Insurance attorneys know about the statutory requirements of making a claim. These rules can be looked up in the Texas Insurance Code. The problem arises when the insurance companies do not comply with these rules. So, what are some of these rules.
Start with Texas Insurance Code, Section 542.056(a). This statute requires an insurance company to give written notice it is accepting or rejecting a claim. A telephone call from the insurance company adjuster notifying the insured of the amount of the loss will not constitute “notice of payment of claim, because the statute requires that the acceptance or rejection be in writing. This writing requirement is discussed in the Houston Court of Appeals [14th Dist.] opinion styled Daugherty v. American Motorists Insurance Company.
However, an insurance company’s written response acknowledging only that a claim has been received does not constitute an acceptance or rejection under the statute according to a Corpus Christi Court of Appeals opinion styled, Northern County Mutual Insurance Company v. Davalos.
The statute does not require that the insurance company pay every claim, only that it promptly investigate , and accept or reject the claim. In a 1999, Tyler Court of Appeals opinion, styled, Dunn V. Southern Farm Bureau Casualty Insurance Co., the court stated:
(the insurance code) does not require an insurer to pay every claim within a certain time. It simply requires steps to be taken within a specified time frame … Nothing in the statute suggests that the insurance company could not dispute and deny the claim. Indeed the statute is premised on the presumption that carriers have the right to dispute claims. It merely requires that they do so promptly.
Some insurance companies have attempted to comply with Chapter 542 by informing the insured their claim is “covered” during the required time period, but then taking a longer period of time to calculate the amount of benefits owed. It is doubtful whether this is sufficient to comply with the statute. Because a claim is more than a request for coverage, a decision on the claim, including its value, arguably must be made and communicated to the insured in the time required by the statute unless an extension is requested. Further, the term “claim” is not defined as “coverage”; it is a demand for policy benefits that must be paid.
The time limits for exactly when the claim has to be made is difficult to calculate. Chapter 542 discusses when certain actions have to be taken by the insurance company, but what is missing in the equation is the actions the insured is required to make. An experienced insurance lawyer understand how this works. If a person finds themselves in a position where they are making a claim. It is important to keep a record of each time the insurance company communicates and each time the insured communicates. Keeping records / copies of all emails, text messages, faxes, letters, etc. go a long way toward being able to hold an insurance company responsible for the wrongs they commit. Dates are important.