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Claim Handling For Texas

ACT TO BE PERFORMED

Acknowledge pertinent communications with respect to claims

COMPLIANCE TIMEFRAME

Within 15 business days

REFERENCE

28 Tx. Admin. Code § 21.203(2)

Acknowledge receipt of first-party claim. If acknowledgment is not made in writing, record date, manner, and content of acknowledgment.

Not later than the 15th day after the date of receipt of notice of claim

Tex. Ins. Code Ann. § 542.055(a)(1)

Tex. Ins. Code Ann. § 542.055(c)

Acknowledge receipt of first-party claim if insurer is eligible surplus lines insurer. If acknowledgment is not made in writing, record date, manner, and content of acknowledgment.

Not later than the 30th business day after the date of receipt of notice of claim

Tex. Ins. Code Ann. § 542.055(a)(1)Tex. Ins. Code Ann. § 542.055(c)

Commence investigation of first-party claim

Not later than the 15th day after the date of receipt of notice of claim

Tex. Ins. Code Ann. § 542.055(a)(2)

Commence investigation of first-party claim if insurer is eligible surplus lines insurer

Not later than the 30th business day after the date of receipt of notice of claim

Tex. Ins. Code Ann. § 542.055(a)(2)

Request from first-party claimant all items, statements, and forms that

will be required from claimant

Not later than the 15th day after the date of receipt of notice of claim

Tex. Ins. Code Ann. § 542.055(a)(3)

Request from first-party claimant all items, statements, and forms that

will be required fromclaimant if insurer is eligible surplus lines insurer

Not later than the 30th business day after the date of receipt of notice of claim

Tex. Ins. Code Ann. § 542.055(a)(3)

Notify first-party claimant in writing of the acceptance or rejection of

a claim. If claim is rejected, state reasons for rejection.

Not later than the 15th business day after the date of receipt of all items, statements, and forms required to secure final proof of loss

Tex. Ins. Code Ann. § 542.056(a), (c)

If insurer has reasonable basis to believethat loss resulted from arson, 

notify first-party claimant in writing of the acceptance or rejection of

the claim. If claim is rejected, state reasons for rejection.

Not later than the 30th day after receipt of all required items, statements, and forms

Tex. Ins. Code Ann. § 542.056(b)-(c)

If additional time is needed to determine acceptance or rejection of first-party claim, notify claimant of reasons additional time is needed

Not later than the 15th business day after the date of receipt of all items, statements, and forms required

to secure final proof of loss or, if reasonable basis for arson, not later than the 30th day after receipt of all required items, statements, and forms.

Tex. Ins. Code Ann. §  542.056(d)

After notifying first-party claimant that additional time to determine 

acceptance or rejection of the claim is needed, notify claimant 
in writing of the acceptance or rejection of a claim

Not later than the 45th day after the date of notification that additional time isneeded

Tex. Ins. Code Ann. §  542.056(d)


ACT TO BE PERFORMED

Pay first-party claim if claimant is notified that claim or part of claim will be paid

COMPLIANCE TIMEFRAME

Not later than the 5th business day after the date notice is made

REFERENCE

Tex. Ins. Code Ann. § 542.057(a)

Pay first-party claim if claimant is notified that claim or part of claim will be paid if insurer is an eligible surplus lines insurer

Not later than the 20th business day after the date notice is made

Tex. Ins. Code Ann. § 542.057(c)

Pay first-party claim if payment of claim or part of claim is conditioned on the performance of an actby claimant

Not later than the 5th business day after the date the act is performed

Tex. Ins. Code Ann. §  542.057(b)

Pay first-party claim if payment of claim or part of claim is conditioned on the performance of an act by claimant if insurer is an eligible surplus lines insurer

Not later than the 20th business day after the date the act is performed

Tex. Ins. Code Ann. § 542.057(c)

On written request of a named insured under a liability insurance policy, provide
insured information relating to the disposition of a claim, including name of each 
claimant, details relating to amount paid on claim, settlement of claim, or judgment on the claim, how claim, settlement, or judgment is to be paid, 
and any other information required by rule of the commissioner

Not later than the 30th day after the date the request is received

Tex. Ins. Code Ann. § 542.101(b)Tex. Ins. Code Ann. § 542.103(a)

Notify insured in writing of an initial offer to settle a claim against a named insured under a casualty insurance policy

Not later than the 10th day after the date an initial offer to settle the claim is made

Tex. Ins. Code Ann. § 542.153(a)

Notify insured in writing of settlement under a casualty insurance policy

Not later than the 30th day after the date the claim is settled

Tex. Ins. Code Ann. § 542.153(b)

File a petition for judicial review (appeal) of a ruling or order of the 
department of insurance regarding unfair claim settlement practices

Not later than the 20th day after the date of the ruling or order

  1. Ins. Code Ann. § 542.011

 

*The statutory link provided is to the entire Texas Insurance Code.

In order to find the specific statutory section, you will need to scroll down.