Dallas Fort Worth Insurance Lawyer Blog

Claims – Segregating Damages

June 30, 2019 | Mark S. Humphreys

For Insurance Attorneys, here is a case that is important to know and understand. The case is from the Western District of Texas, San Antonio Division. It deals with segregation of damages when required under an insurance policy. The case is styled, Mark Sadovsky v. Nationwide Property and Casualty Insurance Company.

Sadovsky had a home owners policy with Nationwide on April 12, 2016, when he suffered alleged hail and wind storm damage to his home. On April 20, 2016, he submitted a claim and Nationwide eventually paid the claim and closed the claim.

In the spring of 2017, Sadovsky noticed several neighbors having their roofs repaired. A neighbors contractor inspected the roof and informed Sadovsky of unrepaired hail damage and informed Sadovsky that the costs of repair would be $68,372.89.

Prompt Notice To Insurance Company Of Claim

June 29, 2019 | Mark S. Humphreys

Insurance attorneys know that a requirement of most insurance policies is that an insured give prompt notice to their insurance company of any claim. This is illustrated in a recent Western District of Texas, San Antonio Division opinion styled, Mark Sadovshy v. Nationwide Property and Casualty Insurance Company.

This lawsuit arises out of a hail and wind damage claim filed by Sadovshy against Nationwide. Sadovsky sued Nationwide for violations of the Texas Insurance Code and Breach of Contract. This case is being decided now on a Motion For Summary Judgment filed by Nationwide.

Nationwide claims it is entitled to summary judgment because Sadovsky failed to perform under the insurance contract by timely notifying Nationwide of his claim for damages.

Timely Naming A Defendant In Federal Court

June 26, 2019 | Mark S. Humphreys

When insurance lawyers know of a defendant who could be named in a lawsuit, they need to sue that defendant immediately. Waiting until after a non-diverse defendant has removed the case to Federal Court may be waiting too long. This is illustrated in the Southern District of Texas, Houston Division, opinion styled, Ali Duhaly v. The Cincinnati Insurance Company.

Duhaly sued Cincinnati in State Court alleging Cincinnati was liable for injuries incurred in a car wreck with Broderick Williams. But, in the lawsuit Duhaly did not sue Williams until after the case was removed to Federal Court. Cincinnati alleges the attempt to sue Williams after removal is only an attempt to defeat diversity jurisdiction.

Federal Rule of Civil Procedure 15(a) states that the court should freely give leave to amend when justice so requires. But this is not automatic. The Fifth Circuit has said that when a party seeks to amend to add a new, non-diverse party, the amendment should be closely scrutinized.

Negligent Misrepresentation

June 23, 2019 | Mark S. Humphreys

Here is a case where the insured’s are claiming the agent misrepresented a policy. The style of the case is Frederic Muratore and Lillian Muratore v. Texas Farmers Insurance Company, and McKenzie Shoaf. The case is from the Southern District of Texas, Houston Division.

The Muratore had purchased flood insurance from Farmers as was required by their mortgage lender. When the mortgage was paid off they asked their agent, Shoaf, to get them a less expensive flood insurance policy and coverage with at least $265,000. The agent represented he did as requested.

The Muratore’s home was damaged in Hurricane Harvey and a claim was made to Farmers. At this time, the Muratore’s learned the flood policy they got from Shoaf only provided up to $400 of coverage.

Life Insurance And Interpleader Action

June 22, 2019 | Mark S. Humphreys

Life insurance lawyers will get calls from people who may or may not be entitled to life insurance proceeds after someone has died. In these situations, that being situations where more than one person is making a claim for life insurance benefits, the insurance company will usually file a lawsuit against the claimants. In the lawsuit the insurance company will inform the Court that a person has died, that the life insurance company is unsure who the correct person is to receive the life insurance proceeds, and then asks the Court to make the determination and to allow the insurance company to get out of the lawsuit while the people contesting for the insurance benefits remain in the lawsuit. This is called an Inter-Pleader Action.

This was situation in a lawsuit in the U.S. Southern District of Texas, Houston Division, recently. The case is styled, Colonial Life & Accident Insurance Company v. Aletha Burke Wade, Serbrina Wade, Lekisha Wade, and Frank Hollingsworth.

Kendrick Wade purchased a Life Policy in 2012 and designated his mother, Helen Wade, as beneficiary. In 2014, Kendrick purchased an Accidental Death Policy designating his sisters, Lekisha and Serbrina, as co-equal beneficiaries. Kendrick married Aletha Wade in 2015 and never amended the policies to name her as a beneficiary. Kendrick was killed in December 2017. Helen pre-deceased Kendric and the terms of the Life Policy made Kendrick’s estate the primary beneficiary.

Press Release # 13

June 20, 2019 | Mark S. Humphreys

There are lots of difficult cases insurance lawyers will see, but here is one that is hard to too.

Mark Humphreys, P.C., announces the settlement of a life insurance case wherein the beneficiaries claim for benefits was declined due to the assertion by the insurance company that the insured intentionally lied on his application for life insurance.

The insured, at the time of applying for life insurance, had been diagnosed with diabetes. The diabetes had become so severe that he had a partial leg amputation by the time the life insurance was purchased.

Fraud Allegations Against The Adjuster

June 19, 2019 | Mark S. Humphreys

Experienced Insurance Lawyers understand that insurance companies want to litigate cases in Federal Court and that the insurance companies will use any method they can to have the case in Federal Court.

A recent case from the Western District of Texas, Austin Division, which is styled, Davis v. Travelers Lloyds of Texas Ins. Co., issued an opinion denying Travelers efforts to litigate in Federal Court.

Davis filed suit in State Court alleging that he had a homeowners policy with Travelers insuring his residence and after sustaining water damage to his home, he filed a claim under the policy. The adjuster assigned to the claim by Travelers was Rick Limer.

ERISA Disability Claim Denied

June 16, 2019 | Mark S. Humphreys

Here is yet another ERISA claim being denied by the Federal Courts. This case is from the United States Fifth Circuit Court of Appeals and is styled, Deo G. Shanker v. United Omaha Life Insurance Company.

The District Court granted United’s summary judgment motion and this appeal followed.

Shanker was President of a company called Intracare and United was the insurer under an ERISA plan which provided for long-term-disability (LTD) benefits. To qualify for LTD benefits, Shanker had to become “Disabled due to an Injury or Sickness, while insured under the Policy.” Disabled is defined to mean: “Because of Injury or Sickness, a significant change in Your mental or physical functional capacity has occurred in which you are prevented from performing at least one of the Material Duties of Your Regular Occupation on a part-time or full-time basis ….” Material Duties is defined as “the essential tasks, functions, and operations relating to an occupation that cannot reasonably omitted or modified” and includes “the ability to work for an employer on a full-time bases.” Regular Occupation is defined as “the occupation You are routinely performing when Your Disability begins.” The definition in the policy also notes:

Insurance Claim And Allegations Of Arson

June 15, 2019 | Mark S. Humphreys

In situations where the insurance company is denying a claim based on their allegation that the claim involves arson, Insurance Lawyers would want to be aware of this decision from the Tyler Court of Appeals. The opinion is styled In Re: United Fire Lloyds, Relator. This is a writ of mandamus case.

The insured, Inner Pipe Pipeline, LLC, owned a Commercial Property, Commercial Auto, and Inland Marine policy issued by Lloyds. Inner Pipe’s property was damaged by fire and filed a claim with Lloyds.

Lloyds alleges that Inner Pipe’s owner, Edward Dailey, intentionally set the fire and had the motive, opportunity and means to set the fire, and there is substantial evidence linking Dailey to the fire, thus rendering coverage by Lloyds, void.

Insurance Claim Denial – Water Leak

June 15, 2019 | Mark S. Humphreys

For lawyers who handle claims against insurance companies, here is a case regarding a claim against a homeowners policy and a water leak. The case is from the Western District of Texas, San Antonio Division. The case is styled, William Burman v. State Farm Lloyds. It is a partial summary judgment case.

Burman had a homeowners policy of insurance with State Farm. Burman experienced a water leak and filed a claim. State Farm retained an engineer, Lara, to determine whether the leak caused the foundation to move. Lara’s report stated “that the observed foundation movements are primarily the result of seasonal moisture changes, and vegetation effects. Also, that a line identified by American Leak Detection was leaking and exacerbated the foundation movements in an isolated area of the residence.

The area effected by the leak was paid for by State Farm but the claim for other areas was denied asserting the foundation problems predated the leak and the leak damage did not warrant underpinning.