Dallas Fort Worth Insurance Lawyer Blog

Insurance Agents Who Cheat

March 3, 2011 | Mark S. Humphreys

There are insurance agents in Grand Prairie, Arlington, Dallas, Fort Worth, Mansfield, Crowley, Everman, Burleson, Benbrook, Lake Worth, and all over Texas. What happens when one of those insurance agent is cheating? The answer would depend on how it is that they are “cheating”. Some of their actions are violations of the Texas Insurance Code. Other times their actions are outright fraud or criminal in nature. One thing for certain is that an experienced Insurance Law Attorney needs to be consulted as soon as you think something is wrong.

A February 8, 2011, article illustrates what some agents do. The article was published in the MetroWest Daily News, a Framingham, Massachusetts, newspaper. The article is titled, “Insurance Scam Hits Framingham Towing Company.” The article is written by Danielle Ameden, a staff reporter for the newspaper.

The article in part says:

Beating An Insurance Company

March 1, 2011 | Mark S. Humphreys

Insured people in Grand Prairie, Weatherford, Arlington, Mansfield, Carrollton, Mesquite, Garland, Fort Worth, Dallas, or anywhere else in the State of Texas would want to know if it is possible to beat an insurance company if you get into a fight with them. The short answer is “heck yeah” you can beat them. Just hire an experienced Insurance Law Attorney.

The Seattle Post-Intelligencer ran an article that published on February 9, 2011, that tells the story of one person beating their insurance company after the insurance company denied their claim for benefits. The article is written by Vanessa Ho and is titled, “Elderly Woman Beats Insurer Over Denied Benefits.”

The article in part said:

Deceptive Trade Practices Act In Texas

February 27, 2011 | Mark S. Humphreys

People in Grand Prairie, Arlington, Mansfield, Crowley, Benbrook, Burleson, Keene, Joshua, Cleburne, Granbury, Pecan Plantation, Acton, and other places in Texas need to have a basic understanding of some of the consumer protection laws enacted to protect them against businesses that violate basic rules of fairness.

The Texas Business & Commerce Code, Section 17.46(b) has a “laundry list” of false, misleading, or deceptive acts or practices that have been declared unlawful by the Texas Legislature. In the appropriate situation, even the district and county attorneys throughout the state will get involved in making sure the public is protected from illegal acts that some businesses engage in.

Here is a partial list of some of the unlawful conduct found in the above section:

Rejection In Writing Of PIP & UM/UIM

February 26, 2011 | Mark S. Humphreys

Insureds in Grand Prairie, Arlington, Irving, Grapevine, Coppell, Keller, Saginaw, Lake Worth, Aledo, Hudson Oaks, Azle, Springtown, Burleson, Benbrook, and other places in Texas need to have an understanding of how Personal Injury Protection (PIP) and uninsured / underinsured (UM/UIM) benefits work in an automobile policy of insurance. Here is a case that gives some insight.

The case is styled, Old American County Mutual Fire Insurance Company v. Zeferino Sanchez. This is a 2004, case decided by the Texas Supreme Court.

Texas Insurance Code Sections, 1952.101 and 1952.152 provide that “any insured named in the policy” may reject UM/UIM and PIP coverages. The question in the case is – whether the insured spouse of the person listed as the “named insured” in the declarations page of a policy may reject those coverages.

Statute Of Limitations In Insurance Policy

February 24, 2011 | Mark S. Humphreys

Here is one for policy holders in Grand Prairie, Arlington, Dallas, Fort Worth, Garland, Mesquite, Irving, Richardson, Wylie, Highland Park, Oak Cliff, and other parts of Texas to consider. What is the statute of limitations for sueing under an insurance policy? Well, it depends.

The Texas Civil Practices & Remedies Code, Section 16.051, says:

Every action for which there is no express limitation period, except an action for the recovery of real property, must be brought not later than four years after the day the cause of action accrues.

Examination Under Oath – Insurance

February 22, 2011 | Mark S. Humphreys

A policyholder in Dallas, Fort Worth, Grand Prairie, Arlington, Crowley, Addison, Mesquite, Garland, Carrollton, Richardson, Mansfield, Rendon, or anywhere else in Texas who has a policy of insurance will probably find a provision in that insurance policy that they submit to an examination under oath if the insurance company requests one. Most people might have an idea what that means, but are not positive.

An examination under oath is not a situation where an insurance adjuster talks to you on the phone and asks you for permission to record the interview. The recorded phone interview is requested on almost all claims that are filed. The insurance adjuster likes to get a recorded version of what you are claiming before you have a lot of time to think about what you are saying and before you have a chance to get “lawyered up.” This recorded phone interview is usually completed within a few days of making the claim and in some cases on the same day. The adjuster asks a bunch of questions about whatever the incident is that you are reporting and then based on what you have told them, they begin conducting an independent investigation. The reality is that in most cases the recorded statement does not really hurt the insured’s claim. The problem of course is in the cases where it does hurt. And also, rarely, will the insured know that what seems like innocent statements, can be used as justification for denying the claim or limiting the value of the claim. What is important to know is that a person does not have to agree to a recorded interview.

The examination under oath is a serious matter. When this is being conducted, the insurance company is usually looking for justification for denying the claim. This examination under oath is usually carried out by an attorney who is hired by the insurance company. It usually takes place in the lawyers office. You are usually invited to attend by certified and regular mail. The examination under oath is recorded by a certified court reporter who places you under oath “to tell the truth – the whole truth – and nothing but the truth”, or something to that effect.

Appraisal In Insurance Policies

February 20, 2011 | Mark S. Humphreys

Policy holders in Grand Prairie, Arlington, Dallas, Fort Worth, Flower Mound, Haslet, Saginaw, Newark, Benbrook, Crowley, Cedar Hill, Hutchins, and other places in Texas will wonder what an “appraisal clause” in their insurance policy means. Insurance companies put these in policies because it is a good thing for them. There are ways of getting around these clauses, but an experienced Insurance Law Attorney needs to be consulted.

Many property insurance policies contain appraisal clauses. These clauses define a process for appraising the value of the damaged property, if the parties cannot agree. Common provisions call for each party to choose an appraiser. Those appraisers then choose a neutral third appraiser, called an umpire. If the parties or their appraisers cannot agree on an umpire, either party may petition a court to appoint one. Once the appraisers and umpire are chosen, they value the loss. If all do not agree on the value, the decision of any two will control. The intent is to give the insurance company and the insured a simple, speedy, and fair means of deciding disputed values. This was stated in the Texas Appeals Court in Waco, as far back as 1938. The reality however is that this is not always the case.

When two appraisers do not agree, the umpire does not simply choose between them. It is the duty of the umpire to ascertain and determine, in the exercise of his own judgment and as the result of his own investigation, the values of the disputed items. This is what a San Antonio Appeals Court said in 1994.

Definition Of Residence In Insurance Policy

February 19, 2011 | Mark S. Humphreys

Here is a case for someone in Grand Prairie, Arlington, Weatherford, Mineral Wells, Mansfield, Cedar Hill, Duncanville, De Soto, Granbury, Burleson, Lake Worth, and other places through out the state of Texas to be aware of. The case is styled, State Farm Fire and Casualty Company v. Matthew Lange. The opinion in this case was issued on January 11, 2011, by Judge Keith Ellison, out of the United States District Court, Southern District Texas, Houston Division.

Before getting into the facts and final outcome of this case, it is noteworthy to point out that Mr. Lange did not have an attorney in this case. In other words, he was pro se, or representing himself.

This case arose out of a one-vehicle accident on February 5, 2009. Two of the passengers in Lange’s car were killed as a result of the accident. The sole determination in this case is whether Lange was insured under his parents’ Personal Liability Umbrella Policy (the “Policy”) at the time of the accident.

Assignment Of Insurance Claims

February 17, 2011 | Mark S. Humphreys

Someone in Grand Prairie, Arlington, Dallas, Fort Worth, Grapevine, Colleyville, Keller, North Richland Hills, Roanoke, Azle, Hurst, Euless, Bedford, or anywhere else in Texas who has a claim may run into a situation where they are considering to assign their claim to someone else. There are multiple reasons they might want to do this. Before actually assigning a claim it might be wise to read the following case.

The case is, Nautilus Insurance Company, et al. v. Concierge Care Nursing Centers, Inc., et al. This case was decided by the United States District Court for the Southern District of Texas, Houston Division, on December 23, 2010. Here is some background:

In 1999, Brae Burn Construction Company, Inc. (Brae Burn) entered into a contract to build a skilled nursing facility for Concierge Care Nursing Centers, Inc. (Concierge). Brae Burn entered into subcontracts with Nevco Waterproofing, Inc. (insured by Nautilus Insurance Company), Antex Roofing, Inc (insured by Travelers), Mitchell Chuoke Plumbing, Inc. (insured by Amerisure) and Conex Constructors, Inc. (insured by Evanston). In August 2000, a Certificate of Substantial Completion was issued, and Concierge took possession and control of the building.

Insurance Fraud Article

February 15, 2011 | Mark S. Humphreys

There are many things insured people in Cleburne, Granbury, Aledo, Burleson, Keene, Joshua, Wylie, Roanoke, Keller, Colleyville, and the major cities, like Dallas, Fort Worth, and others need to be aware of as it relates to applying for, or receiving benefits from an insurance policy. A good example of this is found in an article written by Shan Li in the Los Angeles Times.

The article was published on January 25, 2011, and is titled, “Insurers Are Scouring Social Media For Evidence Of Fraud.” Much of the content of the article is included here and is a good read for “one of those things consumers need to be aware of.”

The internet social network sites such as Facebook and Twitter are great sources of information and fun and communication between relatives and friends. One downside to these sites is that other people can find out things that you may not want being public. But as the article tells us, now there’s another reason to be careful about what you post on Facebook and Twitter: “Your insurance company may be watching.”