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 2210.573. Filing of Claim; Claim Processing

Sec. 2210.573.  FILING OF CLAIM; CLAIM PROCESSING.  (a)  Subject to Section 2210.205(b), an insured must file a claim under an association policy not later than the first anniversary of the date on which the damage to property that is the basis of the claim occurs.
(b)  The claimant may submit written materials, comments, documents, records, and other information to the association relating to the claim.  If the claimant fails to submit information in the claimant's possession that is necessary for the association to determine whether to accept or reject a claim, the association may, not later than the 30th day after the date the claim is filed, request in writing the necessary information from the claimant.
(c)  The association shall, on request, provide a claimant reasonable access to all information relevant to the determination of the association concerning the claim.  The claimant may copy the information at the claimant's own cost or may request the association to provide a copy of all or part of the information to the claimant.  The association may charge a claimant the actual cost incurred by the association in providing a copy of information under this section, excluding any amount for labor involved in making any information or copy of information available to a claimant.
(d)  Unless the applicable 60-day period described by this subsection is extended by the commissioner under Section 2210.581, not later than the later of the 60th day after the date the association receives a claim or the 60th day after the date the association receives information requested under Subsection (b), the association shall provide the claimant, in writing, notification that:
(1)  the association has accepted coverage for the claim in full;
(2)  the association has accepted coverage for the claim in part and has denied coverage for the claim in part; or
(3)  the association has denied coverage for the claim in full.
(e)  In a notice described by Subsection (d)(1), the association must inform the claimant of the amount of loss the association will pay and of the time limit to request appraisal under Section 2210.574.
(f)  In a notice described by Subsection (d)(2) or (3), the association must inform the claimant of, as applicable:
(1)  the portion of the loss for which the association accepts coverage and the amount of loss the association will pay;
(2)  the portion of the loss for which the association denies coverage and a detailed summary of the manner in which the association determined not to accept coverage for that portion of the claim; and
(3)  the time limit to:
(A)  request appraisal under Section 2210.574 of the portion of the loss for which the association accepts coverage; and
(B)  provide notice of intent to bring an action as required by Section 2210.575.
(f-1)  In a notice described by Subsection (d)(1) or (2), the association must include additional information concerning the availability of supplemental payments under the policy, including:
(1)  a description of the process for requesting a supplemental payment; and
(2)  applicable deadlines related to supplemental payments.
(g)  In addition to the notice required under Subsection (d)(2) or (3), the association shall provide a claimant with a form on which the claimant may provide the association notice of intent to bring an action as required by Section 2210.575.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 2 (H.B. 3), Sec. 41, eff. September 28, 2011.
Amended by:
Acts 2019, 86th Leg., R.S., Ch. 525 (S.B. 615), Sec. 14, eff. September 1, 2019.