Texas Insurance Law Newsbrief

by Martin, Disiere, Jefferson & Wisdom, LLP
Contact

IN THIS ISSUE: Paid v. Incurred Medical Expenses; Coverage for Settlement of FTC Class Action; Insurable Interest; Twombly & Igbal; Premium Payment as Condition Precedent to Coverage; Duty to Defend; Policy Issuance; Extra-Contractual Abatement; Healthcare Individual Mandate.

PAID VS. INCURRED MEDICAL EXPENSES: TEXAS SUPREME COURT HOLDS THAT ONLY EVIDENCE OF RECOVERABLE MEDICAL EXPENSES IS ADMISSIBLE AT TRIAL.

In a paramount decision, the Texas Supreme Court recently held that only evidence of recoverable medical expenses, meaning those expenses, which have been or must be paid by or for the claimant, is admissible at trial. Haygood v. DeEscobedo, 2011 WL 2601363 (Tex. July 1, 2011).

FIFTH CIRCUIT DENIES COVERAGE OF $263 MILLION SETTLEMENT

On August 5, 2011, the Fifth Circuit Court of Appeals ruled that five insurers need not cover any part of Citigroup Inc.’s $263 million settlement of a statewide class action suit and a Federal Trade Commission action. Citigroup, Inc. v. Federal Insurance Co., 2011 WL 3422073 (5th.Cir. 2011). The class action and FTC action suits alleged that Citigroup's predecessor, Associates First Capital Corporation, misrepresented the benefits of refinancing to customers regarding policies from primary insurer Certain Underwriters of Lloyd’s of London (“Lloyd’s”) and nine excess insurers. Citigroup settled both cases for $263 million, with $15 million paid to Citigroup by Lloyd’s (of its $50 million limits of liability), without obtaining the consent of the excess insurers.

HARRIS COUNTY COURT DISMISSES INSURANCE CLAIMS ASSERTED BY PLAINTIFFS WHO WERE DEEMED NOT TO BE BENEFICIARIES OF THE INSURANCE CONTRACT

Harris County District Judge Mike Miller granted summary judgment to USAA in a homeowner’s policy dispute against plaintiffs represented by The Mostyn Firm in Schramm, et al v. USAA Texas Lloyd’s Company, et al, Cause No. 2009-33822 (August 2011).

GALVESTON FEDERAL COURT GRANTS MOTION FOR LEAVE TO AMEND PLEADINGS, WITH A WARNING THAT TWOMBLY AND IGBAL HAVE NOT RADICALLY ALTERED THE HEIGHTENED FEDERAL PLEADING REQUIREMENT AS OFTEN TOUTED BY DEFENDANTS

Cruz v. Allstate Texas Lloyds and Pilot Catastrophe Services, Inc. 2011 WL 3502772 (S.D. Tex., J. Froeschner, Aug. 10, 2011). The United States District Court in the Southern District of Texas in Galveston granted a plaintiff’s motion for leave to amend its Complaint on August 10, 2011 allowing the plaintiff to add claims against a newly identified individual adjuster assigned by the Defendants to handle a property damage claim following Hurricane Ike.

CORPUS CHRISTI APPEALS COURT HOLDS NO AMBIGUITY IN AN INSURANCE POLICY WHERE THE INSURED MUST PAY PREMIUM AS A CONDITION PRECEDENT TO THE INSURANCE CONTRACT GOING INTO EFFECT

In Becerra v. Ball d/b/a Ball Insurance Agency, 2011 WL 3366361 (Tex.App.—Corpus Christi [13th Dist.] 2011), the Corpus Christi-Edinburg Court of Appeals upheld a motion for summary judgment as to Plaintiff’s breach of contract claims against defendants because Plaintiff failed to pay the premium for the policy which was a condition precedent for the policy to go into effect.

APPELLATE COURT UPHOLDS DISMISSAL OF AN INSURED’S INSURANCE CLAIMS BASED ON A POLICY ENDORSEMENT EVEN THOUGH IT WAS NOT PROVIDED TO THE INSURED IN THE INSURANCE BINDER

On August 4, 2011, the First District Court of Appeals upheld the trial court’s grant of final summary judgment in favor of the Defendant/Appellee Certain Underwriters at Lloyd's, London after finding that the policy at issue contained an endorsement precluding coverage for a fire loss where the insured failed to install and maintain a central fire alarm at the insured property. QB Investments v. Certain Underwriters at Lloyd's, London, 2011 WL 3359683 (Tex.App.—Houston [1st.Dist] 2011).

COURT HOLDS INSURER HAS NO DUTY TO DEFEND AN INSURED WHO WAS NOT NAMED AS A DEFENDANT IN THE LAWSUIT AND WHERE THE INSURED DID NOT TENDER THE LAWSUIT TO THE INSURER.

In a case involving insurance coverage questions under a homeowners policy and related extra-contractual claims, a federal court in Dallas, held that an insurer did not have a duty to defend or indemnify the insured for lawsuits that alleged business-related claims, in which the insured was not a defendant, or that the insured did not tender to the insurer.

HOUSTON COURT OF APPEALS ORDERS SEVERANCE OF AN INSUREDS’ BREACH OF INSURANCE CONTRACT CLAIM FROM THE INSUREDS’ PROMPT PAYMENT CLAIM

On August 11, 2011, the Houston Court of Appeals ordered severance of breach of contract claim from extra-contractual claims and prompt payment claim in an insurance dispute. In re Loya Insurance Co., 2011 WL 3505434 (Tex. App.—Houston [1st Dist.] August 11, 2011)

11TH CIRCUIT COURT OF APPEALS FINDS THE INDIVIDUAL MANDATE IN THE OBAMA HEALTHCARE LEGISLATION UNCONSTITUTIONAL

On Friday, August 12, 0211, a federal appeals court in Atlanta struck down the "individual mandate" portion of the Patient Protection and Affordable

LOADING PDF: If there are any problems, click here to download the file.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© Martin, Disiere, Jefferson & Wisdom, LLP | Attorney Advertising

Written by:

Martin, Disiere, Jefferson & Wisdom, LLP
Contact
more
less

Martin, Disiere, Jefferson & Wisdom, LLP on:

Readers' Choice 2017
Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up using*

Already signed up? Log in here

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
Custom Email Digest
Privacy Policy (Updated: October 8, 2015):
hide

JD Supra provides users with access to its legal industry publishing services (the "Service") through its website (the "Website") as well as through other sources. Our policies with regard to data collection and use of personal information of users of the Service, regardless of the manner in which users access the Service, and visitors to the Website are set forth in this statement ("Policy"). By using the Service, you signify your acceptance of this Policy.

Information Collection and Use by JD Supra

JD Supra collects users' names, companies, titles, e-mail address and industry. JD Supra also tracks the pages that users visit, logs IP addresses and aggregates non-personally identifiable user data and browser type. This data is gathered using cookies and other technologies.

The information and data collected is used to authenticate users and to send notifications relating to the Service, including email alerts to which users have subscribed; to manage the Service and Website, to improve the Service and to customize the user's experience. This information is also provided to the authors of the content to give them insight into their readership and help them to improve their content, so that it is most useful for our users.

JD Supra does not sell, rent or otherwise provide your details to third parties, other than to the authors of the content on JD Supra.

If you prefer not to enable cookies, you may change your browser settings to disable cookies; however, please note that rejecting cookies while visiting the Website may result in certain parts of the Website not operating correctly or as efficiently as if cookies were allowed.

Email Choice/Opt-out

Users who opt in to receive emails may choose to no longer receive e-mail updates and newsletters by selecting the "opt-out of future email" option in the email they receive from JD Supra or in their JD Supra account management screen.

Security

JD Supra takes reasonable precautions to insure that user information is kept private. We restrict access to user information to those individuals who reasonably need access to perform their job functions, such as our third party email service, customer service personnel and technical staff. However, please note that no method of transmitting or storing data is completely secure and we cannot guarantee the security of user information. Unauthorized entry or use, hardware or software failure, and other factors may compromise the security of user information at any time.

If you have reason to believe that your interaction with us is no longer secure, you must immediately notify us of the problem by contacting us at info@jdsupra.com. In the unlikely event that we believe that the security of your user information in our possession or control may have been compromised, we may seek to notify you of that development and, if so, will endeavor to do so as promptly as practicable under the circumstances.

Sharing and Disclosure of Information JD Supra Collects

Except as otherwise described in this privacy statement, JD Supra will not disclose personal information to any third party unless we believe that disclosure is necessary to: (1) comply with applicable laws; (2) respond to governmental inquiries or requests; (3) comply with valid legal process; (4) protect the rights, privacy, safety or property of JD Supra, users of the Service, Website visitors or the public; (5) permit us to pursue available remedies or limit the damages that we may sustain; and (6) enforce our Terms & Conditions of Use.

In the event there is a change in the corporate structure of JD Supra such as, but not limited to, merger, consolidation, sale, liquidation or transfer of substantial assets, JD Supra may, in its sole discretion, transfer, sell or assign information collected on and through the Service to one or more affiliated or unaffiliated third parties.

Links to Other Websites

This Website and the Service may contain links to other websites. The operator of such other websites may collect information about you, including through cookies or other technologies. If you are using the Service through the Website and link to another site, you will leave the Website and this Policy will not apply to your use of and activity on those other sites. We encourage you to read the legal notices posted on those sites, including their privacy policies. We shall have no responsibility or liability for your visitation to, and the data collection and use practices of, such other sites. This Policy applies solely to the information collected in connection with your use of this Website and does not apply to any practices conducted offline or in connection with any other websites.

Changes in Our Privacy Policy

We reserve the right to change this Policy at any time. Please refer to the date at the top of this page to determine when this Policy was last revised. Any changes to our privacy policy will become effective upon posting of the revised policy on the Website. By continuing to use the Service or Website following such changes, you will be deemed to have agreed to such changes. If you do not agree with the terms of this Policy, as it may be amended from time to time, in whole or part, please do not continue using the Service or the Website.

Contacting JD Supra

If you have any questions about this privacy statement, the practices of this site, your dealings with this Web site, or if you would like to change any of the information you have provided to us, please contact us at: info@jdsupra.com.

- hide
*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.