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<!--Generated by Squarespace Site Server v5.11.81 (http://www.squarespace.com/) on Mon, 28 May 2012 12:31:57 GMT--><feed xmlns="http://www.w3.org/2005/Atom" xmlns:dc="http://purl.org/dc/elements/1.1/"><title>Texas Life Insurance Law Blog</title><subtitle>Texas Life Insurance Law Blog</subtitle><id>http://www.texaslifeinsurancelawyers.com/texas-life-insurance-law-blog/</id><link rel="alternate" type="application/xhtml+xml" href="http://www.texaslifeinsurancelawyers.com/texas-life-insurance-law-blog/"/><link rel="self" type="application/atom+xml" href="http://www.texaslifeinsurancelawyers.com/texas-life-insurance-law-blog/atom.xml"/><updated>2012-04-12T00:36:57Z</updated><generator uri="http://www.squarespace.com/" version="Squarespace Site Server v5.11.81 (http://www.squarespace.com/)">Squarespace</generator><entry><title>Advanced Insurance Law Seminar</title><id>http://www.texaslifeinsurancelawyers.com/texas-life-insurance-law-blog/2012/4/11/advanced-insurance-law-seminar.html</id><link rel="alternate" type="text/html" href="http://www.texaslifeinsurancelawyers.com/texas-life-insurance-law-blog/2012/4/11/advanced-insurance-law-seminar.html"/><author><name>Michael Young</name></author><published>2012-04-12T00:25:45Z</published><updated>2012-04-12T00:25:45Z</updated><content type="html" xml:lang="en-US"><![CDATA[<p>I will be attending the Advanced Insurance Law Seminar in Dallas on April 12 and 13, sponsored by the State Bar of Texas. &nbsp;There are no specific topics on life insurance, but plenty of discussion regarding negotiating with and litigating against insurance companies.&nbsp;</p>]]></content></entry><entry><title>Insurers hold payouts in general accounts</title><id>http://www.texaslifeinsurancelawyers.com/texas-life-insurance-law-blog/2011/12/4/insurers-hold-payouts-in-general-accounts.html</id><link rel="alternate" type="text/html" href="http://www.texaslifeinsurancelawyers.com/texas-life-insurance-law-blog/2011/12/4/insurers-hold-payouts-in-general-accounts.html"/><author><name>Michael Young</name></author><published>2011-12-04T20:58:40Z</published><updated>2011-12-04T20:58:40Z</updated><content type="html" xml:lang="en-US"><![CDATA[<p>A Bloomberg story entitled, <a href="http://www.bloomberg.com/news/2010-07-28/fallen-soldiers-families-denied-cash-payout-as-life-insurers-boost-profit.html" target="_blank">Fallen Soldiers' Families Denied Cash as Insurers Profi</a><a href="http://www.bloomberg.com/news/2010-07-28/fallen-soldiers-families-denied-cash-payout-as-life-insurers-boost-profit.html" target="_blank">t</a>, explores the practice of insurers holding life insurance benefits in their general accounts. Simply put, instead of sending a check to the designated beneficiary for the policy benefit, the insurance company sends the beneficiary a check book.&nbsp; The beneficiary can then write checks against the funds.</p>
<p>What is the problem with this arrangement?&nbsp; For starters, the insurance company typically pays well below market interest rates on the funds.&nbsp; Also, the money is not kept in an FDIC insured account. Instead, the funds are mingled in the general operating accounts of the insurance company:</p>
<p style="padding-left: 30px;">"This unregulated quasi-banking system operated by insurers has none of the protections of the actual banking system. Lawrence Baxter, a professor at Duke University School of Law in Durham, North Carolina, says the potential exists for a catastrophe."</p>
<p>The benefit to the insurance company is obvious: it operates as an unofficial bank and is able to profit from the spread consisting of the difference it pays in interest against the returns it gains by investing the money.</p>
<p><a href="http://www.somlaw.net/areasofpracticedetail.asp?id=6">Texas Insurance Coverage Lawyers</a></p>
<h1 class="disqus_title"></h1>]]></content></entry><entry><title>The insurer's duty of good faith and fair dealing</title><id>http://www.texaslifeinsurancelawyers.com/texas-life-insurance-law-blog/2011/11/26/the-insurers-duty-of-good-faith-and-fair-dealing.html</id><link rel="alternate" type="text/html" href="http://www.texaslifeinsurancelawyers.com/texas-life-insurance-law-blog/2011/11/26/the-insurers-duty-of-good-faith-and-fair-dealing.html"/><author><name>Michael Young</name></author><published>2011-11-27T01:38:50Z</published><updated>2011-11-27T01:38:50Z</updated><content type="html" xml:lang="en-US"><![CDATA[<p><span class="full-image-float-left ssNonEditable"><span><img src="http://www.texaslifeinsurancelawyers.com/storage/shutterstock_74136301.jpg?__SQUARESPACE_CACHEVERSION=1322358930233" alt="" /></span></span>Texas law imposes a general duty of good faith and fair dealing on isurance companies.&nbsp; In essence, it means that an insurance company has a duty to deal fairly and in <span id="co_term_279" class="co_searchTerm">good</span> <span id="co_term_280" class="co_searchTerm">faith</span> with an insured.&nbsp; The duty is imposed because of the following public policy reasons:</p>
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<div class="co_paragraphText">the unequal bargaining power which would allow unscrupulous insurers to take advantage of their <span id="co_term_353" class="co_searchTerm">insureds</span>' misfortunes in bargaining for settlement or the resolution of claims;</div>
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<div class="co_paragraphText">&nbsp;without such a <span id="co_term_368" class="co_searchTerm">duty</span>,  insurers could arbitrarily deny coverage and delay payment of the claim  with no more penalty than the interest on the amount owed; and</div>
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<div class="co_paragraph">
<div class="co_paragraphText">an <span id="co_term_394" class="co_searchTerm">insurance</span> company has the exclusive control over the evaluation, processing and denial of claims.</div>
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<p>Unfortunately, the Texas Supreme Court has gradually chipped away at policy holder rights as the insurance industry has gained political power in Austin over the past dozen or so years.&nbsp; It is important to contact a lawyer if you believe you or your business in Texas are not being dealt with reasonably by an insurance company.</p>
<p><a href="http://www.somlaw.net/areasofpracticedetail.asp?id=6">Texas Life Insurance and Coverage Law Firm</a></p>]]></content></entry><entry><title>Houston federal court rejects insurer's claim denial</title><id>http://www.texaslifeinsurancelawyers.com/texas-life-insurance-law-blog/2011/6/13/houston-federal-court-rejects-insurers-claim-denial.html</id><link rel="alternate" type="text/html" href="http://www.texaslifeinsurancelawyers.com/texas-life-insurance-law-blog/2011/6/13/houston-federal-court-rejects-insurers-claim-denial.html"/><author><name>Michael Young</name></author><published>2011-06-14T02:33:38Z</published><updated>2011-06-14T02:33:38Z</updated><content type="html" xml:lang="en-US"><![CDATA[<p>Gilberto Espinoza, an employee of Houston-based Defendant Becon Construction Company, died in an automobile accident in Kentucky. His blood alcohol levels showed he was legally intoxicated.&nbsp; Life Insurance Company of North America denied his widow's claim for acidental death benefits.&nbsp; The insurance company claimed the death was not an "accident" because it was not &ldquo;a sudden, unforeseeable event."&nbsp; In essence, the insurance company contended that because Espinoza &ldquo;would have been aware of the risks involved in  operating his vehicle while under the influence,"&nbsp; his death was a  foreseeable result of his actions and thus not an accident.</p>
<p><a href="http://tx.findacase.com/research/wfrmDocViewer.aspx/xq/fac.20110415_0000597.STX.htm/qx">In a well-reasoned opinion</a>, the Houston federal district court ruled against the insurance company and its attempt to craft a per se rule that driving while intoxicated is never an accident.&nbsp; Had the insurance company wanted to enforce such an exlusion, it should have explicitly been stated in the policy.</p>
<p>&nbsp;</p>
<p><a href="http://www.somlaw.net/areasofpracticedetail.asp?id=6">Texas Accidental Life Insurance Lawyer</a></p>]]></content></entry><entry><title>Expose: Insurers Dodge Payouts</title><id>http://www.texaslifeinsurancelawyers.com/texas-life-insurance-law-blog/2011/3/3/expose-insurers-dodge-payouts.html</id><link rel="alternate" type="text/html" href="http://www.texaslifeinsurancelawyers.com/texas-life-insurance-law-blog/2011/3/3/expose-insurers-dodge-payouts.html"/><author><name>Michael Young</name></author><published>2011-03-04T01:47:32Z</published><updated>2011-03-04T01:47:32Z</updated><content type="html" xml:lang="en-US"><![CDATA[<p><a href="http://www.bloomberg.com/news/2011-03-01/accidental-death-becomes-suicide-when-insurers-dodge-paying-life-benefits.html">Bloomberg</a> has a feature story on insurance companies refusing to pay valid claims. According to the article, insurers will find creative reasons to deny claims.&nbsp; These denials pay off, because beneficiaries often don't consult attorneys or want to fight a legal battle.&nbsp; The abuses are particularly common when the policy is purchased through an employer.&nbsp; Those policies are covered by the Employee Retirement Security Act, better known as ERISA. Unfortunately, life insurance claim denials are not uncommon in Texas.</p>
<p><a href="http://www.txprobatelitigation.com/life-insurance/">Texas Life Insurance Claim Denial Attorneys</a></p>
<p>&nbsp;</p>]]></content></entry><entry><title>Federal Court rejects effort to rescind policy</title><id>http://www.texaslifeinsurancelawyers.com/texas-life-insurance-law-blog/2011/2/7/federal-court-rejects-effort-to-rescind-policy.html</id><link rel="alternate" type="text/html" href="http://www.texaslifeinsurancelawyers.com/texas-life-insurance-law-blog/2011/2/7/federal-court-rejects-effort-to-rescind-policy.html"/><author><name>Michael Young</name></author><published>2011-02-08T02:20:26Z</published><updated>2011-02-08T02:20:26Z</updated><content type="html" xml:lang="en-US"><![CDATA[<p>In <em>Federated Life Insurance Company v. Jafreh</em>, the life insurance company attempted to rescind a policy over six years after it was issued. The insurance company claimed the insured had misrepresented his health status in the policy application.&nbsp; Both the District Judge in Houston and the Fifth Circuit Court of Appeals rejected this effort and found the insurance company liable for the benefits along with 18% penalty interest.</p>
<p><a href="http://www.somlaw.net/areasofpracticedetail.asp?id=6">Texas Life Insurance Dispute and Denial Law Firm</a></p>]]></content></entry><entry><title>Texas insurance commissioner forbids discretionary clauses</title><id>http://www.texaslifeinsurancelawyers.com/texas-life-insurance-law-blog/2010/12/7/texas-insurance-commissioner-forbids-discretionary-clauses.html</id><link rel="alternate" type="text/html" href="http://www.texaslifeinsurancelawyers.com/texas-life-insurance-law-blog/2010/12/7/texas-insurance-commissioner-forbids-discretionary-clauses.html"/><author><name>Michael Young</name></author><published>2010-12-07T14:44:43Z</published><updated>2010-12-07T14:44:43Z</updated><content type="html" xml:lang="en-US"><![CDATA[<p>Life insurance companies in Texas will no longer be able to rely on so-called discretionary clauses to deny claims. These clauses give insurance companies the right to deny claims based on their own interpretation of policy provisions. Such interpretations can be difficult to overturn in court.&nbsp; A <a href="http://www.dallasnews.com/sharedcontent/dws/news/politics/state/stories/DN-healthinsure_07tex.ART.State.Edition1.43c1819.html#slcgm_comments_anchor">Dallas Morning News</a> article focuses on the problem:</p>
<p><span style="font-size: 80%;">
<p style="padding-left: 30px;">"Health, life  and disability insurers will no longer have blanket authority to decide  what their policies do and don't cover in Texas, under rules approved  Monday by Insurance Commissioner Mike Geeslin.</p>
<p style="padding-left: 30px;">The decision, which  was sought by the state consumer advocate for insurance, ends  long-standing provisions in most health and disability plans &ndash; called  discretionary clauses &ndash; that give insurers the right to interpret their  policies and decide what benefits must be paid.</p>
<p style="padding-left: 30px;">In formally  adopting the new rules, Geeslin wrote that the discretionary powers of  companies "are unjust, encourage misrepresentation and are deceptive  because they mislead consumers regarding the terms of coverage" in their  policies.</p>
<p style="padding-left: 30px;">Prohibiting those provisions, the commissioner said,  will protect consumers from "incorrect and unfair coverage  determinations by insurers and HMOs without a subsequent opportunity for  a full and independent review" of their claims."</p>
<p style="font-size: 120%;"><span >This decision by the Texas Insurance Commissioner was long overdue and levels the playing field somewhat between insurance companies and consumers.</span></p>
</span></p>]]></content></entry><entry><title>Fifth Circuit overturns denial of benefits</title><id>http://www.texaslifeinsurancelawyers.com/texas-life-insurance-law-blog/2010/7/7/fifth-circuit-overturns-denial-of-benefits.html</id><link rel="alternate" type="text/html" href="http://www.texaslifeinsurancelawyers.com/texas-life-insurance-law-blog/2010/7/7/fifth-circuit-overturns-denial-of-benefits.html"/><author><name>Michael Young</name></author><published>2010-07-07T17:06:26Z</published><updated>2010-07-07T17:06:26Z</updated><content type="html" xml:lang="en-US"><![CDATA[<p>Life insurance cases under ERISA can be difficult, because courts review the insurance company's denial under an abuse of discretion standard.&nbsp; Essentially, this means the courts consider whether the insurer had a reasonable basis for the denial, with substantial evidence in support.&nbsp; However, courts do not seek to determine if the insurer made the "right" decision.&nbsp; Furthermore, in ERISA cases there is no jury available to review the insurer's denial. This standard gives plenty of leeway for the insurer to find a reason to deny benefits.</p>
<p>In a recent case, however, the Fifth Circuit Court of Appeals overturned a district court's decision upholding Unum Life Insurance Company's denial of benefits. While the <a href="http://www.ca5.uscourts.gov/opinions%5Cunpub%5C08/08-51106.0.wpd.pdf">decision</a> dealt with disability insurance instead of life insurance, the legal concepts at issue are similar in both contexts.&nbsp; The Fifth Circuit disagreed with the trial court that Unum had not abused its discretion. The Fifth Circuit appeared troubled that Unum pressured its consulting physician to rule that the claimant was not disabled, even though the physician was not provided with an MRI he had previously deemed important to review.&nbsp; Furthermore, Unum based its denial on opinions from its own paid physicians that were somewhat vague and certainly less than concrete.</p>
<p><a href="http://www.texaslifeinsurancelawyers.com/">Life insurance claim denied texas</a></p>]]></content></entry><entry><title>Rescission of life insurance policy during contestability period</title><id>http://www.texaslifeinsurancelawyers.com/texas-life-insurance-law-blog/2010/5/4/rescission-of-life-insurance-policy-during-contestability-pe.html</id><link rel="alternate" type="text/html" href="http://www.texaslifeinsurancelawyers.com/texas-life-insurance-law-blog/2010/5/4/rescission-of-life-insurance-policy-during-contestability-pe.html"/><author><name>Michael Young</name></author><published>2010-05-05T02:06:43Z</published><updated>2010-05-05T02:06:43Z</updated><content type="html" xml:lang="en-US"><![CDATA[<p>Insurance companies routinely try to find a reason to rescind a policy.&nbsp; The reason rescission is a favorite tactic is because it is so powerful.&nbsp; Why fight over whether a particular claim is covered if the insurance company can simply obtain a finding that the entire policy never existed?</p>
<p>Generally a life insurance company can rescind a policy purchased within two years of the insured's death if it proves the application contained a misrepresentation.&nbsp; However, under the Texas Insurance Code, it must be shown that such misrepresentation:</p>
<p><span id="mDocumentText_ctl00_mTextDisplay" class="DocumentBody"><a name="I02B74140B76F11DDA50EFA1EDC14A9B5"></a><a name="I02B5E1B0B76F11DDA50EFA1EDC14A9B5"></a>
<div style="margin-left: 12px;"><a name="SP;f1c50000821b0"></a>(1) is of  a material fact;  and</div>
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<div style="margin-left: 12px;"><a name="SP;58730000872b1"></a>(2)  affects the risks assumed</div>
<div style="margin-left: 12px;">.</div>
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<div style="margin-left: 12px;">Texas Insurance Code: Section 705.051</div>
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<div style="margin-left: 12px;">You should immediately contact an experienced life insurance attorney if you have a claim denied or contested due to an alleged policy misrepresentation.</div>
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<div style="margin-left: 12px;"><a href="http://www.somlaw.net/areasofpracticedetail.asp?id=6">Life insurance de</a><a href="http://www.somlaw.net/areasofpracticedetail.asp?id=6">nial lawyer in Texas</a></div>
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</span></p>]]></content></entry><entry><title>Selling life insurance the latest hot job?</title><id>http://www.texaslifeinsurancelawyers.com/texas-life-insurance-law-blog/2010/4/14/selling-life-insurance-the-latest-hot-job.html</id><link rel="alternate" type="text/html" href="http://www.texaslifeinsurancelawyers.com/texas-life-insurance-law-blog/2010/4/14/selling-life-insurance-the-latest-hot-job.html"/><author><name>Michael Young</name></author><published>2010-04-15T03:05:36Z</published><updated>2010-04-15T03:05:36Z</updated><content type="html" xml:lang="en-US"><![CDATA[<p>According to the <a href="http://online.wsj.com/article/SB10001424052748703954904575110163185399210.html" target="_blank">Wall Street Journal</a>, selling life insurance is a career returning to popularity.&nbsp; A major factor is the vast layoffs in other financial services sectors.&nbsp; Also, the resurgance in whole life policies creates a need for sales staff:</p>
<p style="padding-left: 30px;"><span style="font-size: 80%;">One factor turning this around is the way insurers' core product, whole life, came through the financial crisis. Competing term insurance, priced much lower, was sold on the pitch "Buy term and invest the difference." But when stocks plunged early on in the financial crisis, "invest the difference" sometimes meant "lose the difference." By contrast, money paid for whole life was still there.</span></p>
<p style="padding-left: 30px;"><span style="font-size: 80%;">Term-life sales were flat in the second half of 2009, according to Limra, while sales of whole-life policies were up 12% from a year earlier.</span></p>
<p style="padding-left: 30px;"><span style="font-size: 80%;">Whole life, given its complexity, generally isn't sold via the Internet, but needs an agent to explain it. So now the insurers that specialize in whole life are capitalizing on the more positive light in which it is viewed, adding agents.</span></p>
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