What are my insurance company’s responsibilities?How do I know if my insurance company acted improperly?What deadlines are imposed upon my insurance company?What penalties are available?What about Attorney’s Fees?
What are my insurance company’s responsibilities?You have a contract with your insurance company. The insurance company has a legal duty to treat you with good faith. And the insurance company has a legal duty to promptly pay your claim in the right amount. If your insurance company improperly denies your claim, or fails to promptly and correctly pay you for your damages, you may have rights under the common law and statutes of Texas. Speights & Worrich represents people against insurance companies for Breach of the Insurance Contract, Violations of the Texas Insurance Code and Breach of the Duty of Good Faith and Fair Dealing.How do I know if my insurance company acted improperly?Under the Texas Insurance Code, the following are unfair or deceptive acts by your insurance company:

  • To misrepresent the terms of the policy;
  • To misrepresent the benefits or advantages promised by the policy;
  • To misrepresent a material fact or policy provision relating to coverage at issue;
  • Failing to attempt in good faith to effectuate a prompt, fair, and equitable settlement of:

1) a claim with respect to which the insurance company’s liability has become reasonably clear; or

2) a claim under one portion of a policy with respect to which the insurance company’s liability has become reasonably clear to influence the claimant to settle another claim under another portion of the coverage unless payment under one portion of the coverage constitutes evidence of liability under another portion;

  • Failing to promptly provide to a policyholder a reasonable explanation of the basis in the policy, in relation to the facts or applicable law, for the insurance company’s denial of a claim or offer of a compromise settlement of a claim;
  • Failing within a reasonable time to:

1) affirm or deny coverage of a claim to a policyholder; or

2) submit a reservation of rights to a policyholder;

  • Refusing, failing, or unreasonably delaying a settlement offer under applicable first-party coverage on the basis that other coverage may be available or that third parties are responsible for the damages suffered, except as may be specifically
  • provided in the policy;
  • Undertaking to enforce a full and final release of a claim from a policyholder when only a partial payment has been made, unless the payment is a compromise settlement of a doubtful or disputed claim;
  • Refusing to pay a claim without conducting a reasonable investigation with respect to the claim;
  • It is an unfair method of competition or an unfair or deceptive act or
  • practice in the business of insurance to misrepresent an insurance
  • policy by:

1) making an untrue statement of material fact;

2) failing to state a material fact necessary to make other statements made not misleading, considering the circumstances under which the statements were made;

3) making a statement in a manner that would mislead a reasonably prudent person to a false conclusion of a material fact;

4) making a material misstatement of law; or

5) failing to disclose a matter required by law to be disclosed, including failing to make a disclosure in accordance with another provision of this code.

What deadlines are imposed upon my insurance company?

Your insurance company must notify you in writing of the acceptance of rejection of your claim no later than the 15th day after the date the insurer receives all items, statements and forms required. 

If your insurance company rejects your claim, they must state the reason for the rejection.

If they are unable to accept or reject your claim before the 15th day after they receive all items, statements and forms, they must notify you the reasons why they need extra time, which can not exceed an additional 45 days from the date of their request.

Your insurance company must pay your claim within five business days after they notify you they have accepted the claim (or five days after any conditions are met as put forth by your insurance company).

**Please note that all of the above deadlines are extended for an additional 15 days if the claim was from a catastrophe or major natural disaster.

What penalties are available?

If your insurance company acted improperly or failed to meet the deadlines imposed by the Texas Insurance Code, the penalties are:

  • If your insurance company acted improperly, you can recover your actual damages, plus court costs and attorneys fees. Additionally, if the insurance company acted “knowingly” you can get an additional award not to exceed three times the amount of your actual damages.
  • If your insurance company failed to meet the deadlines imposed by the Texas Insurance Code, you recover the amount of the claim plus interest at 18% per year and attorneys fees.

What about Attorney’s fees?

Speights & Worrich handles its cases on contingency fee arrangements, meaning we are paid out of the recoveries we obtain for you. If we don’t recover, you don’t pay anything. However, we are flexible and consider special arrangements as needed. Please contact us for further information to discuss contingency fees or alternative arrangements.

Speights & Worrich accepts cases from other lawyers and firms and pays referral fees on those cases. Our firm will also Joint Venture cases with other lawyers and firms when it adds value for the client.