Grapevine insurance attorneys need to be able to recognize when fraud or misrepresentation occurs in the insurance context.
To accuse an insurance agent or insurance company of fraud there needs to be proof of the following elements:
1) a material representation was made;
Fort Worth insurance lawyers need to be able to look at the facts of a case and determine whether or not the insurance agent can be held liable for his actions.
One thing to keep in mind as was stated in the Corpus Christ Court of Appeals case, In re National Health Insurance Company, is that to recover damages an insured must prove that the conduct complained of was the cause in fact of the actual damages.
An insurance agent may be liable for negligently failing to inform an insured of a policy renewal date. The case that states this is the Texas Supreme Court case, Kitching v. Zamora. In Kitching the Court held that an insurance agent who receives commissions from a customer’s payment of insurance policy premiums has a duty to reasonably attempt to keep the customer informed about his or her insurance policy expiration date when the agent receives information pertaining the expiration date that is intended for the customer.
Fort Worth insurance lawyers when presented with a claim being denied will want to see if the agent who sold the insurance policy did anything wrong.
The case law in Texas is pretty clear in that insurance agents have no general duty to obtain insurance nor to make sure the coverage is adequate for one of their customers. On the other hand, the Texas Supreme Court issued an opinion in 1992, that found where an insurance agent who undertakes to procure insurance for his customer owes a duty to that customer to use reasonable diligence in attempting to place the requested insurance and to inform the client promptly if unable to do so. This case is styled, May v. United Services Association of America. There is also a case reversing a summary judgment for the agent wherein the customer alleged that the agent failed to raise coverage limits after being asked to do so.
The Texas Supreme Court has held that an agent has a duty to keep the customer informed about the insurance policy’s expiration date when the agent receives information pertaining to the expiration date that is intended for the customer. This case is styled, Kitching v. Zamora. A similar opinion was issued by the Amarillo Court of Appeals in 1992, in the case styled, Horn v. Hedgecoke Insurance Agency.
Dallas insurance attorneys will run across situations wherein it is hard to understand and advise how the law applies based on the facts of the case when applied to the policy language.
The United States District Court, N. D. Oklahoma, issued an opinion in July 2013 that illustrates how complicated it can sometimes be to advise a client. The style of the case is O’Farrell v. State Farm. Here is some relevant information:
O’Farrell and State Farm, both, filed motions for summary judgment. The parties dispute whether Oklahoma or Texas insurance law applies to plaintiff’s claim for underinsured motorist (UIM) benefits, and they agree that the choice of law issue is dispositive. Plaintiff Patricia O’Farrell, in her capacity as the personal representative of the Estate of Samuel Joseph Dash (the Estate), argues that Oklahoma law applies and an insured’s own vehicle qualifies as an “uninsured motor vehicle” as a matter of law. Defendant contends that Texas law applies and an exclusion in the policy providing that the insured’s vehicle is not an uninsured motor vehicle is enforceable under Texas law.
Grand Prairie insurance lawyers need to understand how negligence works in an insurance case.
Negligence in the insurance context as in other situations, consists of three elements. These are:
1) a legal duty owed by one person to another;
Tarrant County lawyers need to be able to understand the case facts that will get them to exemplary damages. To know the difference between the threat of and the reality of getting them based on what transpired in the case.
Texas case law clearly allows for the recovery of exemplary damages in cases involving violations of the Texas Insurance Code and violations of the Texas Deceptive Trade Practices Act (DTPA). In 1994, the Texas Supreme Court issued an opinion in the case styled, Transportation Insurance Co. v. Moriel.
In Moriel, which was a “bad faith” case, the court held that the plaintiff must show that the insurance company had “no reasonable basis” to deny or delay payment of the claim and that the insurance company committed an act that was likely to cause serious injury beyond the injury associated with the underlying breach of the insurance contract. The court suggested that punitive damages could be recovered if the insurance company denied coverage for medical care knowing the insured would suffer serious injury, or denied disability coverage with the inherent extraordinary degree of hardship that would result.
Mineral Wells insurance lawyers need to know the difference between first party claims and third party claims and how that relates to bad faith insurance claims.
The Texas common law duty of good faith and fair dealing extends protection to the insured, whether the insured obtained the insurance coverage directly or coverage was obtained some other way for the insured. The 1987, Texas Supreme Court, in the case, Arnold v. National County Mutual Fire Insurance Co. recognized a common law duty of good faith and fair dealing owed to an insured, which arises from the “special relationship” established by the insurance contract. In the 1988 case, Aranda v. Insurance Company of North America, the Texas Supreme Court extended this duty of good faith and fair dealing to a worker insured under a workers’ compensation policy purchased by his employer.
An injured third party claimant lacks standing to sue the negligent driver’s liability insurance company for breach of the duty of good faith and fair dealing. We know this from the 1994 Texas Supreme Court case, Allstate Insurance Company v. Watson.
Palo Pinto attorneys who handle insurance situations will need to be able to distinguish between situations where an insurance company can be held liable for not paying a claim and where they cannot be held liable for paying a claim.
The United States District Court for the Southern District of Texas issued a ruling at the end of July that hits on this topic. The style of the case is, Sebring Apartments, et al., v. Lexington Insurance Companym et al.,
This was a summary judgment case decided in favor of Lexington. Here are points made by the court when it rendered its opinion.
Dallas insurance attorneys will see commercial policies that need interpretation. A recent El Paso Court of Appeals case will help them to understand how courts interpret insurance policies. The style of the case is, American National Property & Casualty Company v. Fredrich 2 Partners, LTD.
This is a case that was decided on cross motions for summary judgment. Here is some relevant information.
Fredrich owned seven commercial buildings insured against property damage under a policy issued by American National. During a severe winter storm where temperatures remained below freezing for four consecutive days, an insulated copper pipe in one of the buildings froze and ruptured, causing water damage to the building’s two interior units. At the time of the incident, one unit was occupied and heated while the other sat vacant and unheated. The pipe that froze and ruptured was located in the attic above the vacant unit.
Tarrant County insurance attorneys should know about pre-suit notice requirements. But for those who don’t, here is some information to keep in mind.
Both the Deceptive Trade Practices Act (DTPA), Section 17.505 and the Insurance Code, Section 541.154 require a 60 day pre-suit notice be given. There are specific requirements of the notice letter. It must state the consumer’s specific complaint in reasonable detail and the amount of economic damages, mental anguish damages, and expenses, including attorney’s fees. A good lawyer is going to require their client to write out in detail what happened and to write out in detail the loss that has been incurred and how the total dollar amount was calculated. This detailed account by the client prevents misunderstanding by the attorney and prevents something being forgotten by the attorney. Based on what the client has provided to the attorney, the attorney can then compare the acts or non-acts to the applicable statutes and do the “legal” part of the pre-suit notice letter.
It is important for the letter to be sent certified mail as required by the statute. Vocal or oral notice is not sufficient, nor is the fact they may already know what they did wrong, good enough.
Dallas Fort Worth Insurance Lawyer Blog
