Rules for appropriate insurance company conduct

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  • Insurance Companies must PROMPTLY accept a claim when the need is reasonably clear
  • They must acknowledge receipt of a claim, begin an investigation, and request all items, statements and forms they need, in most circumstances within 15 days.
  • They must notify you in writing of the acceptance or rejection of the claim within 15 business days after they receive all information from you. If they feel they cannot comply with this time period, they must notify you why they need additional time and accept or reject the claim within 45 days of their request for more time.
  • They must pay the claim within 5 business days of their acceptance of all or part of the claim, in most circumstances
  • Insurance Companies must confirm whether the need is clear with a REASONABLE investigation
  • Reasonably clear needs must be covered first, and questioned – when actually necessary – later. This ensures the best chances for recovery, protection of Texas families, and a prompt return to normal life
  • Insurance companies must honor the deal they made in the policy. If they promise to pay replacement value, that is what they must pay.
  • Insurance companies must treat their insured as “innocent until proven guilty.” Insurance companies may not act as an adversary or obstacle
  • Insurance companies must hire reasonable, above-board and unbiased reviewers and investigators to inspect your home and property
  • Insurance companies must have a reasonable, good faith basis to deny a claim. They cannot fake or exaggerate reasons for denying claims
  • Insurance companies must take a reasonable “Yes” for an answer. They may not search for excuses to deny claims

Knowing the rules will help you get through the
obstacle course of the insurance claims process