Understanding Insurance Claim Process and Deadlines

Understanding Insurance Claim Process and Deadlines

A Direct Result of the “Prompt Payment of Claims Act”

Many property owners are unaware of the deadlines the insurance company is required to follow when adjusting an insurance claim in Texas. The red tape, the restrictions, the tiny print, and the delay tactics of many insurance companies and bureaucratic entities can make the insurance claim filing process into a nightmare. In an effort to help move things along, and to provide you with the time sensitive information you need to meet deadlines, TDA’s Texas Public Adjuster insurance claims services team compiled the data on deadlines and have listed it here for you.

First: 15 days – the 15th business day after the date an insurance company receives notice of a claim, the insurance company must:

  • 1. acknowledge receipt of the claim;
  • 2. commence any investigation of the claim; and
  • 3. request from the claimant all items, statements, and forms that the insurer reasonably believes, at that time, will be required from the claimant.

Second: 15 days – no later than the 15th business day after the date the insurance company receives all items, statements, and forms required by the insurance company to secure final proof of loss, an insurance company must notify a policyholder, in writing, of the acceptance or rejection of a claim. If insurance company rejects the claim, they must state the reasons of coverage denial in writing. At this time, the insurance company can request a one-time 45 day extension.

Within 10 days, the insurance company shall pay the claim settlement no later than the 10th business day after acceptance of claim, or they must send a denial letter to the policyholder for rejection of the claim.

For areas that have been designated a state and/or federal disaster the following deadlines are extended.

First: 30 days – the 30th business day after the date an insurance company receives notice of a claim, the insurance company must:

  • 1. acknowledge receipt of the claim;
  • 2. commence any investigation of the claim; and
  • 3. request from the claimant all items, statements, and forms that the insurer reasonably believes, at that time, will be required from the claimant.

Second: 30 days – no later than the 30th business day after the date the insurance company receives all items, statements, and forms required by the insurance company to secure final proof of loss, an insurance company must notify a policyholder, in writing, of the acceptance or rejection of an insurance claim. If insurance company rejects the claim, they must state the reasons of coverage denial in writing. At this time, the insurance company can request a one-time 45 day extension.

Within 20 days, the insurance company must pay the claim settlement no later than the 20th business day after acceptance of claim, or they must send a denial letter to the policyholder for rejection of claim.

It is important to know these deadlines and to keep a claim diary of your insurance-claims-services-deadline-tda-texas-public-adjusterinsurance claim settlement process timeline. This diary and timeline can help identify any violations to the insurance code by the insurance company. There is a penalty interest assessed to insurance companies who violate this statute, which is an 18% interest per year fee on the money they should have paid on time. Having TDA’s Texas public insurance adjusters on your side helps you navigate through the intricacies of the ever complicated insurance claim process.

The Disaster Advocates your expert insurance claims services team have the skills, knowledge, and confidence you need to help you “Claim what’s yours” no matter what the insurance companies throw in your way. Contact us today to schedule your no-cost, no-obligation consultation with TDA your licensed Texas public insurance adjuster.


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