Delay in Paying Claim

Late Payment Of Claims

January 24, 2012 | Mark S. Humphreys

When does someone in Grand Prairie, Fort Worth, Burleson, Crowley, Lake Worth, Benbrook, Alvarado, Keene, Joshua, or anywhere else in Texas, know that the insurance company is taking too long to pay the claim?

There is no easy answer to the question. The laws related to the time frame for payment of claims are found in the Texas Prompt Payment of Claims Act. A reading of these laws is confusing. Even an experienced Insurance Law Attorney will have to read the law, look at the facts in the case then reread the law and see how it applies to the facts of the case. A big part of this law is the penalty the insurance company is subject to having to pay for violations of the law. So how is this penalty calculated?

The Fort Worth Court of Appeals decided a case in 2008, that provides some guidance. The case is styled, GuideOne Lloyd’s Insurance Company v. First Baptist Church of Bedford. Here are some relevant background facts:

Insurance Delaying Paying Claim

January 7, 2012 | Mark S. Humphreys

People in Grand Prairie, Arlington, Fort Worth, Dallas, Colleyville, Lake Worth, Keller, Roanoke, Saginaw, North Richland Hills, and other places in Texas will get very frustrated when their insurance company delays in paying a claim. Here is some general information about this happening.

Most insurance companies will pass off claims delays as fluke occurrences. What is important to realize is that these actions, or lack thereof, are actually routine and intentional conduct. A lot of this is the result of the McKinsey system, set up by McKinsey & Company. This system for “lowballing” claims payments is driven by the claims performance management and pay systems from the top to the bottom of the organization.

A Rutgers law professor who has studied this, has suggested that the deck is stacked against individuals who make claims. He says, “You have an accident or a fire in your house. You call up the insurance company. You describe the circumstances. Maybe they send an adjuster out, and they say it’s not covered, or it’s covered but here’s the dollar amount that we’re obligated to pay you .” Most people do not have the expertise “to know whether or not that’s right.”

Insurance Company Delays Payment Of Claim

January 5, 2012 | Mark S. Humphreys

When someone in Grand Prairie, Hurst, Euless, Bedford, Fort Worth, Dallas, Irving, Carrollton, or anywhere else in Texas makes a claim with their insurance company, they expect the claim to be paid promptly.

Here is something to get you upset.

According to an unpublished Harris Interactive Poll conducted in September, 16 percent of surveyed adults have experienced financial hardship while waiting for an insurance claim to be settled or know someone who has. The same poll found that 59 percent of adults believe that most insurers intentionally delay claims — and those with an income of $35,000 or less were more likely to agree.

How Long Can An Insurance Company Take To Pay A Claim?

December 1, 2011 | Mark S. Humphreys

People in Weatherford, Mineral Wells, Palo Pinto, Aledo, Azle, Hudson Oaks, Willow Park, Brock, Cool, Millsap, Peaster, and other places in Parker and Palo Pinto Counties may wonder how long an insurance company can take to pay a claim.

The answer is found in the Texas Insurance Code, Sections 542.051 thru 542.061. These sections are also known as the Prompt Payment of Claims law.

A careful reading of these sections will see that the time frame for paying an insurance claim depends on many factors. Some of those factors are (1) what type of insurance company is involved, (2) what type of claim is being made, (3) what is involved in the investigation, (4) how much has the claimant cooperated in the investigation of the claim, and variations of the preceding.

When Are Claims Suppose To Be Paid?

November 29, 2011 | Mark S. Humphreys

Anyone in Grand Prairie, Arlington, Mansfield, Cedar Hill, Duncanville, De Soto, Irving, Fort Worth, or anywhere else in Texas would naturally wonder when a claim they submit is suppose to be paid. The lawyerly answer is: It depends. One answer in one situation is shown here.

In 2002, the San Antonio Court of Appeals issued an opinion in a case that dealt with when a claim for underinsured motorist (UIM) benefits should be paid. The style of the case is Lawrence F. Wellisch, III and Maria L Wellisch v. United Services Automobile Association. The case came to the appeals court on an appeal on a motion for summary judgement in favor of United Services Automobile Association (USAA).

Here is some background.

Delay In Paying Claim

November 27, 2011 | Mark S. Humphreys

Someone in Grand Prairie, Arlington, Fort Worth, Dalworthington Gardens, Mansfield, Crowley, Rendon, or anywhere else in Tarrant County or Texas may wonder how long an insurance company has to pay a claim. The answer is, it depends.

In 2001, the Texas Supreme Court issued an opinion in the case, Allstate Insurance Company v. Rhonda Bonner. This case dealt with the time frame in which an insurance company must respond to a claim benefit request and the punishment for the insurance company when the time frame is violated.

The Texas Insurance Code has a chapter that deals with the payment of claims and is known as the “Prompt Payment of Claims” statutes. They are sections 542.051 thru 542.061.

Delay In Payment Of Claim

November 26, 2011 | Mark S. Humphreys

People in Weatherford, Mineral Wells, Aledo, Azle, Springtown, Willow Park, Brock, Hudson Oaks, Millsap, Cool, Peaster, Palo Pinto, and other places in Parker and Palo Pinto Counties may wonder: How long does the insurance company have to pay the claim?

The “Prompt Payment of Claims statute” is found in the Texas Insurance Code, Sections 542.051 thru 542.061.

The “Prompt Payment of Claims statute” imposes certain deadlines for an insurance company to acknowledge, investigate, and accept or reject a claim. An insurance company that violates the statute is liable for attorney’s fees and an additional 18% per annum in addition to the amount of the claim.

Timely Payment Of Claims

September 15, 2011 | Mark S. Humphreys

An insured in Weatherford, Mineral Wells, Aledo, Hudson Oaks, Willow Park, Peaster, Azle, Springtown, Millsap, Brock, Cool, Poolville, or anywhere else in Parker County would expect any claim they make to be paid in a timely manner. So what happens if it is not paid in time?

A 1995, Amarillo Court of Appeals case styled, Doris Rusk, Roger Lusk, and Russell D. Daves v. Honorable Cecil G. Puryear, addressed this issue.

Keep in mind that first, an experienced Insurance Law Attorney should be consulted to help in these situations. Next, here is what happened in this case.

Delay In Paying Claim

September 13, 2011 | Mark S. Humphreys

A resident in Grand Prairie, Weatherford, Arlington, Fort Worth, Dallas, Mineral Wells, Mansfield, Crowley, Benbrook, Aledo, or anywhere else in Texas may wonder how long an insurance company has to pay a claim after the claim is made. The answer is not always easy. Worse though, is how to bring a lawsuit to enforce this statutory right against a company who violates the law.

The Prompt Payment of Claims Act is in the Texas Insurance Code, Sections 542.051 thru 542.061. These sections set out in pretty good detail how long an insurance company has to pay a claim. The length of time varies with the circumstances and facts of each claim and the needs of any investigation. Plus the type of insurance company makes a difference in how long the company has to pay the claim.

But stepping beyond how long a company has to pay a claim is, how does someone enforce their rights to timely payment. An experienced Insurance Law Attorney needs to be consulted to get a good answer.

Requirement Of An Examination Under Oath (EUO)

September 4, 2011 | Mark S. Humphreys

Someone in Grand Prairie, Arlington, Hurst, Euless, Bedford, Grapevine, Keller, Saginaw, Roanoke, Fort Worth, or anywhere else in Tarrant County might ask, “Why do I have to submit to an examination under oath?” Here is a case that might shed some light to that question.

The case is styled, Shannon Trahan and Joleen Trahan Woods v. Fire Insurance Exchange and Texas Farmers Insurance. The opinion in this case was issued in 2005, by the Beaumont Court of Appeals. This case is an appeal from a summary judgment rendered in favor of Fire Insurance Exchange (FIE) and Texas Farmers Insurance (TFI). This court upheld the summary judgment.

As some background, on December 31, 2000, the Trahan’s home and automobile were destroyed in a fire. The Trahans filed a fire loss claim. On February 8, 2001, they signed a Proof of Loss form. On February 14, 2001, FIE requested the Trahans submit to examinations under oath (EUOs). Finally, on August 29, 2001, the Trahans submitted to the EUOs, and they were signed and sworn to on September 20, 2001. On October 8, 2001, FIE accepted the Trahans fire loss claim and issued checks.