In Houston, Texas, as in many other cities, insurance companies can play a significant role in personal injury cases. The insurance companies may be involved in a variety of ways.
Insurance Companies’ Involvement in PI Claims
- Insurance Companies Provide Liability Insurance: The law in Texas requires drivers to carry a minimum amount of liability insurance to cover damages and injuries they cause in an accident. You must have at least $30,000 in liability coverage for each injured person, up to a total of $60,000 per accident, and $25,000 for property damage per accident. This basic coverage is called 30/60/25. If a person is injured due to another driver’s negligence in Houston, they would typically file a claim against that driver’s insurance policy.
- First-Party Claims: An injured individual can file a claim with their own insurance company if they have certain types of coverage, like Personal Injury Protection (PIP) or uninsured/underinsured motorist coverage. This particular coverage is not mandatory to have, but must be offered by insurance companies to drivers. This can be especially important if the at-fault driver does not have insurance or enough insurance to cover the damages.
- Evaluating Claims: Once a claim is filed, the insurance company evaluates the circumstances of the accident, the injuries sustained, and any other damages. They will often ask for medical records, bills, proof of lost wages, and other documentation to assess the value of the claim.
Under Texas law, insurers have 35 days from the receipt of a claim to make a determination and settle it. Within that time frame, they must meet three additional deadlines: A deadline by which it must acknowledge a claim, a deadline by which it must make a decision, and a deadline by which it must issue a final payment.
Note that there is an exception to this rule in that in some circumstances, your insurance carrier can gain additional time to settle your claim. The company can get a 45-day extension to make a determination on your claim. Your insurance company must send you notice that it is using its 45-day extension and tell you the reason for the delay.
- Negotiations: Insurance adjusters often negotiate settlements. They might offer an initial settlement that is lower than what the claim might actually be worth. It is a common tactic to see if the injured party will accept a speedy, although lesser amount.
- Defensive Role in Litigation: If a personal injury case goes to court, the defendant’s insurance company will typically provide legal representation and bear the defense costs. They have a vested interest in defending against the claim because they are the ones paying out any damages.
- Settlements and Payouts: If a settlement is reached or a court awards damages, the insurance company pays the amount, up to the policy limits. If damages exceed the policy limits, the at-fault party might be personally responsible for the difference.
- Bad Faith Claims: Insurance companies have a duty to act in good faith and to deal fairly with policyholders. If they unreasonably deny a claim or delay payment without a valid reason, the injured party might have a separate claim against the insurance company for bad faith.
- Medical Payments and Health Insurance: Outside of automobile insurance, health insurance companies also play a role. They may cover an injured party’s medical bills and then seek reimbursement (subrogation) from any settlement or award the injured party receives.
The process that takes place between personal injury plaintiffs and insurance companies can sometimes end up being very unpleasant. Plaintiffs and their attorneys often have to push hard to get the compensation they feel they deserve, while insurance companies, in their effort to minimize costs, can be resistant to paying out these settlements. Having an experienced personal injury attorney in Houston can be essential in navigating these complexities and ensuring an injured individual’s rights are protected. Contact Ceja Law Firm, PLLC as soon as possible to schedule your free initial consultation to discuss your case.