Dallas Fort Worth Insurance Lawyer Blog

Insurance Company Responsibility To Accept Or Reject Claim

August 24, 2013 | Mark S. Humphreys

Dallas County insurance attorneys will understand the responsibilities of an insurance company to accept or reject an insurance claim.

Usually the first thing an experience Insurance Law Attorney will ask of a potential new client who says their claim has been denied, is a copy of the rejection letter.

Texas Insurance Code, Section 542.056(a), is the statute that requires an insurance company to give written notice it is accepting or rejecting a claim. A telephone call from the insurance adjuster notifying the claimant of the amount of the loss will not constitute “notice of payment of claim,” because the statute requires that the acceptance or rejection be in writing. This was an issue that went against the insurance company in the Houston, 14th District, Court of Appeals case styled, Daugherty v. American Motorists Insurance Company. Further, the insurance company’s written response acknowledging only that a claim has been received does not constitute an acceptance or rejection under the statute. This was made clear in the Corpus Christi Court of Appeals case styled, Northern County Mutual Insurance Company v. Davalos.

Insurance Payments And Coverage

August 22, 2013 | Mark S. Humphreys

Parker County attorneys probably know the law about this case even if they have not read the case. The case is an opinion from the Houston Court of Appeals, First District. The style of the case is, Texas Farm Bureau Underwriters and Texas Farm Bureau Insurance v. Douglas Rasmussen and Kathy Rasmussen.

The Rasmussens owned a rental house located in Texas. Beginning in 2006, the Rasmussens insured the house with Texas Farm Bureau. To encourage a shift in their insurance provider, the insurance agent, Bolton, told the Rasmussens that he would take care of the Rasmussens’ insurance needs, provide more personalized service, and notify them of any changes to their policies.

The Rasmussens renewed the policy that covered the rental home in June 2007. They paid the premium for the term of June 1, 2007 to June 1, 2008. They did not pay the premium when it was again due in June 2008. In January 2009, the fire occurred. The Rasmussens submitted an insurance claim, but the Texas Farm Bureau denied it.

Excluded Driver And Lenders

August 20, 2013 | Mark S. Humphreys

Fort Worth insurance lawyers would want to read this case from County Court @ Law #3 in Tarrant County. The case is styled Stadium Auto, Inc. v. Loya Insurance Company and the opinion was issued by the El Paso Court of Appeals.

Here is some relevant information.

Stadium Auto, Inc. appeals from a summary judgment granted in favor of Loya Insurance Company.

Duty To Co-operate With Insurance Investigation Of Claim

August 18, 2013 | Mark S. Humphreys

Dallas insurance attorneys need to know about this recent Federal Court case. The style of the case is Mario Santacruz v. Allstate Texas Lloyds, Inc.

Mario, “Plaintiff” claimed that he reported the damage to Allstate “Defendant”, but Defendant could not inspect the home at that time. Based on a contractor’s recommendation, Plaintiff had the roof repaired to prevent further damage. Defendant then denied coverage for the claim. Plaintiff raises causes of action against Defendant for (1) breach of the common law duty of good faith and fair dealing; (2) violations of the Texas Deceptive Trade Practices Act (“DTPA“); (3) violation of Texas Insurance Code bad faith sections 541.060(a)(2)(A) and (a)(7); and (4) intentional infliction of emotional distress.

Defendant states that immediately after the storm that is alleged to have damaged Plaintiff’s roof, a tarp was placed on the roof to prevent further water intrusion. Plaintiff did not know whether the shingles were blown off by the wind. The next morning, Plaintiff reported the damage to Defendant and spoke to employee Almirna Martinez. Plaintiff told Martinez about the storm and about the roof being tarped and stated that he had workers at the house ready to fix the roof. Because the workers were already on site, Plaintiff requested that Defendant send someone to his home to examine the roof. Martinez informed Plaintiff that Defendant could send an adjuster to his home in a couple of days. Nevertheless, Plaintiff had the entire roof replaced that day. Thus, when Defendant’s adjuster arrived at Plaintiff’s home two days later to inspect the roof, it had already been replaced. Defendant claims that due to its inability to investigate the loss, it did not indemnify Plaintiff’s claim.

Accept Or Reject Claim

August 17, 2013 | Mark S. Humphreys

Arlington insurance attorneys need to know one case real well as it relates to an insurance company accepting or rejecting a claim.

The case is a 1999, Tyler Court of Appeals case styled, Dunn v. Southern Farm Bureau Casualty Insurance Company. This case tells insurance lawyers many things.

1) That each separate claim filed by an insured requires written acknowledgement. It is arguable that separate acknowledgements are required for separate claims arising from the same accident.

Duties Of Insurance Company When Claim Is Made

August 15, 2013 | Mark S. Humphreys

Dallas insurance lawyers should be able to discuss all of the enclosed with you.

The Texas Insurance Code, Section 542.055, says an insurance company shall acknowledge receipt of a claim within 15 days after they receive notice of a claim and begin its investigation and request from the claimant all they reasonably need at that time to further their investigation. So what happens after that?

No additional deadlines are triggered until the insurance company receives all items, statements, and forms reasonably required by the insurance company. Once the insurance company receives that information, seven new responsibilities arise:

What Insurance Companies Have To Do

August 13, 2013 | Mark S. Humphreys

Parker County lawyers who handle insurance cases need to know some of the duties imposed on insurance companies when handling a claim for benefits.

The Texas Prompt Payment of Claims Act is found in the Texas Insurance Code. It details the duties imposed on an insurance company when a claim is made.

When an insurance company receives notice of a claim from one of its insureds, there are four duties that are imposed on them.

Making A Claim

August 11, 2013 | Mark S. Humphreys

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.

Moving Insurance Claims

August 10, 2013 | Mark S. Humphreys

A Fort Worth insurance attorney will want to know about specific cases and the way the courts handled the cases. Here is an example of a case that is not seen very often.

The style of the case is, Bekins Moving & Storage Co. v. Williams. This is a Texarkana Court of Appeals case. The opinion was issued in 1997.

Here is some of the relevant information:

What Kinds Of Companies Are Under The Prompt Pay Statute

August 8, 2013 | Mark S. Humphreys

Fort Worth insurance law attorneys need to know what insurance companies fall under the Prompt Pay statutes of the Texas Insurance Code.

The Prompt Payment of Claims Act applies to all insurance companies, except those specifically exempted. The statute provides the following exemptions:

1) a stock life, health, or accident insurance company;