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.

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.

If someone in Grand Prairie, Arlington, Fort Worth, Dallas, Irving, Hurst, Euless, Bedford, Dalworthington Gardens, Crowley, or some where else in Texas gets mis-led by an insurance company, can they sue them? The answer is a definite yes if the company is that person’s insurance company but is probably a no if it is the other person’s insurance company.

The 1989 case, Hermann Hospital v. National Standard Insurance Company and American Fire & Casualty Company, decided by the Houston Court of Appeals, 1st District, is a good case for an example where you can sue the other person’s insurance for a misrepresentation.

On June 17, 1978, Jose Carreon was stabbed by a fellow worker while working for his employer. He was taken to, and treated at, Memorial Hospital. In September 1978, Memorial sought to transfer Carreon to Hermann for further care and treatment. The insurance company paid Memorial. Three months after Carreon was injured, on September 18 and 20, 1978, and prior to accepting the transfer of Carreon, Hermann verified coverge with the insurers for its care and treatment of Carreon. On September 20, 1978, after verifying coverage, Hermann accepted the transfer of Carreon. Coverge was again verified on October 16, 1978. Thereafter, later in October 1978, the insurers denied that there was insurance coverage for the injury sustained by Carreon and refused to pay Hermann for the expenses incurred. Hermann asserted in the lawsuit it filed that it relied on the representation of coverage in accepting the transfer of Carreon and that it incurred expenses of $217,444.90 in its care and treatment of Carreon.

Anybody in Weatherford, Mineral Wells, Millsap, Aledo, Azle, Springtown, Peaster, Brock, Lipan, Hudson Oaks, Annetta, Poolville, Whitt, or other places in Texas would wonder if they can sue the insurance company. Especially when they feel as if though they are being jerked around and treated in a disrespectful or improper manner. Well the answer to the question is yes, you can sue them. The bigger question is, can you win. Here is a case to think about.

The Texas Supreme Court, in 1994, decided a case styled, Allstate Insurance Company v. Kathleen G. Watson. The issue in the case was whether the state legislature allowed a third party claimant to directly sue the other guy’s insurance company for violation of what is now Section 541.060 of the Texas Insurance Code. The holding by the court was no, it is not allowed in Texas.

Here are some facts in the case:

Many people in Grand Praire, Arlington, Irving, Mansfield, Garland, Mesquite, De Soto, Duncanville, Dallas, Fort Worth, Hurst, Euless, Bedford, and other places in Texas will wonder from time to time if they can sue the insurance company when something goes wrong.

Here is a short answer that does not necessarily apply to all situations.

When it is your own insurance company that commits a wrong then there is a procedure to be followed, but you can sue them.

People who own homes in Weatherford, Aledo, Azle, Poolville, Brock, Hudson Oaks, Willow Park, Peaster, Mineral Wells, Cool, Millsap, and other areas of Parker and Palo Pinto counties might want to pay attention this story.

The Court of Appeals, Beaumont, issued an opinion on March 10, 2011, that gives some insight into how the courts will look at appraisal clauses in homeowners insurance policies. The style of the case is, In Re Southern Insurance Company.

In this case the homeowner, Michelle Neisen, suffered a loss that she alleges was the result of hurricane damage. Southern sought to have an appraisal process to determine the amount of the disputed loss. Neison claimed that Southern waived its right to appraisal because Southern claimed it was not responsible for the loss. The trial court refused to order participation in the appraisal process which Southern was requesting and Southern appealed that decision.

Any homeowner is Grand Prairie, Arlington, Irving, Mesquite, Garland, Richardson, Mansfield, Dallas, Fort Worth, or any other place in Texas who thinks they know a lot about their insurance policy, probably is still not sure how an arbitration clause in the policy works.

The Texas Court of Appeals, Beaumont, issued an opinion on March 24, 2011. The style of the case is, In re Ranchers & Farmers Mutual Insurance Company. This case is being appealed by way of a “writ of mandamus” and is normally referred to as a mandamus proceeding.

The name of a writ, the principle work of which when the proceedings were in Latin, was mandamus, meaning we command. It is a command issuing in the name of the sovereign authority from a superior court having jurisdiction, and is directed to some person, corporation, or inferior court, requiring them to do some particular thing therein specified, which appertains to their office and duty, and which the superior court has previously determined, or at least supposes to be consonant to right and justice.

Consumers in Grand Prairie, Fort Worth, Arlington, Dallas, Mansfield, Burleson, Crowley, Benbrook, Lake Worth, Rendon, Keene, Burleson, and other places in Texas have the protection of the Texas Insurance Code and the Texas Deceptive Trade Practices Act (DTPA) when it comes to having rights against businesses and insurance companies that treat people in an unjust manner.

Regarding these two areas of law, Texas court cases and the statutes themselves tell us that the Insurance Code provisions are to be liberally construed and applied to promote its underlying purposes to define and prohibit unfair and deceptive insurance practices. This is specifically stated in the Insurance Code, Section 541.008, where it says, “This chapter shall be liberally construed and applied to promote the underlying purposes as provided by Section 541.001.” This is also made clear in the 1988, Texas Supreme Court case, Vail v. Texas Farm Bureau Mutual Insurance Company.

The Supreme Court has stated that the similar liberal construction mandate in the DTPA requires that the statute be given “its most comprehensive application possible without doing any violence to its terms.” The courts apply this same reasoning to insurance cases, which is made clear in other court cases.

Homeowners in Grand Prairie, Arlington, Mansfield, Britton, Crowley, Burleson, Benbrook, Lillian, Godley, Glen Rose, Acton, Cresson, and other places in Texas, might be interested in this case.

This case is from the El Paso Court of Appeals and was decided on April 20, 2011. The style of the case is, Pamela Rust v. Texas Farmers Insurance Company.

This is a case where Pamela Rust brought suit seeking medical payment benefits from Texas Farmers Insurance Company under two homeowner policies that it had issued to Frank Kurosky, her father.

Residents of Grand Prairie, Arlington, Dallas, Fort Worth, Mansfield, Irving, Garland, Mesquite, Richardson, Farmers Branch, Carrollton, and other cities in Texas would probably get confused trying to understand what is a covered loss in an insurance policy and what is not a covered loss.

The Fourteenth Court of Appeals in Texas recently issued an opinion is a case covering this topic. The opinion, styled Markel American Insurance Company v. Lennar Corporation, Lennar Homes of Texas Sales & Marketing Ltd., and Lennar Homes of Texas Land & Construction Ltd., was issued on April 19, 2011.

This case involved several legal issues but the most relevant here dealt with how courts examine these cases to see what is a covered loss versus a loss that may have been incurred that is not covered by the insurance policy. Here is some background.

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