Interpreting An Insurance Policy

Insurance Policy Interpretation Of “Theft”

October 12, 2010 | Mark S. Humphreys

Policy holders in Grand Prairie, Mansfield, Arlington, Crowley, Grapevine, Hurst, Dallas, Fort Worth, and all across the state of Texas will be amazed at the different ways they can have claims denied based on the langauge in the policy. For instance, what does the term “theft” mean in an insurance policy?

The Fifth Circuit Court of Appeals in Dallas, decided a case on July 2, 2010, where the main issue was the meaning/definition of the word “theft”. The style of the case is, Nautilus Insurance Company v. Francis Steinberg and Morton Rudberg. This case originated in the 95th Judicial District Court, Dallas County, Texas. The opinion in this case was issued by Justice Morris.

Central to this case is the meaning of the word “theft” as used in an insurance policy that excludes “damage caused by or resulting from theft.”

Medical Payments (Med Pay) In Insurance Policies

October 3, 2010 | Mark S. Humphreys

Policy holders in Dallas, Fort Worth, Grand Prairie, Garland, Carrollton, Grapevine, Mansfield, Arlington, Weatherford, or any other place in this state usually do not have a very good understanding of the various benefits they have in their auto policy. In Texas, liability coverage is required to on automobiles traveling on Texas highways. The Texas Department of Insurance also requires that uninsured and underinsured coverage be offered on all auto policies. Personal Injury Protection (PIP) is also a required coverage unless it is rejected in writing.

But what about other types of coverage on an auto policy? Collision, towing, rental, etc. Here is one most people are not aware of: Medical Payments coverage, otherwise known as “med pay.”

Med pay coverage is an optional coverage. Under this coverage, the carrier agrees to pay “reasonable expenses incurred for necessary medical and funeral services because of bodily injury caused by accident and sustained by a covered person.” This insuring agreement uses the term “caused by accident” as opposed to the more specific phrase “auto accident” used in the liability insuring agreement. This coverage defines “covered person” as the named insured or any family member while occupying or being struck by a motor vehicle. Also, any other person occupying the named insured’s covered auto is entitiled to med pay coverage. The coverage for those persons other than family members, however, is limited to occupancy in a covered auto.

When Does “Use” Equal Coverage On An Auto Policy?

September 26, 2010 | Mark S. Humphreys

A guy in Grand Prairie gets his claim denied. Or maybe, it is someone in Arlington, Grapevine, Bedford, De Soto, Duncanville, Burleson, Crowley, or anywhere else in Texas. How do you know if your insurance policy covers a claim. The lawerly answer is: It depends. But here are two things to do. First, read the policy. Second, consult with an experienced Insurance Law Attorney.

Here is a case that talks about coverage in the uninsured motorist context. The case is, Rick Collier v. Employers National Insurance Company. This is a 1993, case, decided by the Court of Appeals of Texas, Fourteenth District, Houston.

The court in this case, denied Collier’s claim that uninsured motorist coverage extended to the facts in this case. Here are the facts.

Insurance Coverage – Policy Language In Liability Policy

September 19, 2010 | Mark S. Humphreys

Even really educated people in Arlington, Dallas, Fort Worth, Grand Prairie, Weatherford, Mesquite, Grapevine, Mansfield, or out in Parker County will sometimes have a hard time understanding when an insurance policy provides coverage and when it doesn’t.

Here is an old insurance law case that is still good law. The case was decided by the Texas Supreme Court in 1979. The style of the case is, Security Mutual Casualty Company v. Herman G. Johnson et al.

Herman Johnson and Timothy Johnson sued their insurer, Security Mutual Casualty Company, to recover the amount of a judgment rendered against Timothy for damages to a pickup truck driven by him. The Texas Supreme Court ruled in favor of the insurance company. Here are the facts and reasons for their decision.

Auto Insurance And Excluded Drivers

September 12, 2010 | Mark S. Humphreys

A question that may be asked by a resident of Grand Prairie, Arlington, Dallas, Mansfield, Irving, Mesquite, Garland, Fort Worth, Duncanville, or other places in Texas might be; What is an “excluded driver?”

An excluded driver is essentially someone who is driving a car without insurance because that person is excluded from coverage by the insurance policy. This usually happens with teenage drivers who the parents have excluded from coverage on the insurance policy to avoid having to pay the higher premiums the teenage driver would cause by being on the policy.

An excluded driver case was decided by the Court of Appeals of Texas, Houston (14th Dist.), on August 12, 2010. The case is styled, Jose A. Perez and Nancy C. Perez v. Old American County Mutual Fire Insurance Company. The courts’ opinion was issued by Justice, Tracy Christopher.

Automobile Insurance Policy

September 11, 2010 | Mark S. Humphreys

Oops! That’s what someone from Aledo, Hurst, Euless, Bedford, De Soto, Dallas, Fort Worth, Grand Prairie, Arlington, and other cities might say when they wait too long to consult with an experienced Insurance Law Attorney. When a claim is denied it is vital that the person who has that claim denied contact an attorney asap.

The Court of Appeals of Texas, El Paso, rendered a decision on August 24, 2010, where it appears the claimant waited too long to make their claim. The style of this case is, Sonia Caballero de Rangel and Eliazar Rangel v. Progressive County Mutual Insurance Company. The opinion is written by Justice, Ann Crawford McClure.

Here are some facts. On October 20, 2001, the Rangels purchased a vehicle. On the same day they obtained insurance coverage from Progressive for the vehicle. On June 3, 2006, the Rangels drove the vehicle to Juarez, Mexico, and it was stolen. Ms Rangel told a claims adjuster that she drove the vehicle to Juarez on a daily basis because her mother cared for her children. When the adjuster asked if she had driven it thirty times to Juarez in the month, Ms Rangel stated, “No, approximately 20 times per month … I would estimate.” Progressive denied the Rangels theft claim based on a provision in the policy excluding coverage if the vehicle was driven into Mexico more than ten times in the thirty day period leading up to the actual date of loss.

Insurance Law / Policies & Exemplary Damages

September 8, 2010 | Mark S. Humphreys

Here is information for people living in Grand Prairie, Arlington, Mansfield, Burleson, Benbrook, Dallas, Fort Worth, and other places in Texas. If has to do with “exemplary damages.”

Exemplary damages, often called punative damages, are damages awarded in a lawsuit when the defendant’s willful acts were malicious, violent, oppressive, fraudulent, wanton, or grossly reckless.

The United States Court of Appeals for the Fifth Circuit ruled in a case on August 27, 2010, that dealt with a exemplary damages and insurance policies. Judge Haynes issued the opinion of the Court. The style of the case is, Darrell D. Minter, As Receiver, v. Great American Insurance Company of New York.

“Total Loss” In An Insurance Policy

September 5, 2010 | Mark S. Humphreys

Unfortunately, at some point a person in Grand Prairie, Arlington, Weatherford, Dallas, Fort Worth, Crowley, Aledo, Benbrook, and other places in Texas will experience a property loss. This loss may be to their home or their car or some other piece of property. The question will then be; Is the property a “total loss” or is it repairable?

BusinessDirectory.com defines total loss as: Destruction of an asset or property to the extent that nothing of value is left, and the item cannot be repaired or rebuilt to its pre-destruction state. It then says, “some types insurance policies pay the maximum covered amount only in case of total loss.” What is important here is how total loss is determined regarding an insurance policy.

A case decided in 1995 is worth looking at to help understand how a “total loss” is determined. The case was decided by the Texas Supreme Court and is styled, State Farm Fire & Casualty Company and State Farm Lloyds v. Ronald and Marilyn Mower.

“Family Member” In Auto Policy

September 2, 2010 | Mark S. Humphreys

If you live in Mansfield, Arlington, Dallas, Fort Worth, Grand Prairie, Hurst, Euless, Bedford, Grapevine, Keller, Colleyville, or anywhere else in Texas, how is “family member” defined in a Texas Insurance Policy?

The answer would seem to be simple on its face, but it is not. If you are having to decide this based on the definition in an automobile insurance policy, here is a “standard” definition in most auto policies:

Family member means a person who is a resident of your household and related to you by blood, marriage or adoption. This definition includes a ward or foster child who is a resident of your household, and also includes your spouse even when not a resident of your household during a period of separation in contemplation of divorce.

Insurance Policy Declarations Page

August 31, 2010 | Mark S. Humphreys

Someone from Dallas, Fort Worth, Mansfield, Arlington, Grand Prairie, Benbrook, Aledo, Burleson, or anywhere else in Texas might ask. What is the declarations page?

One web-site describes the “declarations page”, otherwise known as the “dec page”, very simply as “this page contains the basic terms of coverage. It is an outline of who and what is covered.”

Insurance policies normally contain a declarations page or pages. This page sets forth the identity of the insured, the policy limits, and the duration of coverage, and it identifies the attached policy forms. The main function of the declarations page is to customize the policy for the particular insured and the specific risks covered by the policy. This is set out in the 14th Houston Court of Appeals case, Frazier v. Wallis, decided in 1998. And the San Antonio Court of Appeals case, Ortiz v. State Farm Mutual Automobile Insurance Company, in 1997.