Whose Job Is It Anyway?

  • July 27, 2013

An insurance agreement is a contract between a policyholder and an insurance company. Most of the contracts spell out whose job it is to investigate the loss. Many policies track the language of the Texas Insurance Code respecting such duties. Even if the contract leaves out the “investigate” language (see below) in the “Our Duties After Loss,” they still owe the duty under Texas Insurance Code.

If the insurance company fails to conform with these requirements timely, they can be held responsible for 18% interest per year on your covered damages PLUS attorney fees in collecting it. (Tex. Ins. Code section 542)

I share this because insurance companies routinely fail in this duty and, oftentimes, blame the insured (you) as a result. In court, it is very hard for them to get around this, however, and they will acknowledge (they have to) that it is their job to investigate the loss, not the insureds.

So, if you have a roof damage claim and your insurance company is telling you to get on the roof and inspect it, they are failing in that duty. If you have water damage on your ceiling and your insurance company fails to inspect the roof, they are failing in their job. If you have significant roof damage and your insurance company fails to inspect the interior for water damage, they are failing in their duty. There is a reason for this — part of the premium you pay is for the professional service of investigation. They are supposed to send investigators trained in evaluating the loss that you are claiming. You, the policyholder, are not expected to know every bit of damage you sustained. Your job is to point out what you see, make your home available for inspection, and prevent further damage as best you can (as well as keep receipts — I will post on your duties in a separate blog article). But, an insurance company is failing in their duty if they come to inspect your damage and only look at the specific areas you show them. You are not a professional inspector.

I see this way too much. I will continue to write about issues pertaining to this topic so check back for more information.