Dallas Fort Worth Insurance Lawyer Blog

Recovery On Breach Of Insurance Contract

July 4, 2013 | Mark S. Humphreys

A Weatherford attorney who handles insurance claims needs to have an awareness of the potential recovery on a breach of insurance contract claim. Here is a little food for thought in that regard.

The 1988, Vail v. Texas Farm Bureau Mutual Insurance Co., case discusses this. The Texas Supreme Court issued the opinion and the case regards lots of issues and discussion regarding insurance law. Part of that law deals with damages for breach of the insurance contract. The Court said that policy benefits are the basic recovery allowed for an insurance company breach of its contractual obligations under the insurance contract. An insurance company’s refusal to pay the insured’s claim causes damages in at least the amount of the policy benefits wrongfully withheld. Some would call this “benefit of the bargain” damages.

In addition, the insured should be able to recover consequential damages that are the foreseeable result of the insurance company breach of the insurance contract. The argument to be anticipated with this rule is being able to explain what and why a consequential damage is actually a consequential damage and not a damage they may have occurred anyway. But as far as consequential damages are concerned, numerous cases hold that insurance contracts are subject to the same rules as other contracts. This is backed up in Texas case law and made clear in the 1994, Texas Supreme Court case, Hernandez v. Gulf Group Lloyds.

Third Party Beneficaries

July 2, 2013 | Mark S. Humphreys

Weatherford and Mineral Wells attorneys need to have some understanding of insurance law. In insurance contracts there are usually what is called intended or third party beneficiaries. Here is a little information about these third party beneficiaries.

Other persons who may sue for benefits under a contract of insurance besides the named insured are “intended beneficiaries,” also known as “third party beneficiaries.”

A third person for whose benefit a contract is made may enforce the contract against the promissor. Texas case law, as stated in 1985, by the Houston Court of Appeals, 14th Dist., tells us the controlling factor in determining whether a third party may enforce a contract is the intention of the contracting parties.

Personal Injury Protection Benefits

June 30, 2013 | Mark S. Humphreys

Grand Prairie insurance lawyers will deal with auto policies from time to time and when doing so will also deal with the portion of the policy dealing with Personal Injury Protection (PIP). The Beaumont Court of Appeals issued an opinion in 2000, dealing with how PIP benefits are paid. The style of the case is, Texas Farmers Insurance Company v. Carabell Fruge. Here are some of the relevant information on the case.

This case raises questions related to PIP provided in an automobile liability insurance policy as required by Texas Insurance Code, Section 1952.151 through 1952.161. The underlying issue in this case is whether or not an insurance company breached its contract by placing the names of medical providers and Medicare as co-payees on checks paying PIP benefits to Carabell Fruge. The Court held that the company did breach its contract but that it was entitled to name Medicare as a co-payee to part of the PIP benefits.

Jackie Ryan had purchased an automobile liability insurance policy from Texas Farmers Insurance Company that provided her with $2,500 in PIP coverage. Fruge was a passenger in Ryan’s vehicle and was injured in a car wreck. After her injury, Fruge’s attorney filed on her behalf a PIP claim with Farmers supported by documents reflecting medical expenses of $3,490. Some of the supporting documents contained some reference to Medicare. At least one document was stamped “Benefits Assigned.” Farmers responded to Fruge’s claim by mailing her six checks totaling $2,500.30. Four of the checks, totaling $1,854.30, named medical providers, Medicare, or both as co-payees with Fruge. All six checks named the law firm representing Fruge as a co-payee. Fruge’s attorney returned all six checks with a letter advising Farmers that “some or all” of the medical bills related to the checks naming co-payees had been paid, complaining that it would take six months to get all of the necessary endorsements, and demanding payment naming Fruge as the sole payee.

Insurance Bosses

June 29, 2013 | Mark S. Humphreys

Most insurance law attorney will keep up with the news related to the insurance field. The Dallas Morning News ran an article recently that is good news for consumers of insurance products. The title of the article is “Texas Senate Forcing Out State Insurance Commissioner.” The author is Terrence Shultz. He keeps up with these issues in Austin and gets good information. Here is what the article tells us:

Texas Insurance Commissioner Eleanor Kitzman will apparently have to step down as the state’s top insurance regulator because she cannot garner the necessary Senate votes for confirmation.

Kitzman, who was appointed by Gov. Rick Perry nearly two years ago, has faced opposition from Democrats and Republicans in the upper chamber, several senators say. To remain as commissioner, she would need the support of at least two-thirds of senators in the current legislative session.

Uninsured Case

June 27, 2013 | Mark S. Humphreys

Insurance attorneys, including those handling injury claims will be both glad and sad to know about a recent case out of the Corpus Christi Court of Appeals. The case is styled, Lilly Helene Schaffer, M.D., v. Nationwide Mutual Insurance Co. and Nationwide Property and Casualty Co. The opinion was issued in May 2013.

The bad news was that a jury awarded zero dollars to a claimant (Schaffer) for pain and suffering. The good news was that the Corpus Christi Court of Appeals said that based on the injuries and the testimony of the witnesses that the award of zero damages was against the great weight of the evidence and remanded the case on this issue.

Here is some relevant information:

ERISA

June 25, 2013 | Mark S. Humphreys

Insurance law attorneys who deal with ERISA plans, do so with a lot of caution. ERISA stands for Employee Retirement Income Security Act.

ERISA was enacted to protect the interests of employee benefit plan participants and their beneficiaries by:

Requiring the disclosure of financial and other information concerning the plan to beneficiaries;

Insurance Claims And Climate Change

June 23, 2013 | Mark S. Humphreys

Attorneys handling insurance claims would want to keep up with general news in the world of insurance. The New York Times published an article of interest.

The article is titled, “For Insurers, No Doubt On Climate Change.” Here is what it tells us:

If there were one American industry that would be particularly worried about climate change it would have to be insurance, right? From Hurricane Sandy’s devastating blow to the Northeast to the protracted drought that hit the Midwest Corn Belt, natural catastrophes across the United States pounded insurers last year, generating $35 billion in privately insured property losses, $11 billion more than the average over the last decade.

Insurance Claims As Breach Of Contract Claims

June 22, 2013 | Mark S. Humphreys

Fort Worth insurance attorneys will tell you that an insurance policy is a contract. A 1992, Dallas Court of Appeals case gives a good example of how the Courts deal with this concept. The style of the case is, St Paul Insurance Company v. Rakkar.

This case deals with many insurance issues but here are the issues as it relates to contracts:

Rakkar owned a house in Jewett, Texas. On August 27, 1988, after the tenants who had been living in the house vacated the property, Rakkar travelled the four hours from his home in Whitesboro, Texas, to Jewett to inspect the property with the real estate agent who helped him manage the property. Rakkar planned to grill some hot dogs for his dinner, spend the night in the house, and return to Whitesboro the next day. With this plan in mind, Rakkar bought hot dogs, a small hibachi-type grill, lighter fluid, and obtained some charcoal. He also bought a bottle of drinking water because the water at the house had been shut off. When he got to the house, he opened the windows to air out the house and started the air conditioner. Because the grass around the house was tall and dry, he decided to light the grill in the kitchen and then carry it onto the patio after clearing a space for the grill on the patio. Rakkar set the grill on the kitchen floor. After lighting the grill, he had begun to work on the ceiling fan when his real estate agent arrived. She told Rakkar that she smelled something “hot,” and Rakkar showed her the hibachi grill sitting on the kitchen floor. She told him that he should move it outside because the heat from the grill could burn the linoleum flooring. After declining Rakkar’s invitation to join him for a hot dog, the real estate agent left. Rakkar decided to take the grill onto the patio. When he bent over the coals, he passed out. When he awoke five or six minutes later, the grill was overturned near the base of the cabinets, the coals were scattered over the kitchen floor, and the cabinets were on fire. Rakkar ran to the sink, but no water came out. Rakkar then ran to his neighbors to get assistance, but they were not at home. He then drove the half mile to the marina and called the fire department, which was fifteen to twenty miles away. By the time the fire truck arrived, the house was completely engulfed in flames. T he house burned to the ground.

Insurance Is A Contract

June 20, 2013 | Mark S. Humphreys

Fort Worth insurance lawyers will tell you that insurance policies are contracts. As such the rules regarding insurance policies are the same rules governing contracts. This was confirmed in the 1994, Texas Supreme Court case, Hernandez v. Gulf Group Lloyds.

A person seeking to recover on an insurance policy must prove the policy was in force at the time of the loss. Arguments by an insurance company that the policy had lapsed is a common reason given for it’s refusal to pay a claim.

Also, when someone sues under a policy of insurance it is important to bear in mind that the person has to prove the existence of the insurance policy. An experienced insurance attorney is always going to ask for a certified copy of the insurance policy at issue at the beginning of a lawsuit.

When Does Uninsured / Underinsured Coverage Kick-In?

June 18, 2013 | Mark S. Humphreys

Dallas insurance attorneys need to know when uninsured / underinsured coverage is available as a benefit.

The Texas Supreme Court case United States Fidelity and Guarantee Company v. Goudeau, which is an opinion issued in 2008, is a good reference.

Here are some relevant points of the case.