Here is a case from the San Antonio Court of Appeals to know and read.  It is styled, MGR, Inc. and Miracle Body and Paint, Inc. v. Geico Casualty Company.

Miracle is appealing a summary judgment in favor of Geico.

Miracle is an independent auto body shop and has performed work on autos insured by Geico and Geico has paid Miracle according to labor rates disclosed in the Geico repair estimates.  Miracle complains that after the work is completed, Geico has failed to pay the labor rates that Miracle charges and thus, sued Geico for breach of contract, among other causes of action.

Here is a type of case insurance lawyers do not see very often.  It is from the Southern District of Texas, Corpus Christi Division.  It is styled, Lamarr Womack & Associates, L.P.; dba LWA Architects, et al v. Lexington Insurance Company.

LWA filed a claim against Lexington seeking a defense and indemnity under the policy with Lexington.  Lexington tendered a defense under a reservation of rights to dispute coverage, claiming LWA had notice of the claim prior to purchasing the insurance policy and failed to disclose it in their application.  Lexington initiated arbitration seeking a declaration that it owes LWA neither a defense nor indemnity for the underlying claim.

LWA filed this declaratory judgment action, seeking a judicial determination of those issues and making a claim for breach of contract.  Lexington filed for dismissal under Federal Rule 12(b)(6), arguing that LWA failed to state a claim on which relief may be granted because of the arbitration agreement.

The Law Office of Mark S. Humphreys, P.C. is pleased to announce a settlement in a life insurance dispute between Mark’s client and the wife of a lady who killed her husband, claiming the killing was self-defense.

Mark’s client was the daughter of the deceased husband and the secondary beneficiary under the life insurance policy.

The primary beneficiary was the wife.

How does Federal law work with the Texas Slayer Statute, Texas Insurance Code, Section 1103.151?

This question is answered in the 1992, Fifth Circuit opinion styled, Metropolitan Life Insurance Co. v. White.

This is a summary judgement case.  Terri Yohey was the named insured under a group life insurance policy issued by Metropolitan under the Federal Employees Group Life Insurance Act (FEGLIA).  At the time of her death she had not designated a beneficiary.  Her widower, Leslie Yohey, was convicted of her murder.

What happens when the named beneficiary on a life insurance policy intentionally causes the death of the insured?  That was the question in this case from the Western District of Texas, San Antonio Division, opinion styled, Garrett Bean and Aneila Bean v. Minerva Alcorta.

Plaintiff’s father,Garry, has a $130,000 life insurance policy under which Alcorta was named the primary beneficiary and Garrett and Aneila were secondary beneficiaries of 50% each of the policy.

Alcorta was charged with intentional first degree murder of Garry.

The Law Office of Mark Humphreys, P.C., is pleased to announce the settlement of a life insurance case wherein the life insurance company recognized they owed the policy benefits but was unsure who was entitled to the money.

In this case, the deceased had named his wife as the primary beneficiary and his wife’s son, from a previous marriage, as the secondary beneficiary.  The deceased had divorced his wife prior to his death without changing the beneficiaries under the policy.

By operation of Texas law and no exceptions applying, the divorce resulted in the ex-wife being automatically excluded as a beneficiary under the policy.  This meant the claim went to the secondary beneficiary, the son of the ex-wife and Mark’s client.

Most insurance attorneys try to stay out of federal court.  Here, a pro se plaintiff filed his case in federal court.  The case is from the Eastern District of Texas, Sherman Division.  It is styled, Marlon Green v. Covenant Transportation Group, Inc., et al.  The case was dismissed because Green failed to properly plead his case.

Green does not enumerate any specific cause of action or claims, but rather broadly states that “administrative abuses are covered by The Civil Rights Act, and American with Disability Act Rights.”  In the most recent amended complaint, Green alleges that the Court has subject matter jurisdiction over this matter pursuant to 28 U.S.C. Section 1332, but avers the claim is less than $75,000.  Green also states “federal law violations include.”  The Court finds, upon review, that Green’s claims should be dismissed for lack of subject matter jurisdiction, and for failing to provide addresses for the preparation of service of process on Defendants, as ordered by the Court.

Federal courts are courts of limited jurisdiction and must have statutory or constitutional power to adjudicate a claim.  Federal courts have subject matter jurisdiction and are authorized to entertain a cause of action only where a question of federal law is involved or where there is diversity of citizenship between the parties and the amount in controversy exceeds $75,000.

The Texas Prompt Payment of Claims Act was interpreted by the United States Fifth Circuit in this 2015 opinion.  The opinion is styled, Cox Operating, L.L.C. v. St. Paul Surplus Lines Insurance Company.

The facts are kinda long ans somewhat confusing, plus there are other issues in the case.  Of relevance here is the Court’s discussing of the Texas Prompt Pay statutes.

Texas Insurance Code, Section 542.054 says in order “to promote the prompt payment of claims,” the act provides for a series of deadlines to which insurers must adhere at each stage of the claim handling process.

The 5th Circuit Court of Appeals issued an opinion on January 31, 2019, in a case that is governed by the ERISA.  The opinion is styled, Karen A. Rittinger v. Healthy Alliance Life Insurance Company.

Here, the beneficiary of a health plan governed by ERISA brought action against the plan administrator challenging the denial of coverage for her bariatric surgery and the follow-up surgery required after she developed complications.  This Court ruled in favor of the plan administrator, ruling the administrator did not abuse its discretion when it treated e-mail from the plan beneficiary’s husband as a first-level appeal, and the administrator did not abuse its discretion in denying health plan beneficiary’s second level appeal.

Pursuant to 29 U.S.C.A., Sections 1001 et seq., the Court of Appeals reviews a district court’s grant of summary judgment in an ERISA case de novo.

Life insurance claims that are denied for missed payments of premiums is pretty common.  This issue was discussed in a Southern District of Texas, Houston Division, opinion styled, Colonial Penn Life Insurance Company v. Ashley E. Parker, et al.

Robert Parker applied for a whole life policy with Colonial on October 30, 2014.  Ashley Parker and Aden Barron were beneficiaries of the policy.  The policy was issued on November 20, 2014.

On June 22, 2015, seven months later, Parker died in a car wreck.  A claim for benefits were made on the life insurance policy.