General Rules Covering Insurers

Although the Supreme Court has issued recent rulings that are considered to generally favor insurance companies, Texas state law does provide some protections to policy holders:

• The insurer must acknowledge receipt of a claim, begin an investigation, and request all items, statements and forms they need, in most circumstances within 15 days.
• The insurer must notify a policy holder in writing of the acceptance or rejection of a claim within 15 business days after they receive all information. If the insurer needs additional time, they must notify the policy holder of the need and why, but still must accept or reject the claim within 45 days of their request for more time.
• The insurer must promptly accept a claim when the need is reasonably clear.
• The insurer must pay the claim within 5 business days of their acceptance of all or part of the claim, in most circumstances
• Insurers must conduct a reasonable and complete investigation.
• Insurance companies must have a reasonable, good faith basis to deny a claim. Just because these rules are in place does not mean that the insurer will follow them. Insurers do not want to pay out any more in claims then they have to. Some insurers and adjusters are fair and will pay what they are supposed to under the policy. Some will not. Most will try to be very nice even. The key is that, regardless of how “nice” they are, you should verify that they are honoring their insurance contract. Don’t be pressured into accepting less than you are supposed to receive under the insurance contract.