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TWIA's Claims Process Gets a Makeover

PRESENTED BY The Texas Windstorm Insurance Association will roll out reforms passed by the 82nd Texas Legislature on September 28. Here's a rundown of the complicated claims dispute process that will take effect. THE TEXAS TRIBUNE IF A CATASTROPHIC STORM HITS THE TEXAS COAST.. 60 DAYS LATER TWIA policyholders must file a claim WITHIN I YEAR THE EXPERT PANEL LA. for property damage caused by wind. The commissioner of the Texas Department of Insurance may form an expert panel to create guidelines for TWIA adjustors investigating whether wind caused the damage to a claimant's property. Using scientific methods and computer modeling, the expert panel will decide whether damage in various regions along the coast was most likely caused by wind, waves, tidal surges and/or rising water. TWIA MUST NOTIFY THE CLAIMANT IN WRITING • Whether the damage is covered by the TWIA policy • How much TWIA will pay to fix covered damage • How the inspector determined damage was not covered by the TWIA policy • The time limit to request an appraisal to challenge the amount IF TWIA ACCEPTS COVERAGE IN FULL OR PART OR IF TWIA DENIES COVERAGE IN FULL OR PART The claimant will not receive compensation for damage the TWIA adjuster determines was not caused by wind. WITHIN 10 DAYS TWIA must pay the claimant. TO DISPUTE THE DAMAGE COVERED BY TWIA TO DISPUTE THE AMOUNT The claimant may file a lawsuit against TWIA. WITHIN 2 YEARS TWIA PROPOSES TO PAY "Binding Arbitration" Policyholders TO FIX DAMAGE WITHIN Policyholders who have agreed to a "binding arbitration" policy may receive up to a 10 percent discount on premiums each month, but they cannot dispute the amount TWIA will pay for the claim. TWIA can request mediation to settle the dispute. 60 DAYS Claimant must request an AFTER FILED appraisal or all rights to dispute the amount are waived. The claimant may request a 30-day extension DEADLINE from the TDI Commissioner 60 DAY MEDIATION The claimant and TWIA select a mediator to help settle the dispute. If both parties don't agree on a mediator, the claimant may be charged a fee to select one at random from a list of qualified people maintained by the Texas Department of Insurance. in the two weeks following the 60-day deadline. THE APPRAISAL PROCESS The claimant and TWIA will both hire an appraiser to estimate the cost of fixing the damage TWIA accepted coverage for. TWIA and the claimant attempt to settle the dispute. WITHIN 60 DAYS· IF THE APPRAISERS AGREE The decision is binding. TWIA pays the claimant the agreed upon amount. OR IF THE APPRAISERS DON'T AGREE! IF MEDIATION FAILS... A third-party umpire will make the final appraisal decision. If both sides cannot agree on an umpire, the claimant may be charged a fee to select one at random from a list of qualified people maintained by TDI. If the claimant believes the TWIA appraiser or the umpire acted in a fraudu- lent or corrupt manner, the claimant may file an action in district court to throw out WITHIN 2 YEARS THE CASE GOES TO COURT the appraisal decision. A judge or jury will decide whether TWIA's denial of coverage was "proper." If the decision is thrown out.. the Appraisal Process starts over again IF YES OR IF NO The claimant loses. The judge or jury decides how much the claimant is owed to fix the damage. THE CLAIMANT MAY COLLECT The actual amount of money to fix the wind damage Prejudgment interest from the date the original claim would have been owed Court costs and "reasonable" attorney fees If it is determined TWIA intentionally* did any of the following • Failed to meet deadlines to act • Disregarded the Expert Panel's guidelines for handling claims • Failed to notify the claimant of TWIA's decision • Denied the claim without reasonable investigation The claimant may also receive "Double and Consequential" Damages: Twice the amount to fix the actual damage, • Denied coverage knowing TWIA was liable plus compensation for indirect losses that resulted from TWIA's actions. *Legal Definition of intentionally: "actual awareness of the facts surrounding the act or practice..coupled with the specific intent that the claimant suffer harm or damages." FOUL PLAY FOUL PLAY

TWIA's Claims Process Gets a Makeover

shared by rmmojado on Mar 23
A flow chart to visualize the new — and complicated — process policyholders with the Texas Windstorm Insurance Association will undergo to claim compensation or dispute coverage if a major storm h...


Texas Tribune


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