Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 5 - PROPERTY AND CASUALTY INSURANCE › Subchapter E - TEXAS WINDSTORM INSURANCE ASSOCIATION › Division 4 - CONSUMER ASSISTANCE; CLAIM PROCESSES › Section 5.4218 - Appraisal Process - Umpire Obligations

Current through Reg. 49, No. 28; July 12, 2024
(a) Conflicts. An umpire must disclose to
					 both parties any potential conflicts of interest. Conflicts of interest are
					 listed in §
											5.4214
					 of this title (relating to Appraisal Process - Umpire Qualifications and
					 Conflicts of Interest). The umpire must disclose the conflicts of interest no
					 later than the fifth day after being hired, and before the umpire begins work.
					 A person may not serve as umpire in an appraisal for which the person has a
					 disqualifying conflict of interest.
(b) Work. The umpire may begin work only if
					 the association's appraiser and the claimant's appraiser fail to reach an
					 agreement on the appraisal amount and tell the umpire in writing to begin
					 work.
(c) Review information. The
					 parties and appraisers may request the umpire to review any information related
					 to the claim, including itemized estimates and supporting documents such as
					 photographs and diagrams. The umpire must review in detail all information the
					 appraisers and parties submit related to the dispute, including the itemized
					 appraisals. At a party's request, the umpire may also consider any conflicts of
					 interest or objections to appraisers. The umpire must allow each appraiser a
					 fair opportunity to present evidence and argument. The umpire may ask
					 questions, and request documents or other evidence, including expert
					 reports.
(d) Limited scope. The
					 umpire's work may only cover items about which the two appraisers disagree. The
					 umpire must review the differences and seek agreement with one or both
					 appraisers regarding the disputed items. The umpire may accept either
					 appraiser's scope, quantities, values, or costs on items in dispute or may
					 develop an independent decision on an item. The umpire may not visit the
					 claimant's property without agreement from both appraisers.
(e) Decision. An itemized decision agreed to
					 by both appraisers or by one appraiser and the umpire is binding on the parties
					 as to the amount of loss the association will pay for the claim. The umpire may
					 enter into an itemized decision with one or both appraisers on a compromise
					 basis. The umpire can issue a decision if agreement is reached on the final
					 total, even if there is disagreement on some of the individual items. The
					 umpire must promptly give the parties and the appraisers an itemized written
					 decision.
(f) Ethics. After
					 accepting the responsibility to be the umpire for an appraisal, the umpire:
(1) may not withdraw or abandon the appraisal
					 unless compelled to do so by unanticipated circumstances that would render it
					 impossible or impractical to continue;
(2) may not be present or participate in
					 settlement discussions unless requested by both parties; and
(3) must decide all matters fairly,
					 exercising independent judgment and utmost integrity. An umpire may not permit
					 outside pressure to affect the appraisal and may not delegate the umpire's
					 decision under subsection (e) of this section to any other person.