ERISA cases are complicated, as any attorney handling ERISA cases can tell you.  This is exemplified in an April 2018, opinion from the U.S. District Court, Western Division, Austin Texas.  The opinion is styled, Kimberley Phillips v. Charter Communications, Inc. Welfare Benefit Plan.

Charter filed a motion to transfer the case to the District Court for the Eastern District of Missouri.  This court granted the motion.

This ERISA plan contains a forum-selection clause (FSC) that states, “any legal action to appeal a denial of claims for benefits shall be brought in a federal court sitting within the Eastern District of Missouri.  Charter argues that the FSC is valid and controlling, warranting transfer.  Phillips, meanwhile, argues that the controlling document to this dispute is the Summary Plan Description (SPD) for the Charter  Short-Term Disability Program ( STD Program), which is a component program of the Plan.  The SPD contains a clause that states, “at the completion of that review process, you have the right to file suit in federal or state court.”  Phillips argues that the SPD’s clause supersedes the Plan’s FSC and confers broad forum-selection authority upon Phillips.  In the alternative, Phillips argues that even if the Plan’s FSC is valid, the Court should refuse to apply it because doing so would be unfair.

The United States District Court, Northern District, Dallas Division, issued an opinion in April 2018, titled, Grand Hotel Hospitality LLC d/b/a Grand Hotel Dallas v. Certain Underwriters at Lloyd’s of London et al.

This is a breach of contract case where Grand Hotel suffered a fire damage and sued Lloyd’s and the adjuster assigned to handle the claim.  There were allegations for violation of the Texas Insurance Code, Section 541.060, made against the adjuster, Brandon Weir.

The lawsuit was filed in State Court and the Defendants caused the case to be removed to Federal Court alleging the joinder of Weir was fraudulent in order to beat diversity jurisdiction under 28 U.S.C. Section 1332.

Life insurance policies are required to have certain provisions.  To begin with, all life insurance policy forms have to be approved by the Texas Department of Insurance.

Texas Insurance Code, Section 1101.004 requires that all policies allow a grace period of at least a month.

Section 1101.003 requires that the submitted application be part of the life insurance contract.

Life insurance lawyers will at one time or another see most of the types of disputes that arise in life insurance disputes.  When there is a dispute, finding an attorney who deals with life insurance cases who can discuss your case can make a big difference.  Here are some of the areas in which disputes arise:

  1. An insurance agent may misrepresent the benefits of an insurer’s policy to induce the insured to switch from another company.
  2. An insurance agent may fail to disclose that health conditions may cause the insured’s application to be rejected.  If the insured was induced to let a rival policy lapse based on the expectation of replacement coverage, the insured may have no insurance.

Here are some basics about life insurance for a life insurance lawyer to understand.

Common life insurance types are term, whole life, and universal life.

“Term” policies simply provide a death benefit in return for a premium payment.  At the end of the policy year, or “term”, the insurance ends, and the policy has no value.  Term policies do not accrue cash value.  Because the insured is only paying for the death benefit, term policies are cheaper in the early years.  As the insured gets older, the risk of death increases and so does the premium, so term may become more expensive than the other types.  Insurers typically sell term policies that promise a fixed premium for a set number of years.  For example, an insurer may sell a 10 year term policy that the insured may purchase and renew for the same annual premium during those years, without having to re-qualify.

Insurance lawyers trying to help client with automobile property damage will find they need to understand and be able to explain the damages in two ways.  Actual Cash Value (ACV) and diminished value.

“Actual cash value” is the value of the vehicle, less depreciation.  The limitation of “actual cash value” has been upheld and found to be reasonable cash market value of the vehicle before the loss.  This is discussed in the 1968, Texas Supreme Court opinion styled, Superior Pontiac Co. v. Queen Insurance Company.

Even after a vehicle is fully repaired, its value may still be diminished, but the insurer is not liable to pay for this diminution of value.  This is discussed in the 20023, Texas Supreme Court opinion styled, American Manufacturers Insurance Co. v. Schaefer.  Keep in mind this is in the context of your own insurer, not the other guys insurance company.  The other guy’s insurance can be held responsible for diminution of value.

The terms “repair” and “replace” mean restoring the automobile to essentially the same condition as it was in immediately before the collision.  It would not be restored to the same condition if the repairs left the market value of the auto substantially less than the value before the collision.  This was the decision in the 1969, Corpus Christi Court of Appeals opinion, Northwestern National Insurance Company v. Cope.

As stated in the 1968, Tyler Court of Appeals opinion, Agricultural Workers Mutual Automobile Insurance Company v. Dawson, if a vehicle is repairable, the insured is entitled to no more than what it would cost to repair the property.  This presumes the vehicle has been repaired to essentially the same condition that it was in before the loss.  But if, after repair, the vehicle has not been restored to the same condition as it was in immediately before the loss, the owner may be entitled to recover for diminution in value without necessarily showing the repairs were inadequate.  This was discussed in the 1968, Texas Supreme Court opinion styled, Superior Pontiace Co. v. Queen Insurance Co.

If an insurer repairs a vehicle, it must use parts of “like kind and quality” according to the 2003, Texas Supreme Court opinion styled, American Manufacturers Mutual Insurance Co. v. Schaefer.

Springtown insurance lawyers need to read this Corpus Christi Court of Appeals opinion dealing with late payment on an insurance policy.  The case is styled, Schrader v. Texas Farm Bureau Underwriters.

The trial court granted summary judgement in favor of Farm Bureau.

Schrader alleged in his lawsuit against Farm Bureau that two farming tractors and related equipment valued at $60,000, were stolen from him sometime between December 5 and 13, 2013.  Farm Bureau had denied the claim based on its assertion that the policy was not in force for the date of loss.  Schrader asserts the policy was “undeniably in force until midnight on December 6 and should have bee reinstated retroactively to November 30, 2013, as premiums were forwarded via the agent.

The United States District Court, S.D. Texas, McAllen Division, denied a defense motion for summary judgment in a case where the defendant settled a claim with a homeowner who had two claims, asserting that the release covered both claims.  The case is styled, Aidee Bazan v. State Farm Lloyds.

Bazan had insurance with State Farm insuring his residential property.  Two storms are alleged to have damaged Bazan’s property – the first in March 2016, and the second in May 2016 – forming the basis of two different lawsuits against State Farm.

A dispute arose about the damages sustained by Bazan and a lawsuit was filed as to the March 2016 damage.  Bazan later filed a lawsuit on the second storm damage.   This second claim was assigned claim number 912. The pleadings on the two lawsuits are essentially the same.

The United States District Court, N.D. Texas, Dallas Division, Judge Boyle, issued an Order remanding a case in March of 2018.  The case is styled, Allied Stone, Inc. v. Acadia Insurance Company, Union Standard Insurance Group, LLC, and James Amato.

Acadia insured property owned by Allied.  In 2016, Allied claims it suffered hail and wind damage and made a claim to Acadia.  Acadia hired Union to adjust the claim.  Acadia sent out it’s employee Amato.

Allied Stone alleges in relevant part that “Mr. Amato did not prepare any estimates