Weatherford lawyers who handle insurance cases need to be able to read and understand a declarations page. So should attorneys in Mineral Wells, Aledo, Springtown, and other parts of Parker County and Palo Pinto County.
The insuring clause is the insurance company’s agreement to provide coverage to the insured. One policy may include several insuring clauses.
The insuring clause is the foundation of the agreement and forms the basis for all obligations owed to the insured. Unless this clause provides coverage for a claim, it is unlikely that any other term of the policy will do so.
The insuring clause usually sets forth the following qualifications for the coverage provided by the policy:
1) who is covered by the policy;
2) what type of loss or damage is covered by the policy;
3) what type of activity or peril is covered by the policy.
Policy forms typically contain numerous exclusions that restrict or eliminate coverage provided by the insuring clause.
In fact most of the several pages of an insurance policy address the exclusions and limitations of the policy.
Insurance policies always impose certain conditions on the coverage provided by the policy. In general, conditions impose certain duties on the insured that the insured must follow in order to be eligible to recover on a claim.
Conditions may be included in a separate section of the policy captioned “Conditions,” or they may be stated in policy clauses, definitions, or exclusions.
All first-party property forms contain provisions regulating when a claim must be made under the policy and how the insured must document the loss.
Here is something for Texas policyholders to know:
The Texas Auto Policy requires:
“We (the insurance company) must be notified promptly of how, when and where the accident or loss happened. Notice should also include the names and addresses of any insured persons and of any witnesses. If we show that your failure to provide notice prejudiced our defense, there is no liability coverage under the policy.”
Under Texas law, to determine whether an insured has give notice “promptly,” all circumstances are considered including the insured’s age, experience, capacity for understanding and knowledge. This guideline was spoken to by the El Paso Court of Appeals in 1970.
To deny coverage because of late notice, the insurance company must show that it was prejudiced by the late notice. This was addressed by the Houston Court of Appeals, 1st Dist. in 1993.
Also, it is important to realize that policies either expressly or impliedly require the cooperation of the insured in the investigation, evaluation, and processing of a claim.
A typical Texas Auto Policy reads:
“A person seeking any coverage must: (1) cooperate with us in the investigation, settlement or defense of any claim or suit; and (2) properly send us copies of any notices or legal papers received in connection with the accident or loss.”
The Texas Supreme Court, in 1978, said in an opinion that the insured’s cooperation regarding the claim is a condition precedent to coverage. In that case, the insured’s failure to forward lawsuit papers was a breach of policy conditions and precluded the insured’s claim for coverage.
An experienced insurance law attorney can give proper guidance on the extent of the cooperation that needs to be given to the insurance company.
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