2023 Texas Statutes › Insurance Code › Title 10 - Property and Casualty Insurance › Subtitle G - Pools, Groups, Plans, and Self-Insurance › Chapter 2210 - Texas Windstorm Insurance Association › Subchapter L. -1. Claims: Settlement and Dispute Resolution › Section 2210.576. Issues Brought to Suit; Limitations on Recovery

Sec. 2210.576.  ISSUES BROUGHT TO SUIT; LIMITATIONS ON RECOVERY.  (a)  The only issues a claimant may raise in an action brought against the association under Section 2210.575 are:
(1)  whether the association's denial of coverage was proper; and
(2)  the amount of the damages described by Subsection (b) to which the claimant is entitled, if any.
(b)  Except as provided by Subsections (c) and (d), a claimant that brings an action against the association under Section 2210.575 may recover only:
(1)  the covered loss payable under the terms of the association policy less, if applicable, the amount of loss already paid by the association for any portion of a covered loss for which the association accepted coverage;
(2)  prejudgment interest from the first day after the date specified in Section 2210.5731 by which the association was or would have been required to pay an accepted claim or the accepted portion of a claim, at the prejudgment interest rate provided in Subchapter B, Chapter 304, Finance Code; and
(3)  court costs and reasonable and necessary attorney's fees.
(c)  Nothing in this chapter, including Subsection (b), may be construed to limit the consequential damages, or the amount of consequential damages, that a claimant may recover under common law in an action against the association.
(d)  A claimant that brings an action against the association under Section 2210.575 may, in addition to the covered loss described by Subsection (b)(1) and any consequential damages recovered by the claimant under common law, recover damages in an amount not to exceed the aggregated amount of the covered loss described by Subsection (b)(1) and the consequential damages recovered under common law if the claimant proves by clear and convincing evidence that the association mishandled the claimant's claim to the claimant's detriment by intentionally:
(1)  failing to meet the deadlines or timelines established under this subchapter without good cause, including the applicable deadline established under Section 2210.5731 for payment of an accepted claim or the accepted portion of a claim;
(2)  disregarding applicable guidelines published by the commissioner under Section 2210.578(f);
(3)  failing to provide the notice required under Section 2210.573(d);
(4)  rejecting a claim without conducting a reasonable investigation with respect to the claim; or
(5)  denying coverage for a claim in part or in full if the association's liability has become reasonably clear as a result of the association's investigation with respect to the portion of the claim that was denied.
(e)  For purposes of Subsection (d), "intentionally" means actual awareness of the facts surrounding the act or practice listed in Subsection (d)(1), (2), (3), (4), or (5), coupled with the specific intent that the claimant suffer harm or damages as a result of the act or practice.  Specific intent may be inferred from objective manifestations that the association acted intentionally or from facts that show that the association acted with flagrant disregard of the duty to avoid the acts or practices listed in Subsection (d)(1), (2), (3), (4), or (5).
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 2 (H.B. 3), Sec. 41, eff. September 28, 2011.