“Bad Faith” attorneys need to read this 2020 opinion from the Western District of Texas, San Antonio Division.  The opinion is styled, Macklin Keller v. State Farm Lloyds.

Keller had property insurance with State Farm.  Keller made a claim for hail storm damage.  Keller sued State Farm alleging, among other things, improper handling of the claim and for allegations of bad faith and statutory violations of the Texas Insurance Code.  State Farm filed a motion for summary judgment on the bad faith and statutory violations.

An insurer holds a duty to deal fairly and in good faith with its insureds.  An insurer breaches this duty and will be liable if it knew or should have known that it was reasonably clear that the claim was covered.  Consequently, under this reasonably-clear standard for determination of liability, an insurer breaches its duty of good faith and fair dealing by denying a claim when the insurer’s liability has become reasonably clear.

Here is a 2022 opinion from the Northern District of Texas, Dallas Division, wherein the Court explains the standards for a summary judgment motion to be granted.  The opinion is styled, Poonam Hospitality d/b/a Quality Inn & Suites v. Lexington Insurance Company.

The facts of the case can be gleamed from reading the opinion.  Here is set out the things that a Federal Court looks at when ruling on a motion for summary judgment.   Here, a response to the motion was not provided to the Court.

Pursuant to Federal Rule of Civil Procedure 56(a), summary judgment shall be granted when the record shows that there is no genuine dispute as to any material fact and that the moving party is entitled to judgment as a matter of law.  A dispute regarding a material fact is “genuine” if the evidence is such that a reasonable jury could return a verdict in favor of the nonmoving party.  When ruling on a motion for summary judgment, the court is required to view all facts and inferences in the light most favorable to the nonmoving party and resolve all disputed facts in favor of the nonmoving party.  Further, a court “may not make credibility determinations or weigh the evidence” in ruling on a motion for summary judgment.

Life insurance claim denials are more common than most people realize.  The majority of denials have to do with the allegation by the life insurance company that the insured misrepresented their health in the life insurance application.  The second most common reason has to do with exclusions in the policy.

Here is a 1998, opinion from the Austin Court of Appeals that deals with an exclusion.  The opinion is styled, Butler v. Group Life and Health Insurance Company.

During a social occasion, the decedent and a number of friends picked up an unloaded gun and began to point the gun into their mouths and pull the trigger.  At some point, ammunition was placed in the gun.  Decedent did not know this.  After the gun was loaded, but while the decedent still believed it was not loaded, decedent picked up the gun, pointed it to his mouth, pulled the trigger and killed himself.  Decedent’s beneficiary made a claim for life insurance benefits, accidental death benefits and attorney fees and interest as provided by the Texas Insurance Code.  The policy in question was issued by Group Life under the terms of the Texas Employees Uniform Group Insurance Act.  The Board administering the policy denied the claim because the decedent died as a result of intentionally self-inflicted injuries and because his death was not accidental.  The district court affirmed and Butler appealed.

Attorneys who handle claim denials in accidental death cases need to know the opinions handed down by the courts on these types of claim.  Here is a 1997, opinion from the Dallas Court of Appeals.  The opinion is styled, Grant v. Group Life & Health Insurance Company.

Grant used a pry bar to break into the residence of Stokes.  When grant entered the residence, Stokes shot him five times, killing him.  Grant’s wife sued Group Life to recover benefits under an accident policy for the death of her husband.  Group Life moved for summary judgement on the basis that Grant died while committing a burglary and, therefore, his death was not accidental.  The trial court granted the summary judgment and Grant appealed.

The Court held that because Grant’s death was not accidental, the trial court correctly granted Group Life’s Motion for Summary Judgement.  Grant argues that because Group Life did not furnish her with a certificate of insurance, it is estopped from relying on undisclosed exclusions.  Because the policy in question does not provide coverage for Grant’s death the policy’s exclusions are irrelevant.

Here is a 2022, opinion from the Northern District of Texas, Dallas Division.  It is styled, Pasha & Sina, Inc. V. The Travelers Home And Marine Insurance Company, And Doug Salsbury.

This is a commercial policy case.

Plaintiff purchased the policy from Travelers.  Plaintiff attempted to recover from Travelers for damage to the property for roof leaks.  A dispute arose and Plaintiff sued Travelers and Salsbury in State Court alleging causes of action for negligence, negligent misrepresentation, common-law fraud, fraud by nondisclosure, violation of the duty of good faith and fair dealing, and violation of Chapter 542 of the Texas Insurance Code.

This is a 2022, homeowners claim from the Eastern District of Texas, Tyler Division.  The opinion is styled, Meridian Security Insurance Company v. Curtis Murphy.

In this case, Meridian seeks a declaratory judgment that it is not liable for damage caused by by a fire at Murphy’s home.  Murphy asserted counter claims.  Meridian now moves for summary judgment.

Murphy’s counter claims were dismissed by the Court.

This is a 2022, homeowners claim from the Eastern District of Texas, Tyler Division.  The opinion is styled, Meridian Security Insurance Company v. Curtis Murphy.

In this case, Meridian seeks a declaratory judgment that it is not liable for damage caused by by a fire at Murphy’s home.  Murphy asserted counter claims.  Meridian now moves for summary judgment.

Murphy’s counter claims were dismissed by the Court.

This is a 2022, homeowners claim from the Eastern District of Texas, Tyler Division.  The opinion is styled, Meridian Security Insurance Company v. Curtis Murphy.

In this case, Meridian seeks a declaratory judgment that it is not liable for damage caused by by a fire at Murphy’s home.  Murphy asserted counter claims.  Meridian now moves for summary judgment.

Murphy’s counter claims were dismissed by the Court.

Insurance lawyers in the Dallas and Fort Worth need to read this 2022, United States 5th Circuit opinion.  It is styled, Advanced Indicator And Manufacturing, Incorporated v. Acadia Insurance Company; Nicolas Warren.

Advanced asserts it suffered damage to the roof of its building as the result of the storm, Hurricane Harvey.  Advanced submitted a claim to Acadia and Acadia assigned Warren to adjust the claim.  Warren inspected the building and determined that the damage was pre-existing and leaks resulted from deterioration and poor workmanship.    Based on Warren’s report, Acadia denied the claim.

On August 7, 2018, Advanced sued Acadia and Warren in state court, alleging various claims, including breach of contract, common law bad faith, and violations of the Texas Prompt Payment of Claims Act.

Insurance lawyers in the Dallas and Fort Worth, plus other parts of the state, need to read this 2022, United States 5th Circuit opinion.  It is styled, Advanced Indicator And Manufacturing, Incorporated v. Acadia Insurance Company; Nicolas Warren.

Advanced asserts it suffered damage to the roof of its building as the result of the storm, Hurricane Harvey.  Advanced submitted a claim to Acadia and Acadia assigned Warren to adjust the claim.  Warren inspected the building and determined that the damage was pre-existing and leaks resulted from deterioration and poor workmanship.    Based on Warren’s report, Acadia denied the claim.

On August 7, 2018, Advanced sued Acadia and Warren in state court, alleging various claims, including breach of contract, common law bad faith, and violations of the Texas Prompt Payment of Claims Act.  On August 30, 2018, Acadia elected to accept responsibility for Warren under Section 542A.006 of the Texas Insurance Code, which provides that an insurer may accept liability for its agents.  The next day, Acadia removed the case to federal court.  One week later, Warren filed a motion to dismiss, arguing in part that Advanced could no longer state a claim against him.  Advanced filed a motion to remand the case to state court, arguing that Warren was not improperly joined notwithstanding Acadia’s Section 542A.006 election. The remand was denied without reason by the District Court except to say that Warren was improperly joined.

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