Interpreting An Insurance Policy

When Your Own Insurance Finds You At Fault

April 30, 2016 | Mark S. Humphreys

Farmers Branch insurance lawyers will have a client walk in and say that their own insurance company has found them at fault for an accident and paid the other party. What can be done? A Dallas Court of Appeals case gives some insight. The style of the case is, Van K. Martin v. State Farm Mutual Automobile Insurance Company.

This is an appeal from a declaratory judgment action and an appeal from an adverse finding in a summary judgment.

Martin’s son was involved in an auto accident with another State Farm insured, Jeffery Lonsdale. No one was injured in the accident, but Lonsdale filed a claim for property damage, which was submitted to State Farm under Part A of Martin’s liability policy. Martin filed a claim for property damage to his vehicle under Part D of the policy. State Farm settled Lonsdale’s claim and provided coverage for the property damage to Martin’s vehicle. Martin alleges that State Farm unreasonably concluded his son was primarily responsible for the accident without interviewing Martin’s son or other witnesses in the car. Martin alleges he paid the deductible to have his vehicle repaired and paid “incremental semi-annual premiums” related to the accident.

Making Home Owner Claims

March 20, 2016 | Mark S. Humphreys

Homeowner insurance policies can be difficult to interpret when it comes time to make a claim for benefits. This 5th Circuit Court of Appeals opinion provides some insight into how the courts review and interpret insurance policies. The case is styled Claudia Ayoub; Gerald C. Ayoub v. Chubb Lloyds Insurance Company of Texas.

The principal question presented in this dispute over a homeowner’s insurance policy is whether a section of the policy setting forth a “reconstruction cost less depreciation” standard for dwelling loss is a coverage provision, on which the insured has the burden of proof, or a limitation of liability provision, on which the insurer has the burden. The court also had to decide how insureds can prove market value under Texas law for personal items which may have no such thing. For the reasons discussed below, the court found that summary judgment in favor of the insurer was not warranted on either issue.

The Ayoubs’ own a home in El Paso. Prior to the loss in this case, it was worth in the neighborhood of $2 million. The home was insured under a “Texas Standard Homeowners Policy” issued by Chubb. Coverage A of the Policy insured the dwelling for up to $2,511,000. Coverage B insured personal property in the home for up to $1,506,600. At additional cost, the Ayoubs purchased replacement cost endorsements for both their dwelling and personal property.

Anti-Concurrent-Causation Exclusions

February 9, 2016 | Mark S. Humphreys

Hail claims lawyers need to read the Texas Supreme Court opinion styled, JAW The Point, L.L.C. v. Lexington Insurance Company. This is a 2015, opinion that is relevant to most hail damage claims, as well as lots of other claims. The case is written about in the State Bar of Texas Insurance Journal It is hard to believe that this case is the Texas Supreme Court’s first occasion to address the proper application of the so-called “anti-concurrent-causation” (the “ACC”) exclusion, which in this case bars coverage for:

loss or damage caused directly or indirectlyby any [excluded cause or event], regardless

of any other cause or event that contributes concurrently or in any sequence to the loss.

Concurrent Causation Clauses

January 5, 2016 | Mark S. Humphreys

Attorneys handling hail damage claims need to read this case. It is a 2015, Texas Supreme Court opinion styled, JAW The Point, L.L.C. v. Lexington Insurance Co.

In this case, the “anti-concurrent causation” (ACC) exclusion reads:

loss or damage caused directly or indirectly by any [excluded cause or event], regardless of any other cause or event that contributes concurrently or in any sequence to the loss.

Interpreting Appraisal Clause

December 22, 2015 | Mark S. Humphreys

Mineral Wells insurance lawyers are aware of appraisal clauses in insurance contracts. Interpreting them is not always easy. The Amarillo Court of Appeals issued an opinion in a 2015 case that needs to be read. It is styled, In Re Century Surety Company.

This is a mandamus proceeding that arises from a lawsuit by an insured, Jefferson, against Century.

The lawsuit filed on December 16, 2013, arises out of a claim submitted for hail damage which occurred on May 28, 2013, alleging breach of contract and extra-contractual claims. A lawsuit was filed suing Century, an adjusting company, and two individuals.

Liability Claims

December 10, 2015 | Mark S. Humphreys

Insurance lawyers need to recognize when coverage will be provided in cases when an insured is being accused of being liable for harm caused to a third party. A 1988, Texas Supreme Court case is insightful to this issue. The style of the case is, Adela Snellberger v Rosita Hernandez.

This is an appeal in a wrongful death action brought by the heirs of Harold Snellenberger against Rosita Hernandez Rodriguez. The trial court granted a summary judgment for Rodriguez. This Court affirmed that finding.

Rodriguez drove her automobile over and critically injured a small child. At the time of the accident, Snellenberger was employed as a police officer. When he and another officer were notified of the accident, they immediately proceeded to the scene in their separate patrol cars. Upon arrival, the other officer administered CPR to the child, while officer Snellenberger moved back the crowd of people which had gathered at the scene. Included in the crowd was the grief-stricken mother of the injured child. As officer Snellenberger began controlling the crowd, he suddenly collapsed and later died of a heart attack. His widow and children brought this action relying upon the rescue doctrine.

Insurance Policy Language

December 8, 2015 | Mark S. Humphreys

Dallas insurance lawyers can tell a client that one of the most important things to do when looking at an insurance claim is to read the policy. What the policy says, coupled with the facts of the claim, go a long way in determining whether or not a claim should be paid. The Texas Supreme Court issued an opinion in 2015, that is a must read for insurance law attorneys. The case is styled, RSUI Indemnity Company v. Lynd Company.

This claim involves two insurance companies, RSUI which provided excess coverage and Westchester Fire Insurance Company which provided a $20 million dollar limit. The total loss was $24.5 million spread over several properties owned by Lynd. The parties agreed that the loss was from a loss from a single occurrence. Westchester paid it’s $20 million dollar limit but RSUI refused to pay the remaining $4.5 million and instead paid Lynd only $750,000.

RSUI cited the excess policy’s “Scheduled Limit of Liability” endorsement as the basis for its denial of coverage. Lynd sued RSUI to recover the difference between its $24.5 million in losses and the $20,750,000 Westchester and RSUI paid out under the policies. As a result, the question of whether coverage existed under the excess policy depended on the interpretation of the “Scheduled Limit of Liability” endorsement.

Put Names On Those Beneficiary Forms Or Else

December 6, 2015 | Mark S. Humphreys

Springtown life insurance lawyers would want to know about an opinion from a Florida Court dealing with beneficiaries under a life insurance policy. The Court looked at the law in Florida at issue and then looked at the language of the policy and issued a ruling that many would disagree with. The opinion is discussed at WealthManagement.com. The article is titled, When Is An Adoption Not Effective To Change Inheritance Rights?

In a case styled Lubin v. AT&T Ret. Sav. Plan (2015 WL 4397703), an adoption was not given effect in determining who would receive the life insurance benefits at issue.

In this case, Austin Hardy participated in a Retirement Savings Plan (“Plan”), which included a life insurance benefit. At his death, he was survived by his sisters, Pauline Lubin and Frances Koryn (Plaintiffs), and his biological daughter, Jennifer Krokey. Although Krokey was Hardy’s biological child, she had been subsequently adopted by a step-father. Under Florida law, a child who is adopted is the child of the adopting parent and ceases to be a child of the biological parent for all purposes.

Actual Cash Value versus Replacement Value

November 29, 2015 | Mark S. Humphreys

Insurance lawyers in Parker County need to read a Houston Court of Appeals [1st Dist.] opinion issued in October 2105. It is styled, John Davis D/B/A J. D. House of Style v. National Lloyds Insurance Company.

This is an appeal by Davis from a Judge’s ruling on a JNOV in favor of National.

The court submitted two measures of damages to the jury, and the jury determined that Davis sustained $0 damages based on the actual cash value of the property claim and that he sustained $100,000 in damages based on the replacement value of the property claim. National Lloyds moved to disregard the replacement value finding, arguing, in part, that the plain language of the policy itself limited Davis to recovery for the actual cash value of his property damage claim.

Concurrent Causation Clauses

November 26, 2015 | Mark S. Humphreys

Dallas area insurance attorneys are most likely to see insurance companies argue “concurrent causation” in claims related to homeowners policies. The Claims Journal published an article discussing this topic in October of 2015. The title of the article is “Texas Supreme Court Upholds Anti-Concurrent-Causation Clauses In Property Policies.”

The article tells us the Texas Supreme Court in JAW the Point, LLC v. Lexington Ins. Co., 460 S.W.3d 597 (Tex. 2015) held, on first impression, that losses incurred in demolishing and rebuilding property damage resulting from Hurricane Ike to comply with city ordinances were excluded under the policy’s anti-concurrent-causation clause. Prior to the Texas Supreme Court’s JAW decision, federal and lower state courts of appeal had interpreted and upheld the applicability of anti-concurrent-causation clauses under Texas law.

Taking its lead from the United States Circuit Court of Appeals for the Fifth Circuit, the Texas Supreme Court held that a policy anti-concurrent-causation clause together with an exclusion for losses caused by flood, when read together, excluded from coverage any damage caused by a combination of wind and water. Previously, the Fifth Circuit Court of Appeals in Leonard v. Nationwide Mut. Ins. Co., had concluded in situations involving combinations of covered wind damage and excluded flood damage that the only species covered under a policy with an anti-concurrent-causation clause is damage caused exclusively by wind. But when wind and water synergistically cause the same damage, such damage is excluded.