Duty To Cooperate With Insurance Company

If you have insurance in Grand Prairie, Arlington, Mansfield, Garland, Richardson, Mesquite, Rowlett, Fort Worth, Dallas, or anywhere else in the Dallas and Fort Worth metroplex area, you most likely have the same obligation as everyone else in the State of Texas, and that is the duty to cooperate with any investigation your insurance company wants to conduct with respect to any claim you are involved in.
The Dallas Court of Appeals issued an opinion in a case on June 21, 2011, that dealt with this duty to cooperate with your insurance company. The style of the case is quite long and is abbreviated here to, Ann Martinez v. ACCC Insurance Company.
In this case there were three insurance entities sued together and the trial court granted a summary judgment in favor of the three entities. Here is some background:
On July 2, 2002, Martinez and her friend, Davilla, were involved in an automobile accident with Carmensa Romero. Martinez and Davilla alleged they were traveling through a controlled intersection when Romero ran a red light and slammed into their vehicle. At the time, Romero was insured under and subject to the terms and conditions of a personal automobile policy issued by the insurance entities. The policy included the following provisions regarding the obligations of a person seeking any coverage:

PART E – DUTIES AFTER AN ACCIDENT OR LOSS A. We must be notified promptly of how, when and where the accident or loss happened. Notice should also include the names and addresses of any injured persons and of any witnesses. If we show that your failure to provide notice prejudices our defense, there is no liability coverage under the policy.
B. A person seeking any coverage must:
1. Cooperate with us in the investigation, settlement or defense of any claim or suit;
2. Promptly send us copies of any notices or legal papers received in connection with the accident or loss.

The policy also contained the following provision regarding legal action agains the insurer:

PART F – GENERAL PROVISIONS …. LEGAL ACTIONS AGAINST US A. No legal action may be brought against us until there has been full compliance with all the terms of this policy.

After the collision, Martinez and Davilla presented claims for injury. On September 6, 2002, counsel for Martinez and Davilla, sent a letter to ACCC which included the following paragraph: We will provide you with every opportunity to provide a defense for your insured. Specifically, we will send you a copy of the Petition when it is filed, and notify you of the date that your insured is served with process. We will also notify you of your insured’s deadline to file an Answer. If no answer is filed, we will seek a default judgment. They lived up to this letter.
According to the evidence before the court, Romero failed and refused to cooperate with ACCC Claims’ investigation of the loss. Romero failed to notify ACCC of the accident and failed to provide ACCC with suit papers. ACCC sent multiple letters to Romero requesting information but Romero failed to respond. They hired an investigator to attempt personal contact with Romero.
The insurance entities filed a declaratory judgment saying they owed nothing and had no duty because Romero failed to abide by the terms and conditions of his policy.
In discussing this case, the court stated, “An insurer’s obligation depends upon proof that all conditions precedent have been performed. Romero’s failure to cooperate in the investigation, defense and settlement of the claims against her is sufficient grounds to support the summary judgment.”
The court pointed out that the record reflects that Romero failed to cooperate with the investigation of the accident and the claims against her. Romero never contacted her insurer or its agents regarding the collision, and failed to respond to their telephone calls and letters requesting information. Investigators were unable to locate her. There was no police report from which the facts could be confirmed with respect to the collision and the claimants’ alleged injuries. Romero’s failure to provide information and the lack of a police report made it impossible for ACCC to identify any witnesses to the accident. The record also reflects that Romero failed to cooperate in any way with the defense of Martinez and Davilla’s claims against her.
This case had bad facts but if an experienced Insurance Law Attorney is consulted, the majority of the time there will be ways to make the insurance company get involved in the claim and pay the claim.

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