PJC Business

DTPA/I NSURANCE C ODE

PJC 102.25

agent, representative, or adjuster who performs any act on behalf of an insurer.” When an agent is acting on behalf of an insurer in dealing with a claim, the jury should be instructed as follows: You are instructed that Don Davis includes [ name of agent ]. Act of claimant’s agent is act of claimant. Notice to the insurer by a person act ing as an agent for the claimant is notice by the claimant. Dunn v. Southern Farm Bureau Casualty Insurance Co. , 991 S.W.2d 467, 473 (Tex. App.—Tyler 1999, pet. denied) (holding that notice given by claimant’s attorney is notice given by claimant because “what a principal does through an agent, he does himself”). When an agent is acting on behalf of the claimant in dealing with the insurer, the jury should be instructed as follows: You are instructed that Paul Payne includes [ name of agent ]. Requests for information from claimant. The statute requires that the insurer, within fifteen days of receipt of the notice of claim (or thirty business days if an eligi ble surplus lines insurer), “request from the claimant all items, statements, and forms that the insurer reasonably believes, at that time, will be required from the claimant.” Tex. Ins. Code § 542.055(a)(3). The insurer may make additional requests for informa tion “if during the investigation of the claim the additional [information] requests are necessary.” Tex. Ins. Code § 542.055(b). An insurer’s requests for information must be reasonable and necessary to decide whether to accept or reject the claim. See Guide One Lloyds Insurance Co. v. First Baptist Church of Bedford , 268 S.W.3d 822, 835 (Tex. App.—Fort Worth 2008, no pet.) (core samples of damaged roof not required to make decision to accept or reject damaged roof claim); Colonial County Mutual Insur ance Co. v. Valdez , 30 S.W.3d 514, 523 (Tex. App.—Corpus Christi–Edinburg 2000, no pet.) (“Common sense indicates that materials such as service records, sets of keys, and photographs of the vehicle are irrelevant to proving the loss of the vehicle.”). Extension of deadline —“ eligible surplus lines insurer.” If the insurer is an “eli gible surplus lines insurer,” the deadline for compliance with section 542.055 is “the 30th business day” after receipt of the notice of claim rather than the “15th day” dead line applicable to insurers that the Texas Department of Insurance has authorized to do business in Texas. An “eligible surplus lines insurer” is an unauthorized insurer meet ing certain minimum requirements and selling insurance that in kind or amount of cov erage is not available from authorized insurers. See Tex. Ins. Code §981.002(4) (definition of “eligible surplus lines insurer”); Tex. Ins. Code ch. 981 (regulation of surplus lines insurers). “‘Business day’ means a day other than a Saturday, Sunday, or holiday recognized by this state.” Tex. Ins. Code §542.051(1). Thus, if the claim is against an eligible surplus lines insurer, the jury should be given the following instruc tion using the statutory definition of “business day” with the dates of the relevant state-recognized holidays inserted in place of the words “holiday recognized by the state”:

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