PJC Business

DTPA/I NSURANCE C ODE

PJC 102.27

Act, the insurer must be “liable for a claim under an insurance policy.” Tex. Ins. Code § 542.060(a); Progressive County Mutual Insurance Co. v. Boyd , 177 S.W.3d 919, 922 (Tex. 2005). If there is a factual dispute whether the insurer is liable for the claim under the policy, the issue must be submitted to the jury. See PJC 101.56–101.60. Definition of “business day” and “day.” The various sections of the Prompt Payment of Claims Act use either “day” or “business day” depending on the statutory deadline involved. “Business day” is defined in Tex. Ins. Code §542.051(1). See Tex. Gov’t Code ch. 662 (listing state-recognized holidays). To avoid confusion the court may wish to define “day” for the jury as “every day, including all Saturdays, Sundays, and holidays.” The appropriate definition should be included depending on the rele vant statutory deadline. 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, 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 ]. Extension of deadline—“eligible surplus lines insurer.” If the insurer is an “eli gible surplus lines insurer,” the deadline for compliance with section 542.057 is “the 20th business day” after the insurer notifies the claimant that it will pay all or part of the claim or after the claimant’s performance of the act the insurer requires as a condi tion of payment, whichever is applicable. Tex. Ins. Code §542.057(c). An “eligible surplus lines insurer” is an unauthorized insurer meeting certain minimum require ments and selling insurance that in kind or amount of coverage 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

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