According to TWIA’s website, as of November 15, 2017, TWIA has received 72,902 claims related to Hurricane Harvey. So, what happens next? Many of TWIA’s policies, procedures and deadlines are different from that of a typical homeowner’s policy. Thus, it is imperative you read your policy to ensure no deadlines are missed. Below are important deadlines and basic information to remember as you are filing your claim.
Claims handling basics:
- TWIA policy coverages: TWIA policies cover losses caused by: 1) wind-driven rain damage, regardless of whether an opening is made by the wind; 2) loss of use; and 3) consequential losses. Flood damage is excluded from TWIA policies, including flood damage caused by waves or tidal surge.
- TWIA policy locations: TWIA provides wind/hail coverage for several Texas coastal properties, which currently includes all 14 first-tier coastal counties (Aransas, Brazoria, Calhoun, Cameron, Chambers, Galveston, Jefferson, Kenedy, Kleberg, Matagorda, Nueces, Refugio, San Patricio and Willacy) and parts of Harris County east of Highway 146.
Claims handling deadlines:
- Deadline to file your claim with TWIA: You are required to file a claim with TWIA no later than one year after the date that your property is damaged. If you show good cause, the commissioner of insurance may extend this deadline up to 180 days.
- Additional information related to your claim: Within 30 days of the date you file your claim, TWIA may request any information necessary to determine whether to accept or reject your claim.
- Timeframe for TWIA to accept or deny your claim: TWIA must provide you a written notice of the amount it will pay, if any, and notice that it has accepted or denied your claim in full or in part within 120 days of receiving your claim or within 120 days from the date TWIA receives the information requested. If TWIA accept all or part of your claim, it must tell you how much it will pay for your loss at that time. (Note: this is usually 60 days, but extended to 120 days for catastrophic events, such as claims resulting from Hurricane Harvey.)
- Claims payment deadline. TWIA must pay your claim within 10 days of the date it notifies you that of its decision to accept all or part of your claim. If payment depends upon your performance of specific actions, TWIA has 10 days from the day you complete those actions to pay the claim.
Claims Dispute Resolution;
Disputes Regarding Accepted Claims- Claims Appraisal
Disputing the amount of loss through the appraisal process: If you are disputing the amount TWIA has paid you for a covered loss, appraisal is your exclusive remedy and below are important deadlines and information you should know.
- The Appraisal process: The policyholder and TWIA each select an individual appraiser to determine the amount of loss. If the appraisers cannot agree on the amount of loss, an independent umpire will be selected by the appraisers. An agreement by any two of these three participants will determine the amount of loss.
- Appraisal Costs: All costs and expenses for appraisal are shared equally by TWIA and the policyholder, including costs for both appraisers and the umpire.
- Final Decision: The appraisal decision is final and binding.
- Deadline to demand Appraisal: usually, the deadline to demand appraisal is 60 days from the date you received notice of TWIA’s decision to accept your claim. However, the Texas Department of Insurance recently extended this deadline for Harvey claims. Now you have 120 days from the date TWIA accepts your claim to demand appraisal. This deadline may be extended 30 more days, if requested within 15 days after the initial deadline. If you miss this deadline, you waive the right to contest the accepted portion of the claim.
- Challenging an appraisal decision: typically, you cannot challenge an appraisal decision, as the decision is final and binding. However, the Texas Insurance Code, Section 2210.574(g) does provide exceptions to this. You may file an action to vacate the appraisal award within 2 years if the decision was obtained by corruption; fraud; undue means; or the rights of the policyholder were prejudiced when either appraiser or umpire exceeded their powers, refused to postpone appraisal after good cause showing, refused to consider evidence material to the claim, or conducted the appraisal in a manner that substantially prejudiced the rights of the policyholder.
Claims Dispute Resolution;
Disputes Denied Claims- Alternative Dispute Resolution/Intent to File a Lawsuit
Disputing TWIA’s decision to deny coverage: If you are disputing TWIA’s decision to partially or fully deny your claim, you must notify TWIA of your intent to file suit but TWIA may require the dispute be handled by alternative dispute resolution (ADR).
- Alternative Dispute Resolution(ADR): TWIA may require you to handle your coverage dispute by ADR. Mediation is the primary for of dispute resolution utilized by TWIA.
- ADR/Mediation costs: all costs and expenses of mediation are shared equally by both parties.
- Filing Suit: You may file a suit against TWIA if ADR was not timely requested or completed, or you are not satisfied by the outcome. You may sue only if the denial was improper and to determine the amount you are entitled to recover. You may only recover the amount payable under the terms of the policy, consequential damages under common law, prejudgment interest, court costs, and reasonable and necessary attorney’s fees.
- Notice of intent to file suit against TWIA: You have 2 years from the date you receive notice of TWIA’s denial of your claim in full or in part to notify TWIA in writing of your intent to file suit. If you miss this deadline, you waive any right to contest TWIA’s denial of your claim and are barred from bringing a lawsuit concerning denial of coverage.
- ADR Timeframe: As a prerequisite to filing suit, TWIA has the option of requiring the policyholder submit the dispute to ADR. Mediation is the primary form of dispute resolution utilized by TWIA. TWIA has 60 days from the date you provide notice of intent to file suit to request the dispute be handled through ADR and the ADR must be completed within 60 days of TWIA’s request for ADR.