PJC Business

PJC 102.25

DTPA/I NSURANCE C ODE

More than one “notice of claim.” During the course of the claims process, the insurer may receive several communications from the claimant that “reasonably apprise[] the insurer of the facts relating to the claim” and thus meet the definition of “notice of claim” in Tex. Ins. Code §542.051(4). If that is the case, the following instruction should be added to PJC 102.25: If Don Davis received more than one notice of claim from Paul Payne , answer with regard to the notice that was received on the ear liest date. Finding “the date the claim was required to be paid” to determine when inter est penalty begins on “forces of nature” real property claims governed by section 542.060(c). The interest penalty for violations in handling claims for damage to real property and improvements caused by “forces of nature” begins “on the date the claim was required to be paid.” Tex. Ins. Code § 542.060(c). For questions and comments on the statute’s requirements for payment, see PJC 102.27 and 102.28. PJC 102.27 sub mits the insurer’s failure to pay what the insurer agreed to pay in its written notice to the claimant accepting the claim in whole or in part. Tex. Ins. Code § 542.057. PJC 102.28 submits the insurer’s failure to pay the claim within sixty days of receiving “all items, statements, and forms reasonably requested and required under Section 542.055.” Tex. Ins. Code § 542.058. The comments provide questions for determining the dates when the triggering event occurred, from which can be determined “the date the claim was required to be paid.” Waiver of notice requirement. “Notice of claim” is defined as “any written noti fication” that reasonably apprises the insurer of the facts relating to the claim. Tex. Ins. Code § 542.051(4) (emphasis added); McMillin v. State Farm Lloyds , 180 S.W.3d 183, 207–08 (Tex. App.—Austin 2005, pet. denied) (insurer’s internal phone logs of con versations with claimant are not “written notice” and actual notice does not trigger statute). Typically, however, claimants give oral notice and insurers start investigating when they receive oral notice, facts that may support submission of waiver of the notice requirements of the statute. See Massachusetts Bonding & Insurance Co. v. Orkin Exterminating Co. , 416 S.W.2d 396, 401–02 (Tex. 1967) (waiver of notice requirement in policy); Daugherty v. American Motorists Insurance Co. , 974 S.W.2d 796, 798 n.3 (Tex. App.—Houston [14th Dist.] 1998, no pet.) (insurer accepted oral notice and acknowledged oral notice in writing). Act of insurer’s agent is act of insurer. Notice to a person acting as an agent for the insurer is notice to the insurer, and thus the date the agent receives notice of the claim is the date the insurer receives notice of the claim. Protective Life Insurance Co. v. Russell , 119 S.W.3d 274, 287–88 (Tex. App.—Tyler 2003, no pet.) (citing Tex. Ins. Code art. 21.02, now Tex. Ins. Code §4001.051, which lists the acts that constitute acting as an agent for an insurer, and holding that “[n]otice to an agent, received while the agent is acting within the scope of his authority, constitutes notice to the princi pal[]”). See also Tex. Ins. Code § 542A.001(1), defining “agent” as “an employee,

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