PJC Business

DTPA/I NSURANCE C ODE

PJC 102.26

PJC 102.26 Prompt Payment of Claims Act — Violation of Insurer’s Duty to Notify Claimant of Acceptance, Rejection, or Need for More Time after Receiving All Necessary Information Reasonably Requested from Claimant (Tex. Ins. Code § 542.056) QUESTION ______ Did Don Davis fail to do either of the following acts within fifteen business days from the date he received all items, statements, and forms reasonably requested from Paul Payne that were necessary to decide whether to accept or reject the claim? “Business day” means every day except Saturday [ , / or ] Sunday [ , or [ insert relevant state holiday(s) ]]. 1. Notify Paul Payne in writing that the claim was accepted; or 2. notify Paul Payne in writing that the claim was rejected and the reason[ s ] for the rejection. Answer “Yes” or “No.” Answer: _______________ COMMENT When to use. PJC 102.26 submits the insurer’s failure to give written notice of its decision on the claim within fifteen “business days” of the date of the insurer’s receipt of the information the insurer reasonably requested from the claimant. If rejecting the claim, the insurer must state its reasons. Tex. Ins. Code §542.056(a), (c). There are two exceptions that extend the deadline for notifying the claimant of acceptance or rejection: the insurer is “unable” to accept or reject within the fifteen-day period (Tex. Ins. Code § 542.056(d)) or the insurer has a “reasonable basis to believe” the loss was the result of arson (Tex. Ins. Code § 542.056(b)). Each exception raises questions to be decided by the jury. See comments below, “Extension of deadline—insurer unable to accept or reject claim within time period” and “Extension of deadline—insurer’s rea sonable belief of arson,” for further discussion of these exceptions. Broad-form submission. PJC 102.26 is a broad-form question designed to be accompanied by one or more appropriate instructions. Tex. R. Civ. P. 277 requires that “the court shall, whenever feasible, submit the cause upon broad-form questions.” Tex. R. Civ. P. 277; see Thota v. Young , 366 S.W.3d 678, 689 (Tex. 2012) (rule 277’s use of “whenever feasible” mandates broad-form submission in any or every instance in

185