If you have an insurance claim, you may submit a Proof of Loss form. Our experienced Houston insurance claims lawyer at Haun Mena explains what a Proof of Loss form is and why it matters to your insurance claim.
What Is a Proof of Loss Form?
A Proof of Loss form is a sworn statement used in insurance claims. The party making an insurance claim submits the form to the insurance company. The form details claim information, including the date and time of loss and the amount claimed.
What Is the Purpose of a Proof of Loss Form?
The purpose of a Proof of Loss Form is to enable the insurance company to process an insurance claim. Requiring the form to be sworn protects against fraud.
Who Requires a Proof of Loss Form?
A Proof of Loss form may be required for many types of insurance claims, including:
- Property damage
- Car accidents
- Health
- Life
- Title
- Flood
The insurance company may not always require a Proof of Loss Form to finalize a claim.
Why Does the Proof of Loss Form Matter in an Insurance Claim?
The Proof of Loss Form matters because a properly submitted form can speed up the processing of an insurance claim. A late, missing, incomplete, or inaccurate form may result in claim denial.
How Long Do You Have to File a Proof of Loss Form?
An insurance policy usually states how long you have to submit a Proof of Loss Form. Thirty to 90 days following the loss or the insurer’s request is common. In general, the form should be submitted as soon as practicable.
Texas Insurance Code § 1201.213 states that a claimant has 91 days to return a proof of loss form for accident and health insurance claims falling under Insurance Code Chapter 1201. There are exceptions that may allow up to one year or longer if legally incapacitated.
FEMA requires the Proof of Loss form within 60 days for National Flood Insurance Program benefits. However, they often grant extensions in the wake of widespread natural disasters.
What Information Is Required on a Proof of Loss Form?
Information required on a Proof of Loss Form may include:
- Policyholder name
- Property address
- Policy number
- Item insured (e.g., property, motor vehicle, etc.)
- Mortgagee, property liens, other interested parties
- Date/time of loss
- Total insured amount
- Loss claimed
- Statement of the insured that the policy is not void
- Notarization
Required items will vary by claim type. Supporting documents may include photos, receipts, repair estimates, police reports, fire reports, medical records, weather records, and other information.
What Happens If You Miss the Proof of Loss Deadline?
If you miss the Proof of Loss deadline, it can be harder to get your payment. You can expect the insurance company to say it’s too late. That might not be true. Today’s law requires that missing the Proof of Loss deadline must be a material breach before it compromises the entire insurance claim. Still, missing the deadline gives the insurance company grounds to argue, and it could prevent you from getting your compensation.
If you missed the deadline because you were incapacitated or because you didn’t know there was an insurance policy, you may still receive payment. You must act without delay, so don’t wait to contact a lawyer.
What Happens If Your Proof of Loss Form Is Denied?
If the insurance company denies your Proof of Loss Form, you may bring a lawsuit. Usually, you have two years from the date of loss to file a lawsuit, but there are exceptions. When you’re having trouble with the insurance company, such as a denial of a Proof of Loss Form or repeated requests for more information, don’t wait to contact a lawyer for guidance.
If there are technical mistakes in your Proof of Loss Form, the insurance company should tell you what they are and give you the opportunity to correct them. Examples of technical issues include missing supporting documents or an unnotarized form.
Understanding Proof of Loss Forms in Texas Insurance Claims
Practically, the Proof of Loss Form is primarily for the insurance company’s benefit. It’s often required by the insurance contract as a prerequisite to filing a lawsuit. Sometimes, insurance companies use the form improperly as a technical barrier to refuse to pay a claim. But the form can be helpful for the insured, too. It can trigger legal timelines that require the insurer to pay. Failing to pay on time can subject the insurance company to interest and other penalties.
Proof of Loss Forms and Final Proof of Loss in Texas Insurance
Texas insurance laws address final proof of loss (Tex. Ins. Code § 542.056). The insured must give the insurer the items, statements, and forms necessary to “secure final proof of loss.” Doing so triggers deadlines for the insurance company to accept or reject the claim and pay. A Proof of Loss Form can be used to meet this requirement, but it’s not exactly the same thing.
The law doesn’t explicitly require an insured to submit a Proof of Loss Form. It’s more likely to be a contractual requirement in the insurance policy.
Proof of Loss in Insurance Litigation
Proof of Loss Forms and proof of loss in a broader context have been the subject of significant litigation. Here are some examples:
Guide One Lloyds Insurance Company v. First Baptist Church of Bedford
In Texas insurance law, the final proof of loss concerns proof that the loss occurred, rather than comprehensive proof of the extent of loss. The plain language interpretation of Texas Ins. Code § 542.056 states that proof of loss triggers the insurer’s timeliness to accept or reject a claim.
Colonial County Mutual Insurance Co. v. Valdez
Service records, keys, and photos of a vehicle for a car theft claim were not required for proof of loss because they weren’t relevant to the claim.
How a Houston Insurance Claims Lawyer Can Help With Your Proof of Loss
A Houston insurance claims lawyer can assist you by preparing and submitting your Proof of Loss Form while identifying potential issues early in the claims process.
A lawyer can reduce the chance of litigation by ensuring that your Proof of Loss Form is thorough and complete. They can also help you handle a situation where the form is due, but you’re still gathering information.
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