Dallas Fort Worth Insurance Lawyer Blog

Pre-existing Coverage For Children?

April 2, 2010 | Mark S. Humphreys

Anybody with children in Grand Prairie, Arlington, Mansfield, Fort Worth, Dallas, or out in Weatherford would want to know how the new federal health bill is being interpreted by lawyers and insurance companies. This was the topic of a recent article in The New York Times.

The article is titled “Coverage Now for Sick Children? Check Fine Print.” This article was published on March 28, 2010. This was right after the new federal health care law was signed into law by President Obama.

One selling point for the new law was that pre-existing conditions coverage for children would immediately go into effect. The reality is that it probably does not. The health insurance companies agree that they must cover pre-existing conditions for children already covered by a policy of insurance. That has consistently been the case. But, the health insurers argue that the new law does not require them to write new insurance for a child and it does not guarantee the “availability of coverage” for all until 2014.

Standing As It Relates To Intended Third Party Beneficiaries In Texas

April 1, 2010 | Mark S. Humphreys

How does someone living in Grand Prairie, Arlington, Fort Worth, Dallas, or Weatherford know whether or not they are entitled to benefits under an insurance policy? Let’s see if this helps.

In the case, Palma v. Verex Assurance, Inc., a 5th Federal Circuit case, the court stated that an intended third party beneficiary may sue under the Texas Insurance Code statutes. This Federal Court reviewed Texas cases and other Fifth Circuit cases and concluded that “if the Texas Supreme Court were presented with the question before us it would hold that standing under Article 21.21 (now Chapter 541.001) is satisfied by not only those who can establish privity of contract or reliance on a representation of the insurer, but also by those who can establish that they were an intended third party beneficiary of the insurance contract.” In this case the court set out the standards under Texas law for third-party beneficiary status:

1) the claimant was not privy to the written agreement between the insured and insurer;

“Standing”? In Texas Insurance Law

March 30, 2010 | Mark S. Humphreys

A Grand Prairie life insurance policy holder passes away. His beneficiaries live in Dallas, Fort Worth, Arlington, Weatherford, and Mansfield. Who has “standing”, or the right to enforce the policy of insurance?

Uslegal.com defines “standing” as follows: Standing is the ability of a party to bring a lawsuit in court based upon their stake in the outcome. A party seeking to demonstrate standing must be able to show the court sufficient connection to and harm from the law or action challenged. Otherwise, the court will rule that you “lack standing” to bring the suit and dismiss your case.

As further general information, there are three constitutional requirements to prove standing:

Deceptive Trade Practices And Insurance Code

March 29, 2010 | Mark S. Humphreys

A few things for people in Dallas, Fort Worth, Grand Prairie, and Arlington to know. First, and most important would be to seek the help and advice of an experienced Insurance Law Attorney when having arguements with an insurance company. The second, is to use the Texas Department of Insurance web-site as a source of some information.

The Texas Insurance Code and the Deceptive Trade Practices Act (DTPA), which is found in the Texas Business & Commerce Code, were adopted together in 1973 by the Texas legislature as part of a package of reform legislation, are interrelated, and incorporate each other. Thus, as is stated by the Texas Supreme Court in the case, State Farm Life Insurance Company v. Beaston, in 1995, and in, Vail v. Texas Farm Bureau Mutual Insurance Company, in 1988; Courts construe the two statutes together.

Texas Insurance Code, Section 541.008, clearly states that the provisions of the code are to be liberally construed and applied to promote the underlying purposes which are to define and prohibit unfair and deceptive insurance practices.

Texas Insurance And The Deceptive Trade Practices Act

March 28, 2010 | Mark S. Humphreys

Grand Prairie residents and residents of Arlington, Fort Worth, Dallas, Weatherford, and every other town in Texas should know a few things about holding insurance companies accountable. One is, they should always report wrongs to the Texas Department of Insurance. The other thing they should do is contact an experienced Insurance Law Attorney.

An attorney will discuss the fact that remedies for the wrongs committed by insurance companies are addressed in at least two areas of law in Texas; The Texas Insurance Code and the Texas Business & Comerce Code which contains the laws dealing with violations of the Deceptive Trade Practices Act (DTPA).

The Texas Insurance Code, Section 541.151(2) cross-references and prohibits conduct defined in The Business & Commerce Code, Section 17.46(b) of the DTPA. The latter statute applies to all types of consumer transactions, not just insurance, thus not all of the provisions are relevant to insurance issues. The sections that matter most in insurance cases are:

Unfair Settlement Practices In Texas

March 27, 2010 | Mark S. Humphreys

Grand Prairie residents, residents of Arlington, Mansfield, Fort Worth, Dallas, Weatherford or anywhere else in Texas have the same insurance laws apply to each other. They all need to know there is a law that prohibits unfair settlement practices in the State of Texas.

Texas Insurance Code, Section 541.060, is titled “Unfair Settlement Practices”. It is the law that prohibits these types of actions. The statute prohibits engaging in any of the following settlement practices with respect to a claim by an insured person or his beneficiary:

(1) misrepresenting to a claimant a material fact or policy provision relating to coverage at issue;

Misrepresentations In Texas Insurance

March 26, 2010 | Mark S. Humphreys

Grand Prairie residents and residents of Arlington, Dallas, Fort Worth, Mansfield, Weatherford, and any other town or city in Texas have a right to have their insurance company and agent be honest with them. Misrepresentation of an insurance policy in Texas is illegal under the Texas Insurance Code and Texas Deceptive Trade Practices Act.

The Texas Insurance Code, Section 541.061, states that misrepresentation of an insurance policy in Texas is an unfair method of competition or an unfair or deceptive act or practice in the business of insurance. The title of Section 541.061 is “Misrepresentation of Insurance Policy”.

A violation of this section of the Texas Insurance Code is also a violation of the Texas Deceptive Trade Practices Act. As it relates to insurance misrepresentation, this section of the Insurance Code states that it is illegal to misrepresent features of an insurance policy by:

Subrogation – What Is It?

March 25, 2010 | Mark S. Humphreys

Someone in Grand Prairie has their insurance company pay a benefit for them. Or maybe the person is in Arlington, Dallas, Fort Worth, Mansfield, or out in Weatherford, Texas. When a claim is paid by a person’s own insurance company, and the claim resulted from the fault of another person or company, then the person’s own insurance company has a subrogation right. Well, what does that mean to you?

One web-site defines subrogation as the substitution of one person in the place of another with reference to a lawful claim or right. Subrogation commonly occurs in insurance matters, when an insurance company which pays its insured client for injuries and losses then sues the party which the injured person contends caused the damages.

There are three types of subrogation: equitable, contractual, and statutory.

Prompt Payment Of Claims Act

March 24, 2010 | Mark S. Humphreys

A Grand Prairie resident makes a claim to his insurance company for benefits. This could be a resident of Arlington, Dallas, Fort Worth, Weatherford, or any other city in Texas.

A question often comes up that goes like this, “How long does the insurance company have before they have to pay me?” The answer is “It depends.” Sounds lawyerly, right. Well it does depend. It depends on a number of factors, including the type of claim, the circumstances surrounding the claim, the type of insurance and the type of insurance company. However, guidelines to go by, are laid out in the Texas Insurance Code, Section 542.051 thru 542.061.

This area of the Texas Insurance Code is know as the “Prompt Payment of Claims statute”. It imposes certain deadlines for an insurance company to acknowledge, investigate, and accept or reject a claim. In situations where the insurance company violates the statute, they are punished by being liable for attorney’s fees and an additional 18% per annum penalty on the amount of the claim. These penalties are set out in Section 542.060.

Health Insurer Loses In California

March 23, 2010 | Mark S. Humphreys

It would be interesting to see if what happened out west, would happen here in Texas, with a resident of Grand Prairie, Dallas, Arlington, Fort Worth, Mansfield, or Weatherford. It probably depends on your insurer.

The Los Angeles Times ran an article on March 15, 2010, about a health insurer in California. The title of the article is, “Anthem Blue Cross Should Reimburse California Man For Transplant, Jury Says”.

This article tells about a Los Angeles jury finding that Anthem Blue Cross (Anthem) should cover the cost of an out-of-state liver transplant that a California man paid for after Anthem Blue Cross balked at paying. The liver transplant cost $206,000.