This section lets a claimant ask for a detailed loss calculation and, if disputing the amount, demand appraisal within 60 days after notice.
Sec. 2210.574. DISPUTES CONCERNING AMOUNT OF ACCEPTED COVERAGE. (a) If the association accepts coverage for a claim in full and a claimant disputes only the amount of loss the association will pay for the claim, or if the association accepts coverage for a claim in part and a claimant disputes the amount of loss the association will pay for the accepted portion of the claim, the claimant may request from the association a detailed summary of the manner in which the association determined the amount of loss the association will pay. (b) If a claimant disputes the amount of loss the association will pay for a claim or a portion of a claim, the claimant, not later than the 60th day after the date the claimant receives the notice described by Section 2210.573(d)(1) or (2), may demand appraisal in accordance with the terms of the association policy. (c) If a claimant, on a showing of good cause and not later than the 15th day after the expiration of the 60-day period described by Subsection (b), requests in writing that the 60-day period be extended, the association may grant an additional 30-day period in which the claimant may demand appraisal. (d) If a claimant demands appraisal under this section: (1) the appraisal must be conducted as provided by the association policy; (2) the claimant and the association are responsible in equal shares for paying any costs incurred or charged in connection with the appraisal, including a fee charged under Subsection (e); and (3) the appraisal must be completed within the period established under Subsection (d-1). (d-1) In consultation with the association, the commissioner shall adopt rules establishing the period in which an appraisal demanded under this section must be completed. In adopting the rules, the commissioner shall: (1) allow flexibility for an adequate investigation of the claim that is the subject of the appraisal; and (2) consider the time necessary to preserve the independence of the appraisers. (e) If a claimant demands appraisal under this section and the appraiser retained by the claimant and the appraiser retained by the association are able to agree on an appraisal umpire to participate in the resolution of the dispute, the appraisal umpire is the umpire chosen by the two appraisers. If the appraiser retained by the claimant and the appraiser retained by the association are unable to agree on an appraisal umpire to participate in the resolution of the dispute, the commissioner shall select an appraisal umpire from a roster of qualified umpires maintained by the department. The department may: (1) require appraisers to register with the department as a condition of being placed on the roster of umpires; and (2) charge a reasonable registration fee to defray the cost incurred by the department in maintaining the roster and the commissioner in selecting an appraisal umpire under this subsection. (f) Except as provided by Subsection (g), the appraisal decision is binding on the claimant and the association as to the amount of loss the association will pay for a fully accepted claim or the accepted portion of a partially accepted claim and is not appealable or otherwise reviewable. A claimant that does not demand appraisal before the expiration of the periods described by Subsections (b) and (c) waives the claimant's right to contest the association's determination of the amount of loss the association will pay with reference to a fully accepted claim or the accepted portion of a partially accepted claim. (g) A claimant or the association may, not later than the second anniversary of the date of an appraisal decision, file an action in a district court in the county in which the loss that is the subject of the appraisal occurred to vacate the appraisal decision and begin a new appraisal process if: (1) the appraisal decision was obtained by corruption, fraud, or other undue means; (2) the rights of the claimant or the association were prejudiced by: (A) evident partiality by an appraisal umpire; (B) corruption in an appraiser or appraisal umpire; or (C) misconduct or wilful misbehavior of an appraiser or appraisal umpire; or (3) an appraiser or appraisal umpire: (A) exceeded the appraiser's or appraisal umpire's powers; (B) refused to postpone the appraisal after a showing of sufficient cause for the postponement; (C) refused to consider evidence material to the claim; or (D) conducted the appraisal in a manner that substantially prejudiced the rights of the claimant or the association. (h) Except as provided by Subsection (g), a claimant may not bring an action against the association with reference to a claim for which the association has accepted coverage in full. Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 2 (H.B. 3), Sec. 41, eff. September 28, 2011. Amended by: Acts 2023, 88th Leg., R.S., Ch. 600 (H.B. 3310), Sec. 1, eff. September 1, 2023.