Duty To Cooperate With Insurance Company After A Loss

An insured in Weatherford, Mineral Wells, Aledo, Azle, Willow Park, Hudson Oaks, Brock, Millsap, Peaster, Cool, Springtown, or anywhere else in Parker County may wonder how much they are suppose to do to help the insurance company when a claim is submitted for coverage. The answer is – quite a bit.
As for homeowners policies in Texas, the form and wording of the majority of policies follow what is called the Texas Homeowners Policy – Form B (“HOB”).
The HOB Policy requires that the insured cooperate with the insurer’s investigation of the claim by promptly submitting notice of the claim, completing an inventory of the damaged property, providing access to the damaged property and records, and signing a sworn proof of loss form. These requirements on the insured constitute a condition precedent to coverage under the policy. A United States, 5th Circuit case styled, Griggs v. State Farm Lloyds, decided in 1999, said absent the insured’s compliance with the conditions precedent to coverage, the insurer has no duty to provide benefits under the contract.
The standard HOB policy says:
Section 1 — Conditions, Section 3 places the following duties on an insured after a loss:
Your Duties After Loss. In case of a loss to covered property caused by a peril insured against, you must:
(1) give prompt written notice to us of the facts relating to the claim;
(2) notify the police in case of loss by theft;
(3) protect the property from further damage;
(4) make reasonable and necessary repairs to protect the property;
(5) keep an accurate record of repair expenses;
(6) furnish a complete inventory of damaged personal property showing the quantity, description and amount of loss. Attach all bills, receipts and related documents which you have that justify the figures in the inventory;
(7) as after as we reasonably require:
(a) provide us access to the damaged property;
(b) provide us with pertinent records and documents we request and permit us to make copies;
(c) submit to examination under oath and sign and swear to it;
(8) send to us if we request, your signed sworn proof of loss within 91 days of our request on a standard form supplied by us. We must request a signed sworn proof of loss within 15 days after we receive your written notice, or we waive our right to require a proof of loss. Such waiver will not waive our other rights under this policy:
(a) This proof of loss shall state, to the best of your knowledge and belief:
(i) the time and cause of loss;
(ii) the interest of the insured and all others in the property involved including all liens on the property;
(iii) other insurance which may cover the loss; and (iv) the actual cash value of each item of property and the amount of loss to each item.
(b) If you elect to make a claim under the Replacement Cost Coverage of this policy, this proof of loss shall also state to the best of your knowledge and belief:
(i) the replacement cost of the described dwelling;
(ii) the replacement cost of any other building on which loss is claimed; and (iii) the full cost of repair or replacement of loss without deduction for depreciation.
What is important for people to know who find themselves in a situation where they are making a claim for benefits is that their duty to cooperate does not relieve the insurance company of the responsibilities they have to promptly and properly investigate the claim and pay damages. Nor does your duty to cooperate mean that you have to do the adjusters job for them. Someone who believes the claim process is not being handled properly and quickly should consult with an Insurance Law Attorney.