Making A Claim

Parker County attorneys who deal with insurance companies need to understand the obligations of insureds making a claim.
Though an insured may end up doing many things, the actions are boiled down to two basic duties:
1) to give the insurance company notice of the claim; and 2) to give the insurance company all items they reasonably need to secure proof of loss. Texas Insurance Code, Section 542.055(a) starts the deadline for the insurance company to act, once they receive notice of the claim. Section 542.056(a) imposes other deadlines once they receive all information required to secure final proof of loss.
Section 542.051(4) tells us that for giving the insurance company notice of the claim, no particular content is required, as long as the claim “reasonably apprises them of the facts relating to the claim.
The statute does require that the notice be in writing. This is found in Section 542.051(4). One Texas Court, the Austin Court of Appeals in 2005, has strictly applied this statute by holding that a phone call was not sufficient.
Since the statute requires written notice, it may be the laying of a trap by an insurance company to accept the claim by way of a phone call. The safe action to take is to put the notice in writing.
The Tyler Court of Appeals said in a 1999 case, that it is sufficient that a claim be presented by an attorney.
Getting hyper technical has been rejected in one case, where the insurance company argued that the insured needed the notice to identify the specific elements of the policy and expressly state an intent to assert a claim under each.
In contrast to the above 2005 case, another Austin Court of Appeals case ruling allowed that a phone call from the insured was sufficient notice to the insurance company.
A Texas Supreme Court ruling from 1967, held that if the insurance company receives oral notice or written notice that is deficient, but the insurance company proceeds to investigate anyway, the insurance company may be held to have waived any complaint. The Court pointed out that insurance companies are aware of the requirement that notice of the claim be in writing. If they proceed without written notice, that is conduct inconsistent with assertion of a known right or a waiver.
This waiver was held to occurred in a 1997, Texarkana Court of Appeals case wherein the court held that the insurance company waived any complaint about the insured’s notice, because they investigated the claim anyway.
Although the insured has a duty to respond to an insurance company request for materials as are necessary to secure proof of loss, the insured need only respond with material that is reasonably necessary to secure the final proof of loss to start the clock running. One Court has held that the failure of the insured to supply all materials pursuant to a broad blunderbuss request even after he supplied what was truly necessary did not operate to prevent the statutory clocks running. As example, to secure proof of loss that a vehicle was stolen, it was unnecessary to provide copies of all vehicle service records and all sets of keys.

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