Dallas Fort Worth Insurance Lawyer Blog

Claims Denial Attorneys – Attorney Misrepresentations

January 25, 2021 | Mark S. Humphreys

Here is a strange case from the Southern District of Texas, Houston Division. It is a 2020 opinion styled, Pruco Life Insurance Company v. Blanca Monica Villarreal, Transamerica Life Insurance Company v. Blanca Monica Villarreal.

This is a hard fought dispute over a large life insurance policy and discovery being conducted in two countries. Many accusations of misconduct are being hurled by both sides.

The two life insurance companies were trying to depose Villarreal’s investigator. Villarreal’s attorney objected to the questions based on it protected by attorney work-product rules.

Claim Denial Lawyer – Segregating Damages

January 23, 2021 | Mark S. Humphreys

Here is an opinion from the Northern District of Texas, Dallas Division, that concerns hail damage and segregating damages. The opinion is styled, Frymire Home Services, Inc. and Whitfield Capital, LLC v. Ohio Security Insurance Co.

This is a summary judgement opinion in filed by Ohio and the Court granted the summary judgment in favor of Ohio.

This is a hail damage insurance dispute. Ohio insured Property owed by Plaintiffs. The policy was in effect from March 23, 2018, until March 23, 2019.

Claim Denial Law Firms – Proper Pleadings

January 18, 2021 | Mark S. Humphreys

Insurance lawyers can tell a client that proper pleadings, especially in Federal Court, are essential to being able to have a day in Court. This is illustrated in a 2020, opinion from the Eastern District of Texas, Sherman Division. It is styled, Albion Investments, Inc. v. Travelers Casualty Insurance Company of America.

Albion owned property that was insured by Travelers insurance. Albion filed a claim with Travelers for property damage after a storm struck the property with hail and high winds. The claim was ultimately denied based on the amount of damages falling below the deductible of the policy.

Albion filed suit alleging that Travelers did not conduct a thorough investigation of the claim, failed to account for all of the damages covered, failed to fairly evaluate and adjust the claim, failed to perform its contractual duty to compensate Albion under the policy, made misrepresentations to Albion regarding the damages to the Property and whether it was covered, failed to make an attempt to settle the claim in a prompt and fair manner, and failed to explain why full payment was not being made.

Insurance Denial Attorneys – Cattle?

January 16, 2021 | Mark S. Humphreys

Here is a case that may apply to many of the rural areas of Texas. The case is a 2020, opinion from the Corpus Christi Court of Appeals and is styled, State Farm Mutual Insurance Company v. Rolando Lopez, Individually and Rolando Lopez D/B/A R&A Transport.

This is an appeal of a summary judgment in favor of Lopez and against State Farm. This Court reversed the trial court and rendered judgment in favor of State Farm.

The main point of this case is the interpretation of the words “in use” in the commercial policy at issue. The policy provides in part:

Insurance Claims Denial Lawyers – Bad Faith And Pleading Requirements

January 11, 2021 | Mark S. Humphreys

Here is a claims denial opinion worth reading. It is a 2020 opinion from the Northern District of Texas, Dallas Division. It is styled, DFWS, LLC v. Atlantic Casualty Insurance Company.

Atlantic insured DFWS. DFWS alleges it suffered damages as the result of a tornado and high winds. After making a claim for damages, DFWS alleges that Atlantic “engaged in a results-based investigation to find a non-covered cause of loss to the detriment of DFWS and contrary to the clear evidence otherwise.”

The resulting lawsuit sued for violations of Texas Insurance Code, Sections 541.060(a)(1), (2), (3), (4), and (7). Atlantic files a Rule 12(b)(6) motion to dismiss in response to the lawsuit.

Insurance Claims Denial Lawyer – Bad Faith Pleadings

January 9, 2021 | Mark S. Humphreys

Here is an opinion from the Northern District of Texas, Dallas Division, that discusses the pleadings in a lawsuit where in the property owner claims to have suffered hail damage and the insurer denied the claim. The opinion is styled, Valtex Properties LLC v. Central Mutual Insurance Company.

The insured, ValTex, sued Central for various violations of the Texas Insurance Code. The allegations are that Central violated sections, 541.060(a)(1), 541.051, 541.052, and 541.061. In response, Central filed a Rule 12(b)(6) motion to dismiss. This blog will deal with only Section 541.060(a)(1). However, the case is a good read on how the Court dealt with remaining Insurance Code sections.

To survive a motion to dismiss, a plaintiff must plead enough facts to state a claim to relief that is plausible on its face. Thread bare recitals of the elements of a cause of action, supported by mere conclusory statements, do not suffice. A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged. The plausibility standard is not akin to a ‘probability requirement,’ but it asks for more than a sheer possibility that a defendant has acted unlawfully. When well-pleaded facts fail to achieve this plausibility standard, the complaint has alleged—but it has not shown—that the pleader is entitled to relief.

Insurance Claims Denial Attorneys – ERISA

January 4, 2021 | Mark S. Humphreys

The Employee Retirement Income Security Act of 1974 (ERISA) offers many of the same types of insurance coverage for individuals as other plans. The distinctions with ERISA is that the plan is a plan for employers to offer to employees that is set and governed by Federal Law rather than State Law.

ERISA plans offer retirement programs, life insurance, disability insurance, and health insurance. The Southern District of Texas, Houston Division, issued an opinion in November 2020, on a case that is governed by ERISA. The opinion is styled, Wagna Mina huerta v. Shell Oil Company and Shell Oil Comprehensive Welfare Benefits Plan.

This case discussed a couple of issues. One of those, rarely seen in an opinion, is discussed here.

Insurance Claims Denial Attorney – Lawsuits

January 2, 2021 | Mark S. Humphreys

It is easy to get focused on the factual parts of a lawsuit. In other words, what happened, who did what, who said what, etc. As insurance lawyers, the legal aspects of the lawsuit need to be watched carefully. This is illustrated in the November 2020, opinion styled, Tim Long Plumbing, Inc. v. Kinsale Insurance Company. The opinion is from the Eastern District of Texas, Sherman Division.

This is an insurance claim denial lawsuit. Plaintiff Tim Long Plumbing had a commercial general liability policy with Kinsale. This facts of this case can be read in the opinion. The focus of this article is on the lawsuit discovery process of this case.

Under Federal Rule of Civil Procedure 26(b)(1), parties “may obtain discovery regarding any nonprivileged matter that is relevant to any party’s claim or defense . . . .” Relevance, for the purposes of Rule 26(b)(1), is when the request is reasonably calculated to lead to the discovery of admissible evidence. It is well-established that control of discovery is committed to the sound discretion of the trial court.

Insurance Claims Denial Attorney – Life Insurance

December 28, 2020 | Mark S. Humphreys

Well, here is a case where the claim isn’t denied. In fact it was paid. But now the insurance company is suing the person who received the money and seeking to have the money returned.

The opinion is a 2020 opinion from the Western District of Texas, San Antonio Division, and it is styled, Metropolitan Life Insurance Company v. Lilliam Soto, Felix W. Soto.

MetLife initiated this declaratory judgment action seeking to resolve a dispute between the Soto’s. Each assert entitlement to life insurance benefits payable under the Federal Employees’ Group Life Insurance Act (FEGLIA). The decedent, Juan Soto, had a policy worth $350,000, which was payable on his death to his properly designated beneficiary and then, only if there was no designated beneficiary, to his wife Lilliam.

Insurance Claim Denial Attorney – ERISA

December 26, 2020 | Mark S. Humphreys

The Employee Retirement Income Security Act (ERISA) provides various kinds of insurance to employees. The important thing for insurance lawyers to know about ERISA is that it is governed by Federal law and it preempts State law. This is illustrated in a 2020, opinion from the Western District of Texas, San Antonio Division. The opinion is styled, Marco Z. v. UnitedHealthcare Insurance Company, Forma Automotive, LLC.

Marco does not dispute that the health plan at issue is governed by the ERISA. Further, it is undisputed that at the time of the incident forming the basis of this action Marco was a beneficiary of the subject ERISA health plan established and maintained by Forma Automotive and administered by UnitedHealthcare.

Marco sustained medical problems in Mexico and was forced to seek medical assistance. Marco assigned insurance benefits to the Hospital, which is not a network provider under the Plan. As a non-network provider, it has no express contract with UnitedHealthcare establishing payment for medical services provided to beneficiaries of the Plan.