Filing of a Claim
- Insured should file a claim with TWIA as soon after the date of loss as possible (TWIA has a one year notice requirement. Any claim reported more than one year after the date of loss is barred).
- Insured should allow TWIA an opportunity to inspect their property, adjust their claim, and issue its decision letter (along with the “undisputed” payment – if any).
Areas of damage TWIA agreed was caused by windstorm
Areas of damage TWIA denied was caused by windstorm
CONVENTIONAL INSURANCE (NON-TWIA)
Filing a Claim
- Insured should file a claim with their insurance as soon after the date of loss as possible (the longer the insured waits to file their claim, the more likely the insurance company is deny their claim on the basis of failure to provide “prompt notice”).
- Allow the insurance company the opportunity to inspect their property, adjust their claim, and issue a payment or denial letter.
- If the insurance company requests the insured complete a sworn proof of loss, the insured must do so within the time period requested. Improperly submitting a sworn proof of loss can negatively affect the insured’s claim, as the sworn proof of loss could define/limit the scope and amount of the claimed damages.
- Once the insured receives his/her insurance company’s payment or denial letter, the insured has two (2) years from the date of the payment or denial letter to file suit against his/her insurance company. However, there has been a recent change in Texas law that now requires an insured to provide his/her insurance company a detailed notice and accurate expert report/repair estimate at leastsixty (60) days prior to filing suit. Failure to provide proper notice as required by Texas Insurance Code Section 542 can result in abatement or dismissal of the insured’s case. This sixty (60) day notice will allow the insurance company an opportunity to re-inspect the insured’s property and re-adjust the claim. If the insured inaccurately estimates the amount of the covered damages, their attorney fees and damages could be proportionately reduced at trial.
- At any time during the claim process or after the case is in litigation, either the insured or the insurance company can invoke appraisal. If appraisal is invoked, both parties must designate an appraiser within twenty (20) days at their own cost. Naming a competent appraiser is critical for a successful outcome.The insured’s appraiser and their insurer’s appraiser will inspect the property and attempt to agree on the scope and amount of covered damages. However, if they cannot agree as to the scope and amount of covered damages, the two appraisers will attempt to agree on an Umpire, who will make the final decision on the amount of covered damages. If the two appraisers cannot agree to an Umpire, an Umpire will be appointed by a judge in the county where the property is located.The Umpire will make the final determination on the scope and amount of covered damages under the insurance policy. The Umpire’s fees will be divided between the insurance company and the insured.