Most automobile and homeowners policies allow you to resolve claim disputes through an appraisal process. You can use the appraisal to negotiate with the company, or to appeal or take the matter to court. Ask your company if your policy allows an appraisal. In the appraisal process, you and the insurance company hire separate damage appraisers. The two appraisers choose a third appraiser to act as an umpire. The appraisers review your claim, and the umpire rules on any disagreements. You are required to pay for your appraiser and half of the umpire's costs. You and the insurance company must accept the umpires decision about the loss amount. If there is a dispute over what is covered, you can ask the company to reconsider the coverage issue.
a copy of both sides of your insurance card a description of your problem what you believe would be a fair resolution of your complaint copies of all supporting documentation, including invoices, canceled checks, advertising materials, and any letters between you and the company or agent.
After you send your complaint to us, we will: Send you an acknowledgment letter with the name and phone number of the complaint specialist assigned to your complaint. Notify the company about your complaint and ask for a detailed response. Send you a copy of the companys response and an explanation of the outcome, usually within 45 days after we receive your complaint. Determine if your issue was handled appropriately and within the terms of the policy or certificate of coverage. Determine if the company, agent, or adjuster broke state insurance laws, and take enforcement action when laws are broken. While we make every effort to help you resolve your complaint, we cannot: Make determinations about negligence or fault in an accident. These types of disputes must be resolved in court. Resolve a dispute between you and the insurance company when the only evidence is your word. Force a company to pay a disputed claim or make an exception to the contract if no insurance laws have been violated. Give legal advice or make medical judgments. Even if we cant resolve your complaint, your complaints and inquiries help us identify issues and potential problems with insurance companies, HMOs, agents, or adjusters. Our involvement can also cause companies to look more closely at your concerns. If youre not satisfied with the results, you can discuss your concerns with an attorney. You may also request alternative dispute resolution (ADR) to settle problems with your insurance company. ADR uses techniques such as mediation with a neutral third party to settle disputes outside court. Look in your telephone book for attorneys and mediation services. If you need help finding an attorney, call the State Bar of Texas Lawyer Referral Information Service 1-800-252-9690 www.texasbar.com
463-6515 in Austin www.tdi.state.tx.us When you call your company: Have your policy number ready. Ask for a written response to your complaint. Follow up in writing. Describe your complaint and how you expect the company to resolve it. Send copies (not originals) of letters, notes, invoices, canceled checks, advertising materials, or other documents that support your complaint.
Be Claim Smart
Most of the complaints we deal with involve disputes over claim settlements. Follow these tips to help avoid claim settlement problems: Read your policy carefully. A policy is a contract between you and the insurance company. Don't rely solely on your agent to tell you what your policy covers. Read the Consumer Bill of Rights. Insurance companies must include it with personal automobile, homeowners, and credit life policies or renewals. It explains your rights and responsibilities. For a copy, call your insurance company or visit our website. Keep copies of all documents and take notes about all calls between you and the insurance company. Include the date and subject of any conversations you have and the name and title of the person you spoke to. Ask the company for the specific language in the policy related to your claim. Determine whether the disagreement is because you and the insurance company read your policy differently.
Keep records of improvements to your property. Maintain an inventory of personal property including furnishings, clothing, and valuables. Videotape or photograph the inside and outside of your home. Keep these photos or tapes in a safe deposit box or in a location other than your home. Homeowners policies do not cover damage by rising water. If you're concerned about the possibility of flooding, consider buying flood insurance. Remember that you don't have to live in a flood plain to suffer a flood loss. For more information about flood insurance coverage, call your insurance agent or company, or the National Flood Insurance Program administered by the Federal Emergency Management Agency (FEMA) at 1-800-427-4661 or visit them online at www.fema.gov.