Here is some very basic information that every insurance lawyer should be aware of. It is also information that every insurance consumer should know.
To understand the different ways disputes can arise, it is helpful to consider the sequence of events that is likely to occur involving an insurance issue. At its very simplest, the insurance transaction can be divided into the initial sale of the policy, and subsequent handling of claims. These can be broken down further to include:
(1) The sale of the policy: Initially, the consumer and insurance company or insurance company’s agent must communicate to establish a contractual relationship. Disputes may arise over what was asked for by the applicant, what was represented by the insurance company or agent, or the timeliness of the insurance company or agent in providing coverage. Issues may also arise about the truthfulness of the applicant or agent in disclosing information requested by the insurer;
(2) Underwriting: At this stage the insurance company considers the application and determines whether the applicant is an acceptable risk. Certain types of discrimination — such as distinctions based on gender, ethnicity, or disability — are unlawful;
(3) Policy administration: During the course of the insured/insurance company relationship, disputes may arise even if there is no claim. For example, the insurance company may choose to cancel or not renew the policy. The insurance company may demand a premium that is higher than the insured was lead to expect; and
(4) Claims: If a claim arises under the policy, the parties may fall into disagreement over the scope of coverage, the amount of payment, the insurance company’s failure to pay, or the timeliness of any payment. An insurance claim may also give rise to disagreements based on the difference between the coverage promised by the insurer or its agent at the time of sale contrasted with the coverage given at the time of the claim.
Also , keep in mind that the Texas Department of Insurance is a good source of information on insurance companies and insurance agents and adjusters. Don’t forget the Texas Insurance Code and the Texas Administrative Code. And finally, if you feel your claim is not being handled by an insurance company, agent, or adjuster, call an attorney who is experienced in dealing with insurance issues.