Duty To Cooperate With Your Insurance Company In Texas

The general rule in Texas is that a policy holder has a duty to cooperate with his insurance company when the insurance company is investigating a claim.

Whether your house in Arlington burns down or you have a vehicle wreck in Grand Prairie the answer is about the same. Ditto for a life insurance claim made in Weatherford or a health insurance claim made in Fort Worth. Every insurance policy is going to place upon you a duty to cooperate with the insurance companies investigation of the claim.

Generally speaking you would have a duty to report the claim as soon as is possible. You would be asked and expected to make a statement to the insurance company. Often times you are going to be asked to fill out reports and other paperwork. You may have to get estimates or appraisals. If the loss being claimed is for physical injury, then an independent medical exam performed by a Doctor of the insurance companies choosing may be necessary.

There are limits on what can be asked or required from you when making a claim for benefits. For example, it is against the law for the insurance company to require you to produce a copy of your federal income tax returns for examination or investigation. This law is found in the Texas Insurance Code, Section 541.060, subpart (9). There are three exceptions to this law. One, is when a court orders the tax returns to be produced. Two, is when the claim involves a fire loss. Three, is when the claim involves lost profits or income.

An experienced Insurance Law Attorney will tell that when the insurance company is requesting from you an examination under oath, that the insurance company is probably going to deny your claim. The EUO is almost always going to be conducted by an attorney hired by the insurance company. The EUO is usually the last thing that is requested. By this time, the insurance company has already taken a recorded statement from you and maybe others who may be involved in the claim. They have also requested and received most documents that are relevant to the claim.

In spite of having all the information they have reasonably requested, the insurance company is still uncertain about their obligations on the claim when they are requesting an EUO. The insurance company is now setting the claimant up for criminal prosecution and why the claimant must seek the assistance of an attorney familiar with the implications of an EUO.

The Texas Criminal Code, Section 37.02 describes the crime of perjury. A person commits the crime of perjury if, with the intent to deceive, he makes a false statement under oath. So you can see that when the insurance company is asking for an EUO, that the matter is getting very serious. This is not to say you are doing anything wrong, but do you really want to get into an arguement about whether something you said was misunderstood or taken out of context?

With regard to a policy holders’ duty to cooperate with their insurance company when making a claim, the failure to cooperate is not necessarily an automatic breach of that duty. It is a fact specific issue that must be looked at on a case by case basis.