Dallas Fort Worth Insurance Lawyer Blog

Insurance Appraisal Process

July 12, 2012 | Mark S. Humphreys

Grand Prairie insurance attorneys and those in Fort Worth, Hurst, Euless, Bedford, Grapevine, Colleyville, Saginaw, and other places in Tarrant County would need to have some understanding of the appraisal process and issues that arise from that process. The United States District Court, Southern District, Galveston Division, issued an opinion on May 25, 2012, that should be of some interest.

The style of the case is, KLM Resources, LLC d/b/a Jan-Pro Houston v. Ohio Casualty Company. Here is some background.

KLM filed suit against its insurer, Ohio Casualty Company, seeking to recover its loss of business income as a result of losses suffered by its franchisees following Hurricane Ike. Ohio Casualty invoked its right to an appraisal as provided in the insurance policy. Harold Asher, who had been retained by KLM as an expert on damages, was also appointed by KLM as its appraiser. Ohio Casualty selected Edward Hoffman, a forensic accountant, as its appraiser. Asher and Hoffman agreed to the appointment of Howard Zandman as umpire. Ultimately, Zandman and Hoffman agreed to an award of approximately $5,000. Asher, who estimated KLM’s loss at approximately $92,000, disagreed and refused to sign the award. Since the award was less that the $10,000 advance that had already been paid to KLM, no additional payment was due. Following the award, and facing a motion for summary judgment as to all of its claims, KLM filed a “Motion to Reopen the Appraisal Process.”

Suing The Other Insurance Company

July 10, 2012 | Mark S. Humphreys

Grand Prairie insurance lawyers and those in Fort Worth, Dallas, Hurst, Euless, Bedford, and other places in Tarrant County would normally know when the other guy’s insurance company can be sued directly. Most people do not realize that when someone causes harm to another, such as when a person drives their car into the back of someone else’s car, that the claim is against the driver of the car, not the insurance company of the person driving the car. If you think about it – the insurance company did not do anything wrong – it was the driver who did something wrong, i.e., wasn’t paying attention to where they were going. So the claim is against the driver. The driver though, hopefully, has a contract with an insurance company that essentially says, “driver if you do something wrong while driving your car, we, the insurance company, will pay for that wrong.”

However, there are exceptions to being able to sue the insurance company directly rather than suing the driver.

The Tyler Court of Appeals issued an opinion in a case on May 23, 2012, wherein the injured party was trying to make one of the exceptions. The style of the case is, Brian W. Haygood v. Hawkeye Insurance Services, Inc. Here is some background.

Living In The Same Household Defined

July 8, 2012 | Mark S. Humphreys

Grand Prairie Insurance Attorneys and those in Fort Worth, Dallas, Carrollton, Farmers Branch, Richardson, Plano, Rowlett, Mesquite, and other places in the Dallas / Fort Worth area would want to be able to understand how insurance companies look at the members of a household when interpreting an insurance policy.

The Waco Court of Appeals issued an opinion in 1977, in the case, Southern Farm Bureau Casualty Insurance Company v. Kenneth C. Kimball et al. that is still good law. Here is some background:

Kenneth is the named insured in a family insurance automobile policy issued by Southern Farm Bureau. Kenneth’s wife, Connie, was killed in an automobile accident with an uninsured motorist when the policy was in force. At the time of her death, she and Kenneth were separated, living in separate residences, and a divorce action filed by her was pending. Southern Farm Bureau brought suit seeking a declaratory judgment as to its responsibilities under the policy for uninsured motorist protection.

Where Is A Child A Resident

July 7, 2012 | Mark S. Humphreys

Grand Prairie insurance lawyers and those in Fort Worth, Dallas, Mesquite, Garland, Carrollton, Richardson, Rowlett, Farmers Branch, and other places in Dallas County need to be able to answer this question properly when handling insurance cases.

The Texarkana Court of Appeals answered this question in a 1978 opinion. The style of the case is, Hartford Casualty Insurance Company v. Phillips.

Here is some background:

How To Determine Residency

July 5, 2012 | Mark S. Humphreys

Weatherford lawyers and those in Mineral Wells, Aledo, Springtown, Willow Park, Millsap, Brock, Hudson Oaks, Azle, and other places in Parker County need to know how to determine residency in an insurance policy.

The Houston Court of Appeals, 1st District, decided a case in 1996, that provides guidance on this issue. The style of the case is, State Farm Mutual Automobile Ins. Co. v. Nguyen. Here is some background.

The court had to decide whether the family member exclusion in Nguyen’ automobile liability insurance policy applied and, therefore, limited the amount of their recovery. The court had to also decide whether their child, whose entire six-day life was spent in a hospital, was a “resident” of Nguyens’ “household.” The court held that the child was a resident of the household and that the family member exclusion limited Nguyens’ recovery to $20,000.

Residents Of The Same Household Issue

July 3, 2012 | Mark S. Humphreys

Grand Prairie lawyers and those in Arlington, Fort Worth, Dallas, Grapevine, Richardson, Farmers Branch, Carrollton, Mesquite, and other places in the DFW area need to understand this part of an insurance policy.

It is the part dealing with defining “residents of a household.” This is usually a fact question for a judge or jury to decide.

A 1958, El Paso Court of Appeals case, Afredo Arellano v. Maryland Casualty Company issued an opinion that is still good guidance today.

How Insurance Companies Adjust Claims

July 1, 2012 | Mark S. Humphreys

Grand Prairie lawyers and those in Fort Worth, Dallas, Arlington, Hurst, Euless, Bedford, and other places in North Texas who handle insurance claims would want to know about this article.

The Consumer Federation of America has published an article titled “Low Ball: An Insider’s Look At How Some Insurers Can Manipulate Computerized Systems To Broadly Underpay Injury Claims.”

Here is some information about the article:

Finding Beneficiaries

June 30, 2012 | Mark S. Humphreys

Weatherford attorneys and those in Mineral Wells, Aledo, Azle, Springtown, Millsap, Brock, Willow Park, Hudson Oaks, and other places in Parker County might find this article interesting. The article is from The Hartford Courant.

Connecticut joined 21 other states that agreed to a settlement with MetLife in a case that questioned whether the insurer did enough to find and pay beneficiaries after policyholders die.

The settlement means $40 million will be paid in penalties and about $438 million will go to unpaid policies that were written more than 50 years ago.This settlement amounts to nearly $900,000 for Connecticut beneficiaries,” Insurance Commissioner Thomas B. Leonardi said Tuesday. “Policyholders made their premium payments and have every right to expect MetLife to make good on its promise to pay claims. Working with fellow regulators on behalf of those policyholders and their families has helped accomplish that.”

Coverage Under An Insurance Policy

June 28, 2012 | Mark S. Humphreys

Grand Prairie lawyers who handle insurance disputes and those in Dallas, Fort Worth, Mansfield, De Soto, Duncanville, Irving, Arlington, and other places in the Dallas Fort Worth area need to understand the coverages under an insurance policy. Specifically, they need to know what an ‘occurrence’ or ‘loss’ is under a policy.

The Fort Worth Court of Appeals issued an opinion in 1996, in the case styled, State Farm Lloyds and State Farm Fire and Casualty Company v. Paul and Mary Kessler. The insurers here filed a declaratory judgement pleading they had no duty to defend a suit pending against the Kesslers by the Fannings’ who had purchased a home from the Kesslers. The trial court ruled in favor of the Kesslers and this appeal followed.

This court said the following: We hold that State Farm has no duty to defend the Kesslers because (1) the Fannings’ petition does not allege property damage as defined by the policy and (2) it does not allege damages from an occurrence or loss as defined by the policy.”

Turning In Claim to Insurance Company

June 26, 2012 | Mark S. Humphreys

Insurance lawyers in Grand Prairie, Fort Worth, Dallas, Richardson, Mesquite, Garland, and other places in the Dallas and Fort Worth area need to know and understand this case. It discusses one of the responsibilities of an insured under an insurance policy relating to claims made and notifying the insurance company.

The case opinion was issued by the Fort Worth Court of Appeals in 1969, and is still good law. The style of the case is, National Union Fire Insurance Company et al. v. Joe Bourn, Jr. Here is some relevant information.

The facts are longs and rather detailed. What is relevant is that on October 5, 1965, Bourn was involved as a victim in an assault and resulting injuries. Bourn sued the attackers and won a judgment against them. National Union defended in the resulting lawsuit but refused to pay any damages rendered against their insureds.