Within days of a crash, and sometimes within hours, an insurance adjuster may call. The adjuster may be polite and may sound eager to help, and the questions can seem routine. But the adjuster's job is to evaluate the claim for the insurance company, and what you say becomes part of the file. This guide covers who adjusters work for, what Texas law requires of your own insurer, and practical ground rules for those conversations.
After a crash, you may hear from two different insurance companies. Your own insurer handles claims under your policy, such as personal injury protection, uninsured or underinsured motorist coverage and collision coverage. The other driver's insurer handles the liability claim against its own policyholder. Both use adjusters, but their positions differ: your own insurer's obligations come from your policy and from statutes written for policyholders, while the other driver's insurer is evaluating a claim against its customer.
The prompt-payment rules in Subchapter B of Chapter 542 of the Texas Insurance Code apply to first-party claims. For that subchapter, Section 542.051 defines a claim as a first-party claim made by an insured or policyholder under a policy that must be paid by the insurer directly to the insured or beneficiary. Under Section 542.055, an insurer must, not later than the 15th day after it receives notice of a claim, acknowledge receipt of the claim, begin any investigation and request the items, statements and forms it reasonably believes it will need. An eligible surplus lines insurer has until the 30th business day.
Under Section 542.056, the insurer generally must then notify the claimant in writing whether it accepts or rejects the claim not later than the 15th business day after it receives all the items, statements and forms it required to secure final proof of loss. A rejection must state the reasons. If the insurer cannot decide within that period, it must explain why it needs more time, and it must then accept or reject the claim not later than the 45th day after that notice.
For personal injury protection specifically, Section 1952.156 requires the insurer to pay benefits periodically as claims arise, and not later than the 30th day after it receives satisfactory proof of a claim. Some lines of insurance are excluded from the prompt-payment subchapter, and how its deadlines apply can depend on the coverage and the claim, but these timelines are one more reason to keep a record of when you reported the claim and what you sent. Your own policy may also require you to cooperate with your insurer, so read its conditions before declining a request from your own company.
The liability adjuster for the other driver's insurer will want to know how the crash happened and what injuries you have. Felix Gonzalez Accident and Injury Law Firm cautions on its car accident page that adjusters "may request recorded statements or ask questions that sound routine but are designed to minimize the claim."
That caution connects to how Texas assigns fault. Under the state's Civil Practice and Remedies Code, responsibility is divided in percentages, and Section 33.001 bars any recovery of damages by a claimant found more than 50 percent responsible. A casual remark about glancing away, or a guess about speed or distance, can turn up later in that discussion.
Get the adjuster's name, company, phone number and claim number before answering anything else. Keep a log of every call: the date, who you spoke with and what was said. Follow up important conversations in writing so there is a record of them.
Stick to facts you actually know. Where you are unsure, say so rather than guessing. Describe injuries the way your doctors have described them, and avoid calling an injury minor before treatment has run its course. As the firm's car accident page notes, some conditions develop over hours or days.
It is reasonable to ask to schedule a call for later, after you have gathered your information or spoken with a lawyer. A request for a recorded statement in particular is worth pausing over.
Read any authorization form before you sign it. A broadly worded form may reach medical records that have nothing to do with the crash, so ask what records it covers and for what period.
An early settlement offer can be tempting when bills are arriving. A settlement is ordinarily paid in exchange for a signed release of further claims, so accepting before the extent of the injuries is known can mean giving up compensation for treatment that has not happened yet. Settlements can also matter later: if a suit is brought against others, Section 33.012 generally has the court subtract the dollar amounts of all settlements from the damages. Before signing any release, make sure you understand exactly what it covers.
No rule requires a lawyer to talk to an insurer. But when injuries are significant, fault is disputed or an adjuster is pressing for a recorded statement, a consultation can help you understand where you stand. The firm offers free consultations, and its outline of the case process places the demand package ahead of the step of filing a lawsuit.
This article is general information, not legal advice. Every case turns on its own facts; for advice about your situation, speak with a licensed Texas attorney.