Recently, an off-duty police officer was hit by an automobile while directing traffic. The officer was in uniform but was working for a private company directing traffic when struck by a driver that denied seeing the officer. The injured officer has incurred tens of thousands of dollars in medical bills; however his workers compensation carrier is denying coverage and his own insurance has denied coverage. The woman who hit him only had minimal coverage.
According to the officer the workers compensation carrier and his medical insurance carrier are pointing fingers at each other.
The lesson from this story is that even when you believe that you are fully covered by having auto, health and workers compensation insurance the carriers will use loopholes to get out of paying valid claims if possible. Many people believe that their insurance company must treat them fairly; however, this is not true. The idea of an insurance company having a special obligation beyond what is spelled out in the contract is sometimes referred to as the obligation of “good faith and fair dealing.”
Many years ago, the Texas Supreme Court believed that insuring contracts included the requirement that the insurer treat its customer fairly. They routinely held that contracts between consumers and companies included the requirements of “good faith and fair dealing”. This was partly based upon the unequal bargaining position of the parties. In other words, because you are required to have auto insurance, and if all auto policies have loopholes and technicalities, the Court would ignore the insurance loophole and say they must treat the consumer fairly regardless of the loophole.
However, now the Courts only look to the exact wording in the contract and they will let the insurance company off on a technicality if possible. If you have been seriously injured and are seeking the insurance benefits you have paid for, it is all too often necessary in many cases to hire a Texas Lawyer with insurance coverage experience to get the benefits owed.