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The Insurance Adjuster's Essential Guide for Handling Texas Claims - 2010

 

The Adjuster's Essential Guide for Handling Texas Claims has been updated.  Please refer to the 2016 edition of the Guide. 

 

The 2010 Guide

1 Introduction
2. Who are Texas Insurance Adjusters?
3. Sources of Ethical Standards
A.   Insurance Adjusters
B.   Public Adjusters
4. The Insurance Policy
A.   The Consumer Bill of Rights 
B.   Duties Set out in the Insurance Contract
5. Common Law Conflict of Interest
A.   Uninsured Motorist claims and the Hunt Presumption
B.   Subrogation
6. Privacy Issues
A.   Non-Public Personal Financial Information
B.   Non-Public Personal Health Information
7. Prohibited Conduct under the Texas Insurance Code
A.   Prohibited Misrepresentations Regarding Policy or Insurer
B.   Prohibited Misrepresentations Regarding an Insurance Policy
C.   Prohibited Settlement Practices
8. Breach of the Duty of Good Faith and Fair Dealing
A.   Failure to Investigate
B.   Use of Experts as Basis for Denial
C.   Good Faith Duty to Insured for Third-Party Liability Claims
9. Extra-Contractual Claims Against the Insurer
A.   Where There is No Coverage
B.   Where There is Coverage
C.   No Claim for Negligent Claims Handling
D.   No Duty to Notify Addit'l Insd. of Coverage or Defend without Request for Coverage
10. Prescribed Conduct under the Texas Insurance Code
A.   Records of Complaints
B.   Providing Claim Information on Request
C.   Provide Written Notice of Offer or Settlement on Casualty Policy Claims
D.   Action to Recover Deductible Under Certain Auto Insurance
E.   Special Notice Requirements for Claimants regarding Motor Vehicle Repairs
11. Prompt Payment of First Party Claims
A.   Importance of Compliance
B.   What Claims are Covered
C.   Initial Response to Receipt of Claim
D.   Deadline for Acceptance or Rejection of Claim
E.   Payment of Claim
F.   Penalties for Violation of the Act
G.   Recommendations about Complying with the Act
12. Insurance Policy Construction and Defenses
A.   Texas Rules of Policy Interpretation
B.   Policy Defense and Exclusions
13. Handling Third-Party Claims
A.   The Insurer's Duties for Third-Party Claims - Defend & Indmenify
B.   Responding to the Insured's Tender of Defense
C.   Reservation of Rights
D.   The Carrier's Right to Control the Defense
E.   Should a Declaratory Judgment Action be Commenced on Coverage
F.   Assignments Against Insurers - Important New Development
G.   Equitable Virtual-Representation Doctrine
H.   Settlement Issues
I.    Attorney Billing Guidelines and Attorney Ethical Issues
14. Demands for Policy Limits
A.   The Stowers Duty
B.   When is the Stowers Duty Triggered?
C.   Determining Policy Limits
D.   Reasonable Settlement
E.   Excess Insurance and Self-Insured Retention
F.   Recommendations
15. The Texas Deceptive Trade Practices Act
A.   Introduction
B.   Intent to Deceive Irrelevant to DTPA Liability
C.   Who is a Consumer
D.   Who is a Proper DTPA Defendant
E.   Prohibited Trade Practices Actionable Under the DTPA
F.   The Laundry List of Prohibited Conduct
G.   Contrast to Breach of Contract Claims
H.   Damages
I.    Claims Excluded from the DTPA
16. Procedural Issues for DTPA and Insurance Code Claims
A.   Notice Requirements
B.   Offers of Settlement
C.   Mediation
D.   Recommendations
17.  Conclusion
   
APPENDICES
A. Consumer Bill of Rights of Homeowners, Dwelling and Renters Insurance
B. Provisions From Homeowner and Auto Policies Relating to Insurer Duties After Loss
C. Map of Texas Counties
D. Map of Texas Metropolitan Statistical Areas, 2003  
E. Map of Texas Counties With County Seat
F. Texas Prompt Payment of First Party Claim Worksheet
G. The Texas "Stowers" Liability Worksheet
H. Notice & Response Worksheet for Demands Pursuant to DTPA and Insurance Code
I. Texas Unfair Claim Settlement Practices
J. Statutory Notice required for Motor Vehicle Repairs

  
 
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