Dallas Fort Worth Insurance Lawyer Blog

Insurance Claim Denied – Experts

June 4, 2011 | Mark S. Humphreys

No matter where you live, Grand Prairie, Arlington, Mansfield, Fort Worth, Dallas, Garland, Mesquite, Richardson, Coppell, Carrollton, or anywhere else in Texas, at some point you are probably going to have an insurance claim denied. To what extent will an insurance company go to prove they do not owe you anything?

The Texas Court of Appeals, Eastland, decided a case in December, 2008, wherein the insurance company appealed the findings of an injured persons own treating experts. The style of the case is, American Casualty Company of Reading, Pa. v. Donna Zachero. Here is some background information.

On March 17, 2003, Zachero was injured at work when she fainted and fell. She hit her chin, shoulder, chest, and elbow during the fall and developed bruises on those areas. She also injured her knee when she fell. On April 17, 2003, Zachero went to the emergency room due to pain and swelling in her knee. She was x-rayed and instructed to see an orthopedic, Dr. Luke, a specialist for the injury.

Insurance Regulation

June 2, 2011 | Mark S. Humphreys

At least a few people in the Dallas – Fort Worth area and surrounding counties such as Parker County, Palo Pinto County, Johnson County, and others in Texas know that the insurance industry in the State of Texas is regulated by the Texas Department of Insurance.

Each state in the United States is able to enact its own rules and regulations for insurance companies. The New York Times published an article on May 8, 2011, that discusses how some states regulate insurance in such a way as to encourage insurance companies to come to their state to do business. There are pros and cons to this. The title of the article is, “Seeking Business, States Loosen Insurance Rules” and the authors are Mary Willams Walsh and Louise Story.

The first sentence in the article says, “Companies looking to do business in secret once had to travel to places like the Cayman Islands or Bermuda.”

Uninsured Motorist Coverage Rejection

May 31, 2011 | Mark S. Humphreys

Drivers in Grand Prairie, Arlington, Duncanville, De Soto, Cedar Hill, Mansfield, Irving, Dallas, and other places in Dallas and Tarrant County are required by law to be offered Uninsured Motorist protection when they purchase liability insurance on their vehicles. This is mandatory unless the coverage is rejected in writing.

A 1974, Beaumont Court of Appeals case deals with this issue in a fact pattern that has an unusual twist to it. The style of the case is, Oran Greene v.Great American Insurance Company. In this case the court ruled in favor of the insurance company.

Here is some background.

Personal Injury Protection Benefits

May 29, 2011 | Mark S. Humphreys

Drivers in Weatherford, Mineral Wells, Aledo, Azle, Springtown, Decatur, Peaster, Millsap, Brock, Hudson Oaks, Poolville, Newark, Willow Park, and other parts of Texas are all offered Personal Injury Protection (PIP) benefits coverage when they buy coverage for their automobile. It is the law.

It is the law that the coverage be offered. However, it can be rejected. To reject it, the rejection must be clearly made and in writing. This law is found in the Texas Insurance Code, Section 1952.152(b).

Here is a 1978 case by the Texas Supreme Court dealing with the rejection. The style of the case is, Unigard Security Insurance Company v. Charles Schaefer et al. Here is some background.

Excluded Drivers In An Automobile Policy

May 28, 2011 | Mark S. Humphreys

Insureds in Grand Prairie, Arlington, Fort Worth, Pantego, Dalworthington Gardens, North Richland Hills, Saginaw, Lake Worth, Benbrook, and other places in Tarrant County and Texas need to have some understanding of what an excluded driver is in an automobile insurance policy. An excluded driver is a driver who is not insured under an automobile insurance policy. For some reason the insurance company is refusing to insure the driver. The reasons could vary widely.

A case decided in July, 1993, by the Texarkana Court of Appeals deals with excluded drivers and is worth having an understanding about for future reference. The style of the case is, John DiFrancesco and DSS Partnership d/b/a DS & S Farms v. Houston General Insurance Company. Here is some background.

In July 1990, an automobile accident occurred in which a pickup truck owned by the Partnership and driven by their employee, Thomas V. Avey, was involved. The Partners and Avey were sued for damages by Troy and Nikki Beckham. The Beckhams were allegedly forced off the road and injured by a pickup truck owned by the partnership and operated by Avey. The Partners demanded Houston General defend them which Houston General did, subject to a reservation of rights.

Uninsured Motorist Insurance Coverage / Umbrella Policies

May 26, 2011 | Mark S. Humphreys

This could happen to someone in Grand Prairie, Arlington, Fort Worth, Mansfield, Hurst, Euless, Bedford, Colleyville, Keller, or anywhere else in Tarrant County or the State of Texas. It is a case dealing with umbrella insurance policies and uninsured motorist automobile policies.

The case was decided in January, 1996, by the Austin Court of Appeals and is styled, Joel Sidelnik et al v. American States Insurance Company. Here is some background.

Sidelnik brought a declaratory judgment action seeking a determination that, as a matter of law, his umbrella insurance policy issued by American provides uninsured motorist coverage for the car accident in which his wife was killed. The trial court and this appeals court ruled in favor of American.

Insurance Claims – Commercial Policies

May 24, 2011 | Mark S. Humphreys

Every business owner in Grand Prairie, Fort Worth, Arlington, Irving, Dallas, Mansfield, or any other DFW city would need to have a basic understanding how their commercial insurance policies are interpreted. Especially the policies that have arbitration clauses in them. When there is a question, the first thing to do is to consult with an experienced Insurance Law Attorney. A second thing to do would be to read the following case for some guidance.

The Texas Supreme Court issed an opinion this month in the case, In Re Universal Underwriters of Texas Insurance Company. This case dealt with the interpretation of an appraisal clause in an insurance contract and the standard for judging whether or not that appraisal clause has been waived by either party.

Here is some background. Grubbs Infiniti, a car dealership, suffered hail damage to buildings on its property. Grubbs filed a claim with its insurer, Universal, and a claims representative inspected the property and subsequently paid Grubbs $4,081.95 for the damage. Grubbs asked for a reinspection and as a result, Universal reinspected and issued a $3,000 supplemental payment. At the time of this second payment Universal sent a letter to Grubbs inviting them to discuss the issue further and reminding them that under the policy they had a certain amount of time to file suit and that the file would remain open.

Damages In Insurance Cases

May 22, 2011 | Mark S. Humphreys

Grand Prairie, Fort Worth, Arlington, Mansfield, Crowley, Benbrook, Burleson, Cresson, and other Tarrant County residents would naturally wonder what the value of their claim is when their insurance company violates the law in the way they treat one of their customers. In other words, what will it cost the insurance company.

The most common actual damages when an insurance company treats somebody wrong are the actual policy benefits themselves. In certain cases under the Insurance code, the amount of policy benefits wrongfully withheld is an element of damages caused by the insurance company’s conduct. This is often held to be the case as a matter of law. This was stated in the Texas Supreme Court case, Vail v. Texas Farm Bureau Mutual Insurance Company, decided in 1988. The Supreme Court in the Vail case rejected the insurance company arguement that damages for an unfair settlement practice had to be something more than the amounts due under the policy. The court held that damages for a wrongful refusal to pay are at least equal to the policy benefits, as a matter of law. The reasoning of the court was:

The fact that the Vails have a breach of contract action against Texas Farm does not preclude a cause of action under the Texas Deceptive Trade Practices Act and what is now Section 541 of the Texas Insurance Code. Both the DTPA and the Insurance Code provide that the statutory remedies are cumulative of other remedies. They said it was well settled that persons without insurance are allowed to recover based on false representations of coverage, and that an insurance company may be liable for damages to the insured for its refusal or failure to settle third-party claims. It would not be right to bar an insured person who has paid premiums and is entitled to protection under the policy of insurance from recovering damages when the insurance company wrongfully refuses to pay a valid claim. The court stated that “Such a result would be in contravention of the remedial purposes of the DTPA and the Insurance Code.”

Insurance Recovery Solutions

May 21, 2011 | Mark S. Humphreys

Solutions – that is what someone in Grand Prairie, Arlington, Fort Worth, Bedford, Hurst, Euless, North Richland Hills, Keller, Colleyville, Grapevine, and other Tarrant County cities want when they are having problems with their insurance company.

One thing that can be recovered in an insurance claim situation is “actual damages.” Actual damages are the real damages someone suffers. Actual damages are also called compensatory damages. Compensation paid for harm, loss or injury suffered by an aggrieved party due to an act or a failure to act by another party/parties. Actual damages can be measured. For example, ‘A’ suffers a loss of income and or wages due to injuries that resulted in A’s unemployment. They also include medical expenses and specific losses due to breach of contract, like in insurance cases where a house burns down or a car suffers hail damage. It is usually amounts that can be easily proven. Examples that are not so easy to prove are, pain and suffering, impairment, disfigurement, mental anguish, loss of comfort.

The Texas Supreme Court, in 1997, set out the following principles that govern recovery of “actual damages” under the similar language that existed under the Texas Deceptive Trade Practices Act – that is that the same analysis should apply to the Texas Insurance Code, Section 541.152(a)(1). The relevant case was, Arthur Andersen & Company v. Perry Equipment Corporation.

Insurance Law Solutions

May 19, 2011 | Mark S. Humphreys

Solutions are what someone in Grand Prairie, Fort Worth, Dallas, Arlington, Cockrell Hill, Irving, Mesquite, Richardson, Garland, Duncanville, and other places want when it comes to a situation where they are being taken advantage of by an insurance company.

One of the first things an experienced Insurance Law Attorney has to decide when taking on an insurance case is – Who can be sued.

The Texas Insurance Code, Section 541.151, provides that a person who has sustained damages caused by another’s engaging in unfair or deceptive insurance practices may sue the person engaging in those acts or practices. The statute itself defines “person” to mean “an individual, corporation, association, partnership, reciprocal or interinsurance exchange, Lloyd’s plan, fraternal benefit society, or any other legal entity engaged in the business of incurance, including an agent, broker, adjuster or life insurance counselor.