Escobar Martin
New Member
- 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.