Dallas Fort Worth Insurance Lawyer Blog

Prompt Payment Of Claims And Attorney Fees

January 11, 2014 | Mark S. Humphreys

Fort Worth insurance attorneys need to have an understanding of how the Texas Prompt Payment of Claims Act works. Here is a case that explains how it works in relation to attorney fees. It is a 2013, United States 5th Circuit Court of Appeals case styled, The City of College Station, Texas v. Star Insurance Company. Here is some of the relevant information.

Star Insurance Company (“SIC”) refused to defend or indemnify its insured, the City of College Station (“the City”), in a lawsuit brought by Weingarten Realty Investors (“WRI”), a real-estate investment trust not party to this appeal. The City settled the underlying litigation with WRI and sued SIC to recover defense costs, indemnification, and statutory penalty interest. Applying Texas law, the district court concluded that SIC had no duty to defend or indemnify the City in the litigation with WRI and, consequently, no penalty liability for late payment. This appeals court reversed the trial court and remanded for further proceedings consistent with their ruling.

The actual facts of the case are not important. What is important is that the court ruled in favor of the insurance company and that on appeal this appeals court ruled that not only should the insurance company paid for a defense in the case, but their failure to do so results in the insurance company having to pay for violations of the Prompt Payment of Claims Act on those attorney fees.

Pain & Suffering

January 9, 2014 | Mark S. Humphreys

Attorneys who handle injury cases need to know this case. It is a 2013, case from the Corpus Christi Court of Appeals. It is styled, Schaffer v. Nationwide. Here is the relevant information.

In February 2006, Schaffer, who was driving north-bound on United States Highway 77 and was beginning to merge onto Interstate Highway 37 in northwest Corpus Christi, Texas, collided with a truck driven by Brady Lovins. Schaffer alleges that she suffered injuries to her lower back as a result of the accident. To treat her injuries, Schaffer underwent: physical therapy, first in April to June 2006 and, again, from September 2007 to January 2008; a series of lumbar steroid and other injections in the summer and fall of 2006 and throughout 2007; and, finally, lumbar fusion spinal surgery in February 2008. Schaffer alleges that she continued to suffer severe pain even after her surgery.

In connection with the accident, Schaffer sued Lovins for negligence. Schaffer also sued Lovins’s employer, Tracey Barrett d/b/a Barrett Pools, for vicarious liability because Barrett owned the truck Lovins was driving. Finally, Schaffer sued Nationwide for underinsured motorist benefits owing under her auto and umbrella policies with the company.

Additional Living Expense

January 7, 2014 | Mark S. Humphreys

Insurance lawyers in the Dallas – Fort Worth area need to be able to discuss coverage for “additional living expense” ALE with clients.

In 2005, the United States District Court for the Southern District of Texas issued an opinion in the case styled, Howard v. State Farm Lloyds. Here is some of what the case says.

The insured, Howard, filed a mold claim with her insurer, State Farm, under a standard homeowner’s policy. Under the terms of the policy, the insurer extended coverage to the insured for ALE she incurred as a result of inability to live in her residence pending remediation. Shortly thereafter the insured presented a six-month lease on another residence along with a copy of a check for $12,500 allegedly representing first and last months rent at $4,500 per month plus deposits on the residence. Based on these and similar representations, the insurer paid total ALE benefits to the insured of more than $126,000 over a two year period. As it turned out, the ALE benefits included overpayments of more than $80,000 procured through submission of false documents. The insured subsequently sued her insurer for breach of contract, breach of duty of good faith and fair dealing, and violations of the Texas Deceptive Trade Practices Act (DTPA) and Sections of the Texas Insurance Code, including violations of the Prompt Payment of Claims Act. The insurer counter-claimed and filed a motion for summary judgment on the affirmative defense of concealment and fraud.

Insurance Agent Misrepresentations

January 5, 2014 | Mark S. Humphreys

Dallas insurance lawyers know the ways insurance agents can be held liable for the misrepresentations they make to insureds. A 1994, El Paso Court of Appeals case is good to review. It is styled Hart v. Berko. Here is some of the relevant information.

This is a suit brought under provisions of the Texas Deceptive Trade Practices Act and the Texas Insurance Code by the policy owner against its insurance agent for damages arising out of a dispute over alleged representations concerning the amount of fire insurance coverage in effect at the time of a substantial fire loss.

In January of 1990, Berko, Inc. d/b/a El Encanto (Berko), through its Vice President, Sara Blaugrund (Blaugrund), requested that Phil Hart (Hart), employed by D.J. Enterprises, Inc. d/b/a Associated Insurance Agency (D.J.), increase the amount of insurance coverage on its building from $242,000 to $650,000. According to Blaugrund, Hart represented to her that he had obtained fire coverage of $600,000 on the building. On February 27, 1990, the building was completely destroyed by a fire. On the day after the fire, Hart notified Blaugrund that the building had only $242,000 coverage.

Insurance Company “Knowing” Conduct And Mental Anguish Damages

January 4, 2014 | Mark S. Humphreys

Fort Worth insurance lawyers need to have an understanding how the courts look at mental anguish damages as compensation for insurance code violations.

The 1995, Texas Supreme Court case, State Farm Life Ins. Co. v. Beaston case is a reference point. Here is some of the relevant information from that case.

Terri and David Beaston bought life insurance policies from State Farm. The Beastons failed to pay the premium on David’s policy due. His policy lapsed and the thirty-one day grace period expired. Three days after the expiration of the grace period, David died in an automobile accident. State Farm refused to pay the benefits under his life insurance policy, claiming that coverage had expired before his death.

Mental Anguish Insurance Claims

January 2, 2014 | Mark S. Humphreys

Fort Worth insurance lawyers need to be able to recognize a claim wherein conduct arises to a level allowing recovery for mental anguish damages. The 1999, Fort Worth Court of Appeals case styled, “Mid-Century v. Foreman” is helpful. Here is some of the relevant information.

Joyce Foreman was involved in a car accident with Karl Buehner. Foreman’s policy included $250,000 in underinsured (UIM) benefits. Foreman settled with Buehner’s insurance for the limits of $20,000. Because of extensive medical bills, Foreman filed an UIM claim with Mid-Century. Fisher, the Mid-Century adjuster, mailed an acknowledgement of the claim and a request for information. Foreman told Fisher that they had previously settled their liability claim and that they had hired a lawyer. As a result, Fisher stopped all contact with Foreman.

Foreman sued Mid-Century to recover contractual and extra-contractual damages. After reviewing Foremans’ medical records, the claim was denied.

Mortgage Accidental Death Insurance

December 31, 2013 | Mark S. Humphreys

Dallas life insurance attorneys will find this case valuable to know. It is a 2006, Texas Supreme Court case styled, Minnesota Life Insurance Company v. Vasquez. Here is the relevant information.

In November 1998, Minnesota Life issued a Mortgage Accidental Death Insurance policy to Joe and Elia Vasquez, promising to pay their home mortgage in the event either died due to an accident. In June 2000, Joe Vasquez became ill, was hospitalized, suffered a seizure, and lapsed into a coma. Twelve days later, he emerged from the coma and was transferred to a hospital room. Later that day, while no one else was present, he apparently fell, hit his head, and died.

On October 6, 2000, Elia Vasquez filed a claim with Minnesota Life requesting payment of the balance due on her mortgage (about $41,000) and submitted copies of the death certificate and autopsy report. After reviewing the documents, Minnesota Life sought advice from a medical consultant as to whether Mr. Vasquez’s death resulted from an accident “independently of all other causes,” as required by the policy. The consultant advised that he needed to see the relevant medical records.

Loss Of Use For Automobile

December 29, 2013 | Mark S. Humphreys

Tarrant County insurance attorneys will find the following case useful on many claims they encounter. The case is a 1984 Texas Supreme Court case styled, Luna v. North Star Dodge Sales, Inc. Here is some of the relevant information.

In March 1980 Luna sought to purchase a 1980 Dodge Omni from North Star. A 30-day/1,000 mile “money back guarantee” was offered to new car purchasers. If a purchaser was not satisfied with the car, then the purchase price would be refunded if the car was returned prior to the expiration of 30 days from the purchase date or before the 1000-mile limitation occurred. Luna took delivery of the car and while driving it home noticed a constant vibration and rattling with the steering wheel.

Two days later Luna took the car back to North Star and asked salesman Lewis to refund her purchase money. North Star never told Luna they would not refund the purchase money, nor did North Star ever say they would. Luna claimed North Star told her the refund decision was up to someone who was not available at that time. North Star offered to fix the car. Luna claimed it was never fixed. Luna returned to North Star several times with the car. Luna testified she requested the purchase money back each time she brought the car back. Luna felt she had no choice but to let North Star attempt to repair the car because she was unable to obtain the purchase money refund she requested. Luna thought that if North Star did not fix the car, then she would still get her purchase money back.

Loss Of Use

December 28, 2013 | Mark S. Humphreys

Dallas County insurance lawyers will run into situations where a claim for “loss of use” as it relates to a vehicle will need to be made. An opinion that is a good case to look for guidance is from the Austin Court of Appeals in 1997, and is styled, “Mondragon v. Austin.” Here is some of the relevant information.

The facts of this case are undisputed. In mid-1993, Austin borrowed money and purchased a car for his daughter to drive while she was away at college. About two months later, Mondragon, driving drunk and backwards down the road, collided with Austin’s car while Austin’s daughter was driving it. As a result of the accident, the car could not be driven. Austin had the car towed to his home.

Shortly after the accident, Austin filed a claim with Mondragon’s insurance company. The company chose to deny the claim despite the circumstances surrounding the accident. Because Austin had no money and no collision insurance, he had no way to repair the car and did not obtain an estimate of the damage until September 1994, over one year after the accident.

What Happens When Named Insured Dies

December 26, 2013 | Mark S. Humphreys

Dallas insurance attorneys need to be able to answer the above question. This was addressed in a 1990 opinion from the Houston Court of Appeals [14th Dist.]. The style of the case is, Nielson v. Allstate. Here is some relevant information.

This is an appeal from a summary judgment in favor of Allstate Insurance Company. For the reasons discussed here this court affirmed the trial court decision.

In November of 1978 Johanna Timm purchased an automobile insurance policy from Allstate. Timm was the sole named insured, and the insurance policy, by its terms, could not be assigned without Allstate’s written consent. Upon the death of the insured, however, coverage would extend to the legal representative of the deceased until the end of the policy period. Timm died in March of 1979. Allstate received renewal premiums for the policy and automatically renewed the policy in November of 1979 and 1980, but Allstate was not apprised of Timm’s death. In July of 1981 Charlotte Doyle died in a two-car automobile accident while driving the insured vehicle. Doyle was operating the automobile with the permission of the executor of Timm’s estate. Michael Shou Nielson, driver of the second auto, was severely injured in the accident. Nielson filed suit and received a default judgment against the administrator of Doyle’s estate. The administrator assigned any claim he might have against Allstate to Nielson. Nielson subsequently initiated this suit against Allstate.