With hurricane season fast approaching and the Texas Windstorm Insurance Association (TWIA) the largest insurer of coastal property in Texas, now is the time to address one of the most common questions I receive from clients and public adjusters. This blog has previously addressed how the TWIA statute works in Texas and the dual paths of a claim that an insured must take. If TWIA accepts the claim, an insureds only remedy is appraisal, and if TWIA denies the claim, then the insured can file suit. Conceptually this sounds easy but in reality, can be difficult if TWIA accepts damage but doesn’t pay everything owed.

Recently, the Corpus Christi Court of Appeals looked at what happens when an insured files a claim for the damage to their home totalling over $330,000.00 and then TWIA “accepted the claim in full” but pays less than $170,000.00.1 The “Notice of Claim Acceptance” notice form TWIA that accepted coverage for roof damage, exterior damage, interior damage, and personal property damage from Hurricane Harvey. The insured argued that TWIA had actually denied his claim because the claim was for the total loss of his home and his home needed to be bulldozed and rebuilt in its entirety. The insured reported his damages to include many specific items that TWIA did not include in the estimate with the payment made. The insured argued that everything not paid for by TWIA was denied.

The court looked at the “Notice of Claim Acceptance” sent to the insured stating TWIA “accepted your claim in full.” The court pointed out that TWIA fully accepted coverage for the claim and did not indicate in any way that coverage for the claim was, in actuality, fully or partially denied. The court went on to hold that because TWIA accepted coverage for the claim in full and no appraisal was demanded, the insured waived the right to contest TWIA’s determination of the amount of loss and the suit is barred. The court concluded that TWIA was entitled to judgment as a matter of law and dismissed the insured’s suit.
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1 See Texas Windstorm Ins. Association v. Park, No. 13-18-00634-CV, Tex. App.—Corpus Christi, April 25, 2019).

  • Jim Johnson

    My question on this article is, will TWIA consider and review and consider estimates submitted by a contractor or a PA without going to appraisal? If not, it would seem very unfair for an insured to be forced into an appraisal every time there is a disagreement on the value of a loss!

    TWI

    • That is what State Farm does on nearly every claim in which there is a disagreement on the amount of loss – even if the amount in dispute is less than the cost of their appraiser, let alone the appraiser plus umpire.

    • Ryan Fowler

      Jim,
      There isn’t a good answer to your question. Each case is different and I never attempt to guess what any insurance carrier will do. I have heard stories from clients and public adjusters with completely different experiences. Ultimately every time TWIA decides it doesn’t want to negotiate and there is a disagreement the case will be forced into appraisal.
      Ryan