly” allegations. The style of the case is, St. Paul Surplus Lines Insurance v. Dal-Worth Tank Co. Here is some of the relevant information.

Mission Butane Gas Co., a customer of Dal-Worth, notified Dal-Worth that it intended to sue Dal-Worth for several thousand dollars in damages caused when trucks it had bought from Dal-Worth had rolled over. Dal-Worth sent this notice to St. Paul and St. Paul opened a claim file. Mission’s insurer also contacted Dal-Worth. St. Paul concluded that Dal-Worth was not liable and refused to pay. Mission sued Dal-Worth. Evidence showed these lawsuit papers were forwarded to St. Paul. St. Paul heard conflicting accounts about the lawsuit papers from Missions insurer.

Dal-Worth did not answer Mission’s lawsuit and Mission obtained a default judgment in the amount of $794,100. Dal-Worth received a copy of the judgment but did not realize it’s significance and did not sent it to St. Paul. St. Paul did not hear of the judgment until 78 days after it was signed. Mission would have settled the claim at this point for $17,000, but no settlement offers were made. Four weeks later, St. Paul denied coverage, but offered to pay an attorney to handle an appeal for Dal-Worth, which Dal-Worth accepted. St. Paul refused to supersede the judgment and Dal-Worth was forced into bankruptcy.

Attorneys in Weatherford who handle insurance claims need to be aware of the exclusions that apply to home owners policy. One of those exclusions is an exclusion for intentional acts. The courts have interpreted sexual molestation to be an intentional act as a matter of law. The 1996, Houston Court of Appeals case, J.E.M. v. Fidelity & Casualty Company is the case to know about. Here is some of the relevant information.

Fidelity issued a standard homeowner’s policy to the home owners. The policy included coverage for personal liability, but excluded coverage for bodily injury or property damage caused intentionally by or at the direction of the insured or to sickness or disease transmitted through sexual contact.

J.E.M. and S.J.B. sued the home owners. The petition alleges that James B. sexually abused his stepdaughter, J.E.M., in 1977, 1978, and 1979. The petition also alleges that James B. sexually abused his step-grandson, J.B., Jr., during December 1990, and that the sexual abuse was “either intentional torts or the result of uncontrolled sexual urges brought about by an underlying psychosexual disorder.” The petition states that James B. “was negligent in failing to inform other responsible adults of his conduct, in failing to seek professional held, and in continuing to allow himself to be alone with his stepdaughter and step-grandson.”

Insurance lawyers in the Dallas and Fort Worth area need to have an understanding as to intentional acts that are not covered under an insurance policy. Many times the only way to actually recover money for a clients injuries such as medical bills, lost wages, pain, etc. is to have an insurance policy to recover under. Being aware of this Houston Court of Appeals [14th Dist.] case is important. It is a 1992 case styled, Bonner v. United Services Automobile Association. Here is some relevant information.

This is an appeal from a take nothing judgment in favor of United Services Automobile Association (USAA). The issue involved is whether a Texas Homeowner’s Insurance Policy issued by USAA to Gloria Padgett provided liability coverage to her son, Roger Padgett, for damages for the death of Roger’s girlfriend, Linda Tarrant, or whether there was no coverage for such death because of specific exclusions contained in the policy.

The insurance policy involved in this case is a Texas Standard Homeowners Policy issued by USAA to Gloria C. Padgett, mother of Roger Padgett. The premises covered by the policy is defined as a dwelling located at Route 3, Box 5388, Canyon Lake, Comal County, Texas. The Liability Section of the policy provides under coverage D that USAA will pay on behalf of the Insured all sums which the Insured shall become legally obligated to pay as damages because of bodily injury. That same Liability Section of the policy also contains the following exclusion:

Palo Pinto County insurance lawyers will need to be aware of this case from the Dallas Court of Appeals. It is a 1997, case styled, Wessinger v. Fire Insurance Exchange. Here is some of the relevant information.

Morrison initially sued Wessinger in a Dallas County district court, alleging that Wessinger negligently caused him injury when, in a drunken fit, Wessinger punched Morrison repeatedly in the head. A jury found Wessinger liable and awarded Morrison $127,187 in damages.

Fire Insurance Exchange, Wessinger’s homeowner’s insurance company, then filed this declaratory judgment action challenging coverage for the incident made the basis of Morrison’s original lawsuit.

Dallas insurance lawyers need to know that when an insurance company breaks the contract it has with it’s insured, that is not enough by itself to support a claim for bad faith insurance. The 1988, Beaumont Court of Appeals case, Gulf States Underwriters v. Wilson, states this very clearly. Here is some of the relevant information from that case.

Wilson entered into an insurance contract with Gulf States effective June 29, 1979, and initially paid $85. This case has as its basis a dispute between Wilson and the insurance company over how this $85 should be classified: as a “deposit” against future premium shortfalls (according to Gulf States) or as a premium paid in advance (according to Wilson). The regular monthly premium was to be based on a percentage of cords of pulpwood Wilson’s employer produced each month. In late April 1982, Wilson paid $419 premium. Gulf States applied this payment to Wilson’s coverage from March 28, 1982, through April 29, 1982. Wilson was subsequently injured on May 1, 1982. On May 10, 1982, Gulf States mailed Wilson a notice of intention not to renew his policy. Wilson did not pay a premium on the next due date at the end of May. According to Gulf States, the letter did not actually cancel the policy, but rather, the policy lapsed for non-payment of the premium due at the end of May.

Gulf States theory at trial was that Wilson’s first payment of $85 was not the first month’s premium, but merely a “deposit” which was consideration for issuing the policy but did not effect coverage for any period of time. Following this logic, the first premium was not paid until the end of July 1979. That premium would apply retrospectively for coverage during July 1979. Gulf States thus maintains that the payment at the end of April 1982 was for insurance coverage during the month of April 1982. And, since Wilson paid no premium at the end of May, the policy lapsed as of the end of April 1982, so the injury on May 1, 1982, was not covered.

Dallas insurance attorneys need to be able to answer the above question in the context of an insurance policy. A 1997, Texas Supreme Court case provides some guidance for the question. The style of the case is, Farmers Texas County Mutual Insurance Company v. Griffin. Here is some of the relevant information.

This is a declaratory judgment action. Farmers sought a declaration that it had no duty to defend or indemnify its insured, James Royal III, in a suit brought by Robert Griffin. The trial court granted summary judgment for Farmers. This Court affirmed the judgment for Farmers.

Gunshots from a passing vehicle hit and injured Robert Griffin as he walked down the street in Beaumont, Texas. Griffin sued the driver of the vehicle, James Royal III, and others for negligence and gross negligence resulting in injury to his right leg. Griffin alleged that Royal drove the vehicle while his two passengers fired the shots. Royal invoked Farmers’ duty to defend him under his personal automobile liability insurance policy. Farmers defended Royal subject to a reservation of rights and then filed this declaratory judgment action to challenge its duty to defend and indemnify Royal.

Weatherford insurance attorneys know that most insurance policies are going to exclude coverage for intentional acts. A 1997, Texas Supreme Court case makes this clear. The style of the case is Farmers Texas County Mutual Insurance Company v. Griffin. Here is some of the relevant information.

This is a declaratory judgment action. Farmers sought a declaration that it had no duty to defend or indemnify its insured, James Royal III, in a suit brought by Robert Griffin. The trial court granted summary judgment for Farmers. This court held that, under the facts alleged against Royal, Farmers had no duty to defend Royal in the underlying suit.

On October 22, 1991, gunshots from a passing vehicle hit and injured Robert Griffin as he walked down the street. Griffin sued the driver of the vehicle, James Royal III, and others for negligence and gross negligence resulting in injury to his right leg. Griffin alleged that Royal drove the vehicle while his two passengers fired the shots. Royal invoked Farmers’ duty to defend him under his personal automobile liability insurance policy. Farmers defended Royal subject to a reservation of rights and then filed this declaratory judgment action to challenge its duty to defend and indemnify Royal.

Insurance lawyers in Fort Worth, Arlington, Hurst, Euless, Bedford, Lake Worth, Saginaw, and other places in Tarrant County need to be tuned in to what looks like or constitutes insurance fraud. The Texas Penal Code, Chapter 35 deals with insurance fraud in the State of Texas. Also the Texas Department of Insurance has information that may be helpful for learning more about it.

The Associated Press ran an article in August 2012, that dealt with an example of insurance fraud:

The article tells us that a man who reported his father missing at a beach in New York was charged with insurance fraud and filing a false report several days after his father turned up alive in the State of South Carolina. This was following a massive air and water search that cost tens of thousands of dollars.

Grand Prairie insurance attorneys and those in Dallas, Fort Worth, Mansfield, Irving, De Soto, Cedar Hill, Arlington, and other places in the Dallas / Fort Worth metroplex need to know how to evaluate a case. There will be those times when a person may be trying to commit insurance fraud. An attorney needs to know the penalties associated with such efforts.

The Insurance Journal ran an article dealing with new penalties enacted in the State of Alabama. Here is most of the article:

A number of recently enacted laws in Alabama concerning property-casualty insurance became effective on August 1.