Dallas Fort Worth Insurance Lawyer Blog

Interpreting Insurance Policies

February 1, 2011 | Mark S. Humphreys

Anyone in Grand Prairie, Arlington, Mansfield, Cedar Hill, Duncanville, De Soto, Lancaster, Hurst, Euless, Bedford, Dallas, Fort Worth, or anywhere else in Texas who reads an insurance policy is going to get through with the reading and with their blurred eyes, wonder what they just read. Here is a case where the interpretation of a policy exclusion was at issue.

The case is styled, RLI Insurance Company v. Sylvia Gonzalez; Alma Alicia Gonzalez, Individually and as Representative of the Estate of Hector Gonzalez and as Next Friend of I R G G, a Minor; Hector Gonzalez, Jr. This is a case where the opinion was issued on January 7, 2011, by the United States Court of Appeals for the Fifth Circuit.

This is a lawsuit between family members of a deceased sandblaster and RLI Insurance Company (RLI). The court ultimately ruled in favor of RLI based on a policy exclusion.

Bad Faith And Insurance Contracts

January 30, 2011 | Mark S. Humphreys

How does this stuff work?! That is a question someone in Dallas, Fort Worth, Grand Prairie, Weatherford, Arlington, Mansfield, Irving, or anywhere else in Texas might ask when it comes to insurance contracts and bad faith insurance.

“Insurance coverage claims and bad faith claims are by their nature independent. But, in most circumstances, an insured may not prevail on a bad faith claim without first showing that the insurer breached the contract.” This was stated in the Texas Supreme Court case styled, Liberty National Fire Insurance Company v. The Honorable Ted Akin, decided in 1996.

The case is called a mandamus proceeding.

Disability Claim Denied

January 29, 2011 | Mark S. Humphreys

If someone in Dallas, Fort Worth, Grand Prairie, Arlington, Irving, Mesquite, Garland, Richardson, Plano, Coppell, Mansfield, Cedar Hill, or anywhere else in Texas has a claim under their disability insurance policy denied, what can be done?

Start with the legal reality that an insurance policy is a contract. When a party to a contract is obligated by the contract to another, absolutely repudiates the obligation without justification, the obligee is “entitled to maintain his action in damages at once for the entire breach, and is entitled in one suit to receive in damages the present value of all that he would have received if the contract had been performed, and he is not compelled to resort to repeated suits to recover the monthly payments.” This was stated in the 1937, Texas Supreme Court case, Universal Life & Accident Insurance Company v. Sanders.

Here are some of the facts of the Sanders case:

Insurance Policies Are Contracts

January 27, 2011 | Mark S. Humphreys

Someone in Grand Prairie, Arlington, Mansfield, Dallas, Fort Worth, Cedar Hill, Duncanville, De Soto, Benbrook, Burleson, Cleburne, Weatherford, Granbury, or just about anywhere else in Texas might ask; What is the difference between an insurance policy and a contract!

Here is the answer – An insurance policy is a contract. Insurance policies are contracts, and as such are subject to rules applicable to the rules governing contracts. The Texas Supreme Court had this argued before them in a 1994 case styled, Hernandez v. Gulf Group Lloyds. In the case, the Texas Supreme Court affirmed this legal position regarding insurance policies.

A person who is sueing, that is, seeking to recover on an insurance contract must prove that the contract was in force at the time of the loss. Also, the person who is claiming under a policy is required to produce the insurance contract upon which he sues or to prove its terms. That is what the Tyler Court of Appeals stated in 1975, in the case Hartford Accident and Indemnity Company v. Spain.

Home Owners Policy

January 25, 2011 | Mark S. Humphreys

Not many people in Dallas, Fort Worth, Grand Prairie, Arlington, Mansfield, Cedar Hill, Duncanville, De Soto, Lancaster, or elsewhere in North Texas have to worry about an issue that some gulf coast residents have to be concerned about. That is the drywall cases that have resulted from hurricane Katrina and hurricane Ike.

The Miami Herald published an article on January 3, 2011. The article is titled, Drywall Insurance Coverage Still Possible.” It was writen by Duane Marseller. Much of the article is quoted here.

The drywall cases are cases that resulted after hurricanes where homes were damaged. When this occurred there were a large number of homes that were repaired using a drywall product that was manufactured in China. It turned out that the drywall product was defective.

Theories Of Recovery In Insurance Cases

January 23, 2011 | Mark S. Humphreys

Weatherford, Parker County, Aledo, Azle, Mineral Wells, and other residents through out Texas would wonder what are the different ways of recovering losses that result from an insurance company or insurance company agent doing something wrong in the sale of an insurance policy.

The Texas Department of Insurance has a web-site that provides some information about insurance companies and insurance agents. There is also information at this site about insurance adjusters.

The Texas Supreme Court hears and issues opinions about situations that have happened across the state dealing with insurance related issues. Plus the lower appeals courts and the local courts have to hear and decide on insurance related cases on a fairly regular basis.

Negligent Misrepresentation

January 22, 2011 | Mark S. Humphreys

People in Grand Prairie, Dallas, Fort Worth, Arlington, Mansfield, Garland, Mesquite, Rowlette, De Soto, Cedar Hill, Duncanville, and other places in Texas would like to think that people are honest with them in their business dealings. The majority of the time, this is true. Rarely does someone intentionally lie about a subject, but occassionly a misrepresentation is made, not on purpose, but accidently. When this is done it is called negligent misrepresentation.

Here is an example of negligent misrepresentation. This is from a 2003 case styled, New York Life Insurance Company, et al v. Phillip M. Miller. This case was decided by the Texas Court of Appeals, Austin.

Here is some background:

First Party Theories Of Recovery

January 20, 2011 | Mark S. Humphreys

Insureds in Dallas, Fort Worth, Grand Prairie, Mansfield, Cedar Hill, De Soto, Duncanville, Red Oak, Lancaster, Arlington, Forest Hills, and other places in Texas do not really understand the different parts of insurance transactions. Let’s try to get an understanding and be more educated about insurance transactions.

To understand the different ways disputes can arise, it is helpful to consider the sequence of events that is likely to occur. At its very simplest, the insurance transaction can be divided into the initial sale of the policy, and subsequent handling of claims. These can be broken down further to include:

(1) The sale of the policy: Initially, the consumer and insurer or insurer’s agent must communicate to establish a contractual relationship. Disputes may arise over what was asked for by the applicant, what was represented by the insurer or agent, or the timeliness of the insurer or agent in providing coverage. Issues may also arise about the truthfulness of the applicant or agent in disclosing information requested by the insurer;

Disability Policies – Illness Versus Accident

January 18, 2011 | Mark S. Humphreys

Someone is Burleson, Granbury, Cleburne, Bembrook, Crowley, Dallas, Fort Worth, Grand Prairie, Arlington, or any other place in Texas who has a disability insurance policy probably is not sure exactly how the policy works. Most people who have these types of policies get them through their job. When obtained through work the person usually gets a pamplet explaining some of the benefits but rarely is much attention paid to it. A few people will purchase them through an independent insurance agent who explains the coverage but even then, the explanation is quickly forgotten or not completely understood.

The Beaumont Court of Appeals decided a case in 1978, dealing with an insurance policy. The policy had different periods of disability that applied depending on whether the disability resulted from an accident or an illness. The style of the case is, Lone Star Life Insurance Company v. Joseph B. Griffin.

At the trial level, Griffin obtained a judgment against Lone Star Life Insurance Company (Lone Star). Lone Star appealed.

Total Disability Coverage

January 16, 2011 | Mark S. Humphreys

Disability income insurance coverage for someone in Grand Prairie, Dallas, Fort Worth, Arlington, Bedford, Euless, Hurst, Lake Worth, Aledo, or anywhere else in Texas is usually expensive. In addition to being expensive, the policy language is sometimes difficult to interpret.

Disability income policies typically specify an amount that will be paid in the event of a disability (as defined in the policy) and a maximum length of a disability (as defined in the policy) and a maximum lenght of time for which such benefits will be paid (e.g., “$200 per month for up to 60 months”).

A beginning place to look to see how Texas regulates disability income insurance policies is the Texas Administrative Code. Title 28, Part 1, Chapter 3, Subchapter S, Rule Section 3.3005 deals with the definitions in policies. It reads: