Dallas Fort Worth Insurance Lawyer Blog

Total Disability

January 28, 2014 | Mark S. Humphreys

Aledo insurance attorneys need to know how the court interpret “total disability” in an insurance policy. The 1961, Texas Supreme Court case styled, Prudential Insurance Company of America v. Tate is a good case to read for understanding. Here is some of the relevant information.

This policy provided for certain benefits to be paid to Tate in the event he was disabled before reaching the age of 60 years. It was stipulated that Tate was under 60 years of age at the time he claimed he became totally and permanently disabled. Upon answer to special issues in favor of Tate by the trial jury, the trial court granted Tate’s motion for judgment on the verdict for the sum of $2,922, due under the terms of the policy, and $350.64 as 12% penalty provided by statute for failure of Prudential to pay upon demand by Tate.

This court held that the lower courts were in error in determining the amount due under the terms of the policy and reversed the judgments of both lower courts and remand the cause to the trial court.

Denials – Don’t Wait To File A Lawsuit

January 26, 2014 | Mark S. Humphreys

Arlington insurance lawyers know it is a mistake when a lawsuit is not filed asap after a claim is denied. A 1998, Corpus Christi Court of Appeals case illustrates this well. The style of the case is, Pena v. State Farm Lloyds.

This is an appeal from a summary judgment. Here is some relevant information.

The Penas purchased their home in July 1989. The single-story house was built in 1939 with a pier-and-beam foundation system, and a basement. The home’s hardwood floor was installed in 1939 without sub-flooring or a vapor barrier. In 1987, the then-owner, Ward Thomas, Jr., added a bathroom to the master bedroom at the rear of the house. The bathroom sits on a concrete slab foundation. Thomas never experienced any problems with the foundation or plumbing. After purchasing the home, the Penas obtained homeowner’s insurance coverage from State Farm.

Property And Casualty Insurance Bills

January 25, 2014 | Mark S. Humphreys

Burleson insurance attorneys and all insurance attorneys need to keep up with the law related to insurance. The Insurance Journal printed a story that should be read to keep up to date in the insurance field of law.

The article tell us the Texas Department of Insurance has posted information and brief summaries of selected bills enacted during the 83rd Legislative regular session that relate to property/casualty insurance.

The bills listed may require action by regulated individuals and entities. The department advised affected entities to refer to the actual bills for the complete content of the legislation.

Read The Policy

January 23, 2014 | Mark S. Humphreys

Saginaw insurance attorneys and their clients need to read and understand the insurance policies they are presented with by the insurance company. The United States 5th Circuit issued an opinion in November 2013, that illustrates why. The style of the case is Willoughby v. Metropolitan Lloyds. Here is the relevant information.

This appeal involves the timeliness of a homeowner’s lawsuit against her insurer. The district court determined the lawsuit was untimely and granted summary judgment. This appeals court affirmed.

Willoughby contracted with Metropolitan Lloyds for a homeowner’s insurance policy. The policy included a shortened limitations period, stating that “[a]ction brought against [Metropolitan] must be started within two years and one day after the cause of action accrues.” In November 2007, Willoughby reported to Metropolitan that a fire had damaged her home in Blooming Grove, Texas. Metropolitan subsequently investigated Willoughby’s insurance claim and examined her under oath regarding the circumstances of the fire. During the course of this examination, Willoughby provided her mailing address and stated that her and her husband’s attorney was Paul Lewallen. Nine months later, in a letter dated September 25, 2008, Metropolitan denied Willoughby’s claim, explaining that it believed “the fire was set by or at the direction of one or more of the named insureds.” The letter further explained that Willoughby had not complied with her insurance policy’s reporting obligations, one of which required her to provide a signed “proof of loss” statement. Metropolitan sent this letter to the mailing address provided by Willoughby. Willoughby denies ever receiving it.

The Other Person’s Insurance And Bad Faith

January 21, 2014 | Mark S. Humphreys

Texas insurance attorneys already know that bad faith claims in Texas only apply to 1st party claims, not 3rd party claims.

The 1994, Texas Supreme Court case styled, Allstate Insurance Company v. Watson, explains how Bad Faith claims apply to 1st party claims. Here is the relevant information from that case.

Kathleen Watson was injured in a car accident. The driver of the other car was M.D. Townley, an insured under an automobile liability policy issued by Allstate Insurance Company. Watson filed suit against Townley alleging that Townley was negligent and that his negligence was a proximate cause of the accident and her injuries. In the same action, Watson also sued Allstate under art. 21.21, section 16, for alleged unfair claim settlement practices in failing to attempt in good faith to effectuate prompt settlement of her claims where liability had become reasonably clear and in denying or unreasonably delaying payment of her claim. Watson alleged that Allstate’s conduct violated 28 Tex.Admin.Code § 21.3 and section 17.46 of the Texas Deceptive Trade Practices–Consumer Protection Act (DTPA). In addition to her claim under art. 21.21, Watson alleged violations of the DTPA, breach of contract, breach of the duty of good faith and fair dealing, and sought a declaratory judgment that Watson was an intended third party beneficiary of the Allstate liability policy.

Misrepresentations In Life Insurance Policy

January 19, 2014 | Mark S. Humphreys

Weatherford lawyers who handle life insurance disputes need to know the law relating to when an insurance company can void a policy after it has learned of a misrepresentation. The particular statute can be found in Texas Insurance Code, Section 705.005.

A 1969 case from the San Antonio Court of Appeals helps to show how this statute works. The style of the case is, Prudential Insurance v. Torres.

The facts are substantially undisputed. Prior to January 5, 1967, Torres was an employee of Gonzaba Lumber Company, which was owned by Luis Gonzaba, brother of Mrs. Bertha Torres. For some time, Luis Gonzaba and some of his six employees had considered securing a group insurance policy to provide hospitalization and medical benefits.

What If You Make A Misrepresentation?

January 18, 2014 | Mark S. Humphreys

An experienced insurance law attorney will tell that insurance misrepresentations made by the insured do not always mean “no coverage.”

A 1956, Texas Supreme Court case is a good illustration of the above. The style of the case is, Womack v. Allstate. Here is the relevant information.

This is a summary judgment case. On January 4, 1952, Allstate issued a policy of public liability automobile insurance to Mrs. L. N. Coffee, the wife of William T. Coffee. Malcolm Womack and others, recovered judgment in the 99th District Court of Lubbock County against William T. Coffee for the damages which they sustained on July 20, 1952, when the automobiles in which they were riding collided with a vehicle operated by the latter. Womack instituted this suit to recover the amount of the judgment from Allstate, alleging that at the time of the accident William T. Coffee was driving, with the consent of the insured, the automobile covered by Allstate’s policy. The trial court entered summary judgment for Allstate, and the Court of Civil Appeals affirmed. This court reversed the summary judgment.

Prompt Payment Of Claims Law

January 16, 2014 | Mark S. Humphreys

Tarrant County insurance attorneys should be familiar with the Texas Prompt Payment of Claims Act. Here is a little information taken from a State Bar of Texas publication that attorneys and their clients should know. The article was discussing the legality of ordering an insurance company to pay restitution for it’s failure to promptly pay claims.

In 1999, the Texas State Legislature enacted House Bill 610, commonly known as the Prompt Pay Act. It’s general purpose was to require payors under the act, such as insurance companies including health insurance companies, to pay or deny the bills of medical providers within forty-five days after receipt of a bill, provided the claim was “clean,” as defined by the Act. If an insurance company violated this Act, they were subject to the various penalties provided for in the legislation itself. In addition, certain violations might subject an insurance company to administrative penalties under former article 1.10E of the Insurance Code, which is currently Texas Insurance Code, Section 843.342(k). However, these penalties are not the exclusive penalties for violating the Prompt Pay Act. The Act contains a “dragnet” provision clearly reading, “in addition to any other penalty or remedy authorized by this code or another insurance law of this state.”

The language in the dragnet provision indicates the Texas Insurance Commissioner can resort to the power of restitution for violations of the Prompt Pay Act, since restitution is an “other remedy” authorized by the Insurance Code in Section 82.053. Senate Bill 403 allowed the Insurance Commissioner to order restitution to “each entity operating in the state that is harmed by a violation of, or failure to comply with, this code or a rule of the commissioner. Since a medical provider would be an “entity operating in this state,” the Insurance Commissioner could order an HMO, for example, to pay “restitution” to any medical provider that was harmed by a violation of the Act.

Insurance Agent Getting Wrong Policy

January 14, 2014 | Mark S. Humphreys

Parker County insurance lawyers need to understand the responsibility that insurance agents have regarding getting coverage for one of their customers. A 1992, Texas Supreme Court case is good reading for understanding their responsibility. The style of the case is, May v. United Services Association of America. Here is some of the relevant information.

This case involves the scope of an insurance agent’s common-law duty to a customer in rendering advice about and procuring a policy for health insurance. May asserted only common-law causes of action, making no claim under the Texas Deceptive Trade Practices-Consumer Protection Act, or any other statute. While the jury found favorably for the Mays on a claim of the agent’s negligence, it failed to find for the Mays as to misrepresentation. On this verdict, the trial court rendered judgment for the Mays, but the court of appeals reversed. This court affirmed the judgment of the court of appeals because there was no evidence in the record before them that the agent breached the duty to use reasonable care, skill and diligence in procuring insurance in any way that proximately caused harm to the Mays.

On March 16, 1983, Faith May visited with insurance agent Wiley about the policy at issue. Wiley explained the basic provisions of the policy to her.

Agent Misrepresentations

January 12, 2014 | Mark S. Humphreys

Dallas insurance lawyers need to understand when an agent can be held liable for mis-representations regarding an insurance policy. A 1998, San Antonio Court of Appeals case is a good read for understanding when this can be done. The style of the case is, Moore v. Whitney-Vaky Insurance Agency. Here is some relevant information.

Moore contends the trial court erred in granting summary judgment because Whitney-Vaky owed him a common law and statutory duty to disclose any limitation in his insurance coverage.

Moore repossessed an apartment complex known as Oakhills Village. After he reacquired the complex, McLain, an agent for Whitney-Vaky, asked whether he could handle the insurance for the complex. Moore did not recall specifically discussing any types of coverage with McLain; however, Moore had been responsible for obtaining insurance for businesses in the past and expected to receive fire, extended coverage, liability and workmen’s compensation coverage. When he received the policy from McLain, Moore did not discuss the contents of the policy with him; however, Moore thought when he bought liability insurance that he was being covered for any liability that may occur. Moore admitted that McLain never told him that the liability policy would cover all lawsuits against him.