The real world can be quite different. Insurance companies make money when they collect premiums and lose money when they pay claims. Insurance companies earn over $1 trillion a year, and they do not want to pay more than they have to..
Since property insurance adjusters are in short supply these days, adjusters often take shortcuts during the busy season. When adjusters and other insurance company employees take shortcuts, the Houston bad faith insurance lawyers at Williams Hart & Boundas step into action. Our experienced legal team ensures that insurance companies treat everyone equally and approach every claim the same way. We all have to follow the rules, and that includes property insurance companies.
Filing a Claim
Simply beginning the claims process is difficult for many people. Houstonians speak about 145 languages, and almost half of Houston residents speak a language other than English at home. Legalese is not a language most people understand. Having a competent attorney and law firm to help you navigate your claim is vital.
Improper paperwork delays the claims process. Clerks often look for ways to avoid dealing with forms. Improperly completed paperwork gives these processing clerks an excuse to immediately return forms. Frequently, the reason for the return isn’t very clear.
More commonly, improperly-filed paperwork leads to claim denial. Many questions on many forms are quite vague. A single wrong answer, or arguably the wrong answer, is the only thing an insurance adjuster needs to deny a claim.
In some cases, incorrectly-filed paperwork could lead to insurance fraud charges. Prosecutors are very aggressive in this area, mostly because insurance companies promote the myth that fraud significantly drives up insurance premiums.
The Investigation
Incorrect paperwork gives insurance adjusters a quick way to sidestep claims. The quest for shortcuts continues during the investigation process. Under Texas law, a property insurance claim investigation must meet or exceed five key requirements.
Prompt
During the busy storm season, many insurance companies use claim volume as an excuse to delay investigations. That’s especially true if the company is short-staffed, which as mentioned above, is a very strong possibility. The responsibility of an insurance company doesn’t change because the insurance company has problems complying with the law.
Generally, a company must acknowledge a claim within three days. Acknowledgment means a message that says, “we received your claim and we’re on it.” The formal investigation must begin within thirty days, once again at least in most cases. Usually, this initial contact must include an outline of the investigation process and a timeline for its completion.
Thorough
Insurance companies may try to rubber stamp claims quickly without taking the time to thoroughly investigate. A wind damage claim is a good example. Usually, adjusters start by looking at weather reports. The relationship between wind speed and wind damage is as follows:
- 25mph: Branches move,
- 35mph: Trees uprooted,
- 45mph: Branches break,
- 55mph: Moderate structural damage,
- 65mph: Severe structural damage, and
- Over 65mph: Catastrophic structural damage.
Next, adjusters usually examine the damage at the policyholder’s home. At the same time, they do informal neighborhood surveys. If the neighbors’ houses need roof work or other repairs, the policyholder’s house might need such work as well.
Other insurance investigations, like water damage and theft claims, must follow a similar process.
Efficient
Insurance adjusters cannot rush through investigations, but they cannot drag their feet either. Unnecessary tests and second opinions are a good example. Experienced adjusters can tell the difference between wind damage and another kind of damage. They don’t need to run tests to know what happened. Additionally, insurance adjusters don’t need to ask for second opinions which confirm things they already know.
Inefficient investigations often force policyholders to accept lower settlements. If the matter drags out, the adjuster drops subtle hints that the claim may be denied, and the homeowner needs legal advice immediately. Don’t settle without speaking to an attorney.
Transparent
Adjusters cannot make important decisions or hold important conferences behind closed doors. Policyholders usually don’t have a right to access meeting transcripts and other specific information. But they do have a right to know the gist of the meeting. They also have a right to know the rationale behind the adjuster’s decision.
Fair
This decision must be based on the evidence the adjuster gathered in the investigation and nothing else. Documenting the damage and the cost of repairs is critical to prove how fair an insurance claim payout is.
Appealing a Denial
In most cases, the five components of an investigation outlined above are also the five possible grounds for appeal. Technically, policyholders can appeal denials on their own. However, a lawyer-negotiated settlement is about 3.5 times larger than a nonlawyer-negotiated settlement.
Insurance companies must follow the rules when they evaluate claims. For a free consultation with an experienced bad faith insurance lawyer in Houston, contact Williams Hart & Boundas LLP. We do not charge upfront legal fees in these matters.