Texas Auto Claim-Is an Adjuster required to investigate any potential Coverage

[Escobar Martin]

Jurisdiction

Texas

So Tman was adjusting this claim involving a Fatality. The claim had been opened because a claimant who is not an insured but was a guest passenger in a vehicle that Company X insured formerly. About two weeks before the loss occurred the vehicle was removed from the policy as it was sold to another party. That Party's son (who has been operating the vehicle Company X insured only 2 weeks ago) was killed by a drunk driver and the person that was driving the vehicle that company once insured was also unlisted and unrelated to the policy holder for Company X. Company X's protocol is to move the claim to litigation whenever a fatality is reported, but management elected not to do this. Instead they instructed me to only send the PIP/UM denials as that is all the attorney requested in his letter. Normally I would of course issue a denial for unlisted vehicle and driver but the company has instructed me that the claim is closed and effectively denied in that a response was given to the request for PIP/UM information. Would this be a violation of Texas insurance code/Consumer Bill of Rights? i.e to issue no general coverage denial for Unlisted vehicle and Unlisted Driver? Tman knows the bill of rights says a decision must be rendered in 15 days, and this is the only claim in Tman's career where he did not close a claim by either denying coverage, liability, or obtaining a release and issuing payments. I understand that Company X is trying to avoid any possibility of Bad Faith as the case involves vehicular manslaughter and that litigation believes that by sending the PIP/UM rejections all Company X's obligations to responding to the atty's letter have been fulfilled, but I want to do the right thing. And not jeopardize my license or expose me to liability as not issuing a coverage denial for ULV and ULD when it would seem to apply might be seen as a failure to comply with the Consumer Bill of rights. Is Tman exposed to a liability here or could there be any repercussion's against Tman's license. Tman has asked management several times now to move the claim out of Tman's name as per Company policy but thus far they have not done so, which has caused Tman to be very concerned and worried.

 

[army judge]

Would this be a violation of Texas insurance code/Consumer Bill of Rights?

Only a judge, a jury after a trial, or the Texas Insurance Commissioner could issue a legitimate
ruling sufficient to answer your wistful query.

I want to do the right thing

Tman should consult his management or corporate counsel, rather than seek guidance from strangers.

And not jeopardize my license or expose me to liability as not issuing a coverage denial for ULV and ULD when it would seem to apply might be seen as a failure to comply with the Consumer Bill of rights.

Tman should note my previous response hereinabove!

Tman has asked management several times now to move the claim out of Tman's name as per Company policy but thus far they have not done so, which has caused Tman to be very concerned and worried.

If Tman were really worried, Tman would HIRE an attorney to keep Tman safe!

 

[Escobar Martin]

Only a judge, a jury after a trial, or the Texas Insurance Commissioner could issue a legitimate
ruling sufficient to answer your wistful query.




Tman should consult his management or corporate counsel, rather than seek guidance from strangers.




Tman should note my previous response hereinabove!




If Tman were really worried, Tman would HIRE an attorney to keep Tman safe!

Thanks for the quick replies. But tbh it seems like you've never been just a cog in the wheel of a company. Tman doesn't get to demand speaking to corporate counsel (I could call some of our defense counsels but they work for the corporation not me as an adjuster in any way shape or form, the company has made this clear with other employees in other situations) and of course I have consulted management. The problem is if you put up a fuss on anything at a company they shift you into the problem category and start loading you with all sorts of random tasks and goals to try to grind you to quit or wait for you to screw up on some of the numerous tasks and goals they throw at you and try to fire you based off that and then try to use that to deny your unemployment insurance. That's insurance corporate policy toward employee's 101, super basic stuff. It's like you think corporations want to protect their employees. I wish. but this aint the 50's no more.

 

[army judge]

Thanks for the quick replies. But tbh it seems like you've never been just a cog in the wheel of a company. Tman doesn't get to demand speaking to corporate counsel (I could call some of our defense counsels but they work for the corporation not me as an adjuster in any way shape or form, the company has made this clear with other employees in other situations) and of course I have consulted management. The problem is if you put up a fuss on anything at a company they shift you into the problem category and start loading you with all sorts of random tasks and goals to try to grind you to quit or wait for you to screw up on some of the numerous tasks and goals they throw at you and try to fire you based off that and then try to use that to deny your unemployment insurance. That's insurance corporate policy toward employee's 101, super basic stuff. It's like you think corporations want to protect their employees. I wish. but this aint the 50's no more.

Tman might wish to reevaluate his position.

It seems someone has ALREADY affixed a bullseye to Tman's back.

We have a very experienced, knowledgeable, insurance expert who will be along sooner or later.

I'll allow @adjusterjack to dispense his wit and wisdom to assist you with your dilemma.

 

[zddoodah]

So Tman was adjusting this claim

What is "Tman" supposed to mean?

a claimant who is not an insured but was a guest passenger in a vehicle that Company X insured formerly. About two weeks before the loss occurred the vehicle was removed from the policy as it was sold to another party. That Party's son (who has been operating the vehicle Company X insured only 2 weeks ago) was killed by a drunk driver and the person that was driving the vehicle that company once insured was also unlisted and unrelated to the policy holder for Company X.

This is incredibly convoluted to the point that I can't really tell who's who and what exactly happened.

Company X's protocol is to move the claim to litigation whenever a fatality is reported

What does that even mean?

they instructed me to only send the PIP/UM denials as that is all the attorney requested in his letter.

Who are "they," and what is your relationship to the situation you described. Are you an employee of an insurance company that issued an auto liability policy that is implicated in this situation? If so, what is your position in the company? What attorney requested denials of coverage? Whom does this attorney represent?

Would this be a violation of Texas insurance code/Consumer Bill of Rights? i.e to issue no general coverage denial for Unlisted vehicle and Unlisted Driver?

Ummm...no, it is not illegal not to deny a claim.

The rest of your post is fairly equally unintelligible. If you're concerned that your employer is doing something inappropriate, discuss it with a supervisor, with HR and/or with a local attorney. If you don't feel comfortable continuing your employment there, find another job.

 

[adjusterjack]

I'm a retired claims adjuster and I couldn't understand it either.

I'm guessing that "Tman" is the poster's nickname and he referred to himself in the third person.

Beyond that.....?????