Insurance And Proof Of Loss

Insurance policies require that the insured cooperate with the insurance company investigation of a claim.  Part of that cooperation includes filing a written proof of loss.  This filing of a proof of loss is a precedent to enforcement of the policy as explained in the 1926, Texas Supreme Court opinion styled, Commercial Union Assurance Co. v. Preston.  The Fort Worth Court of Appeals restated the Texas Supreme Court opinion in the 1954, opinion styled, Whitehead v. National Casualty Company.  A “proof of loss” is a statement to the company, stating, among other things, the cash value of each item of property lost or damaged by fire, and the amount of loss.  The insurance company may require that the insured swear to the accuracy of the proof of loss.

Another Fort Worth Court of Appeals in 1960, told us that policy provisions requiring a proof of loss are for the insurer’s benefit and may be waived by the insurance company.  That case is styled, International Service Insurance Co. v. Brodie.  The Court said the requirement was waived where the insurer would only accept proof asking for an amount its adjusters agreed to, although the insurer wanted more.

Compliance with the proof of loss requirement may be excused, for example when the failure to file a proof of loss does not affect the insurer’s exposure, or when the lack of a proof of loss is due to the beneficiary’s non-negligent ignorance of the requirement.  This was explained in the Whitehead opinion.

The Texas Supreme Court in the 1990 opinion styled, Viles v. Security National Insurance Co. ruled that if the insurance company denies the claim before the time by which the insured must file a proof of loss, the insured is relieved of that requirement.

28 Texas Administrative Code, Section 21.203(7) tells us it is an unfair claim settlement practice for an insurance company to fail to provide promptly to an insured any forms the insurer requires as a prerequisite for claim settlement.

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