Interpreting An Insurance Policy

Who Is Insured Under The Policy

October 27, 2011 | Mark S. Humphreys

Policy purchasers in Grand Prairie, Arlington, Irving, Fort Worth, Crowley, Hurst, Euless, Bedford, Mansfield, Dallas, and other places in Texas would like to think they know who is covered under a policy they purchase. What is surprising is the difference between what the policy purchaser thinks and what the insurance company thinks.

A 1972, Texas Supreme Court case styled, Robert Snyder, et al. v. Allstate Insurance Company, is an interesting case. Here is a little bit about it.

The controversy is between Allstate, which issued an auto policy to J.B. Rhodes about whether or not they should pay damages arising out of a claim in the possession of and used by Darla Rhodes (minor daughter of J.B.) while being driven by Robert Snyder with Darla Rhodes as a passenger.

Coverage Under An Auto Policy; Family Member Exclusions

October 25, 2011 | Mark S. Humphreys

Insured’s in Weatherford, Mineral Wells, Aledo, Willow Park, Hudson Oaks, Azle, Brock, Millsap, Springtown, Cool, Peaster, and other places in Parker County would be confused when trying to figure out some aspects of coverage as it relates to auto insurance policy’s. The meaning of “Family Member” in a policy might sound pretty easy at first glance, but looking at individual situations makes it not so easy. What about when people just filed for divorce, are separated, not married but living together, away at college or trade school? Are they a “Family Member?” Here is a different look:

The Houston Court of Appeals, First District, issued an opinion in 1996, that is interesting. The style of the case is, State Farm Mutual Automobile Ins. Co. v. Ms. Hanh Thi Dinh Nguyen, and Dr. Bay Van Nguyen, Individually and as Next Friend of His Deceased Infant Daughter.

This appeal is from a summary judgment hearing wherein the court had to decide whether the child in the case, whose entire six-day life was spent in a hospital, was a “resident” of the insured’s household.

Insurance – Resident Of The Same Household – Divorce

October 20, 2011 | Mark S. Humphreys

Insured’s in Grand Prairie, Irving, Garland, Mesquite, Dallas, Carrollton, Richardson, Duncanville, De Soto, and other places in Dallas County might have a hard time believing some of the reasons an insurance company will use for denying a claim. Here is one they tried but it did not work regarding the child of divorced parents.

The case was decided by the Texarkana Court of Appeals in 1978. The style of the case is, Hartford Casualty Insurance Company v. Barbara Smith Phillips, Individually and as Personal Representative of the Estate of Jerry Glenn Phillips.

This case involves the question of coverage under the uninsured motorist provisions of a policy of automobile liability insurance. Barbara Phillips was the named insured and sought recovery of damages for bodily injuries sustained by her son, Jerry Glenn Phillips, as a result of an accident caused by an uninsured motorist. At trial, the jury found that Jerry was a “resident of the same household” as Barbara. Hartford contended that Jerry was not such a resident as a matter of law; that there is no evidence to support the jury finding; that there was insufficient evidence to support such finding; and that such finding was so against the great weight and preponderance of the evidence as to be manifestly wrong and unjust.

Residents Of The Same Household

October 18, 2011 | Mark S. Humphreys

Insureds in Grand Prairie, Arlington, Fort Worth, North Richland Hills, Hurst, Euless, Bedford, Dalworthington Gardens, Lake Worth, Crowley, or anywhere else in Tarrant County may wonder when a person is determined to be a member of the household for insurance purposes under an insurance policy. Guidance to an answer of that question was provided in a case in 1977.

The style of the case is, Southern Farm Bureau Casualty Insurance Company v. Kenneth C. Kimball et al. The opinion was issued by the Waco Court of Appeals.

Kenneth Kimball was the named insured under a policy issued by Southern Farm Bureau Casualty Insurance Company. Kenneth’s wife, Connie was killed in an automobile accident with an uninsured motorist when the policy was in force. At the time of her death, she and Kenneth were separated, living in separate residences, and a divorce action by her was pending. Farm bureau filed a declaratory judgment as to its responsibilities under the policy for uninsured motorist protection benefits, personal injury benefits, and death indemnity benefits. On the trial, under stipulated facts, the only issue raised by the parties was whether Connie and Kenneth were “residents of the same household,” as that term is used in the policy, at the time of Connie’s death.

Flood Insurance Coverage

October 16, 2011 | Mark S. Humphreys

Whether you live in Weatherford, Mineral Wells, Aledo, Willow Park, Hudson Oaks, Peaster, Millsap, Brock, Springtown, Azle, Cool, or anywhere else in Parker County, there are odds that you may be subject to suffering a loss from flood damage. A natural question would be, “How does flood insurance work?”

Because most property insurance policies covering property at fixed locations exclude flooding, flood insurance must be purchased separately. In 1969, Congress created the National Flood Insurance Program to administer the sale of flood insurance. National flood insurance is available directly from the Federal Insurance Administration or through hundreds of private insurers who participate in federal flood insurance programs. The Federal Emergency Management Agency (FEMA) reinsures private companies against flood losses.

Flood insurance premiums are calculated based upon geographic maps setting forth the boundaries for various flood zones.

Replacement Cost In Insurance Policy

October 15, 2011 | Mark S. Humphreys

People in Grand Prairie, Arlington, Mansfield, Fort Worth, North Richland Hills, Saginaw, Keller, Roanoke, and other places in the Tarrant County area and Texas would want to know how their insurance policy pays for their property that is damaged in a loss that is covered by the policy.

A 1998, Austin Court of Appeals case helps us understand how some losses are calculated and paid. The case is styled, Great Texas County Mutual Insurance Co. v. Emmett C. Lewis. This is an appeal from the trial court finding in favor of Lewis.

The facts are undisputed. While covered by a policy issued by Great Texas, Lewis’s 1989 Dodge Caravan car sustained damage to the engine. The car had 110,000 miles on it. Great Texas inspected the car and calculated the cost of repairs to be $3,608.27. which included the cost of a re-manufactured engine, replacement parts, and labor. From the $3,608.27, Great Texas subtracted the policy deductible of $527 and $2,031.72 for betterment or depreciation, leaving a net sum of $1,049.55. Great Texas offered Lewis that sum to discharge the obligation under the policy.

Lender-Placed Policies

September 22, 2011 | Mark S. Humphreys

On occasion someone in Grand Prairie, Arlington, Fort Worth, Dallas, Mansfield, De Soto, Duncanville, Cedar Hill, Irving, or some where else in North Texas will find themselves in a situation where they have lender-placed insurance on their property. This is also sometimes called forced-placed insurance.

These types of insurance usually are the result of a borrower, who has a contractual obligation to keep certain property insured, fails to do so. When this happens the lender purchases insurance and applies the cost of the insurance to the loan. The big problem for these types of insurance is that the insurance is for the benefit of the lender, not the borrower.

The United States District Court, Southern District of Texas, Houston Division issued an opinion on August 16, 2011, in a case dealing with lender-placed insurance. The Judge was Judge Kenneth M. Hoyt. The style of the case is, Horacio Barrios, et al. v. Great American Assurance Company, et al.

Who Is The Named Insured

September 17, 2011 | Mark S. Humphreys

People who buy insurance in Grand Prairie, Arlington, Fort Worth, Mansfield, Hurst, Euless, Bedford, Grapevine, Mesquite, Richardson, and other places in the DFW metroplex area need to make sure the named insured on an insurance policy is the person or business who needs to be covered by the policy.

A 1991, case decided by the Houston 14th, Court of Appeals, serves as an example of making sure the correct person or entity is named on the insurance policy. The style of the case is, St. Paul Lloyd’s Insurance Company v. Fong Chun Huang, Individually and as Trustee for Teppan Yaki Management. Here is some background information to know on the case.

St Paul’s denied coverage under its insurance policy claiming Fong Chun Huang was responsible for the burning of the Happy Buddha Restaurant. Fong sued St. Paul’s for failure to pay on the policy and for breach of the duty of good faith and fair dealing. The trial court awarded damages to Fong for the cash value under the insurance policy. The trial court further reformed the insurance policy to change the named insured from Fong Chun Huang, individually, to Teppan Yaki Management, Inc., which was the apparent true owner of the restaurant.

Policy Interpretation

September 11, 2011 | Mark S. Humphreys

Grand Prairie, Weatherford, Fort Worth, Dallas, Arlington, and other business people in Texas need to understand what the insurance policy they have purchased covers, and what it does not cover.

The United States District Court, Northern District, Dallas Division, issued an opinion on July 27, 2011, in the case styled, Great American Insurance Company v. AFS/IBEX Financial Services, Inc., that would be interesting for these business people. The Judge in this case is Reed O’Conner. Here is some background.

This case arises out of a dispute over insurance coverage. AFS entered into an agreement with McMahon Sr., the owner of Charles McMahon Insurance Agency, authorizing McMahon Sr. to originate, create, and sign premium fiance agreements on behalf of insureds. AFS sought insurance coverage from Great American Insurance Company (GAIC) to protect it from crime risks. GAIC sold AFS two applicable policies.

Homeowners Policy And Examination Under Oath

September 6, 2011 | Mark S. Humphreys

People in Grand Prairie, Dallas, Fort Worth, Arlington, Richardson, Garland, Duncanville, De Soto, Irving, Mesquite, and other places in Texas, who have a homeowners insurance policy, probably know they are suppose to pay their premiums. Beyond paying those premiums, most people do not understand what other obligations they have as part of the policy.

One of the obligations most insureds have under a homeowners policy is to submit to an examination under oath (EUO) if requested by the insurance company. A 2005, case out of the Beaumont Court of Appeals discusses this obligation. The style of the case is, In re Foremost County Mutual Insurance Company and Jim Doland. Here is some information on the case.

It is a mandamus proceeding arising out of Foremost’s denial of a fire loss claim. The claim was denied after the insured, Kenneth Whitney, refused to submit to an EUO. Foremost sought an abatement of the lawsuit filed by Whitney until he had complied with the policy requirement of submitting to an EUO. The trial court refused Foremost’s request and the mandamus proceeding resulted.