Theories Of Recovery In Insurance Cases

Weatherford, Parker County, Aledo, Azle, Mineral Wells, and other residents through out Texas would wonder what are the different ways of recovering losses that result from an insurance company or insurance company agent doing something wrong in the sale of an insurance policy.
The Texas Department of Insurance has a web-site that provides some information about insurance companies and insurance agents. There is also information at this site about insurance adjusters.
The Texas Supreme Court hears and issues opinions about situations that have happened across the state dealing with insurance related issues. Plus the lower appeals courts and the local courts have to hear and decide on insurance related cases on a fairly regular basis.
The best source for learning about the different theories of recovery in insurance cases would be an experienced Insurance Law Attorney. An attorney who handles a lot of these cases will be familiar with how the courts handle these cases and he would know about the resources available through the Texas Department of Insurance that are helpful in dealing with these insurance cases.
The Texas Insurance Code has rules and regulations dealing with just about everything you can imagine related to insurance.
One of the most common basis for an insurance dispute is the complaint that someone misrepresented something. After a claim arises, the insured person or business entity may feel that the coverage accepted by the insurance company is less than the coverage promised at the time of the sale of the policy. Depending on the facts of the case, a representation by the insurance company or its agent may lead to liability for breach of contract, unfair insurance practices, deceptive trade practices, negligence, or fraud.
The insurance agent may be held liable for misrepresentation even where the insured fails to read the coverage, when the jury could find the insurance company and the agent misrepresented the extent of coverage under the policy. This was the decision in the case, Omni Metals, Inc. v. Poe & Brown of Texas, Inc., decided by the Texas Court of Appeals — Houston [14th Dist.], decided in 2002.
Closely related to misrepresentation is the theory that the insurance company, insurance agent, or insured person failed to disclose information. For example, if an exclusion is not adequately disclosed, the insurance company may be liable for breach of contract by relying on the exclusion to deny a claim. Failing to adequately disclose limitations or exceptions to coverage may also make the insurer or agent liable for unfair practices or deceptive trade practices.
There are several statutory prohibitions specifically aimed at settlement practices in the Texas Insurance Code. Liability may arise from failing to pay benefits that are owed under the policy, for failing to pay benefits that were promised by the insurance agent, for failing to act promptly to settle once liability is reasonably clear, for paying too little, or for paying too slowly. Liability may also arise from the insurance company’s failure to adequately investigate a claim.
Other disputes may arise that do not fit neatly within the above categories, such as unreasonable cancellation of a policy, unconscionable conduct, or unfair discrimination.
The theories of liability discussed above may vary depending on who is seeking recovery. It may make a difference whether the person is the insured, a named beneficiary, an intended beneficiary, or an injured person seeking recovery under another’s liability policy. Questions also arise whether an agent can sue his own insurance company, and under what theories, and whether other persons affected by the insurance company’s conduct can sue.