What You Will Need to Report a Claim

Claim Reporting Checklist

Below is the information you need to have ready when reporting a claim to TWIA:

• Your TWIA policy number
• What you believe caused your damage (e.g., wind, hail, or both)
• The details and a brief description of what caused the damage
• Your current contact information and any additional ways to reach you
• Any documentation or photographs of the damage

Click here for a printable worksheet for the TWIA claims process.

Claims Deadlines

Important Milestones

• Policyholders have one year from the date the property was damaged to report a TWIA claim.
• After receiving all the requested information from the policyholder, TWIA has 60 days to investigate and notify the policyholder if it will accept or reject the claim.
• TWIA has 10 days to pay a claim after it has accepted coverage for a claim and the policyholder has provided all requested materials.

After Reporting a Claim

What Are the Next Steps?

Temporary Repairs

Make temporary repairs to protect your property. Save receipts. Do not make any permanent repairs until you discuss your claim with a TWIA representative. See our guide to Temporary and Permanent Repairs to learn more.

Review Your Policy

Understanding your policy will help you make informed decisions and better prepare you to navigate the claims process. Knowing the amount of your deductible and which endorsements you have is especially helpful. For example, while our policies allow us to pay to remove trees fallen on covered structures, they do not allow us to pay for downed trees that did not fall onto covered structures.

• Talk to Your Agent. Your agent can be a valuable resource to help you understand your insurance policy coverage.

Property Inspection

TWIA will assign your claim to a field adjuster, who will reach out to you to schedule an inspection of the damaged property, if necessary.

• What is the field adjuster’s role? The TWIA field adjuster is a state-licensed property adjuster who has also received TWIA training. They will inspect your property and take photos of damaged and undamaged areas. Based on their documentation, they will prepare damage estimates (learn more) and send those reports to TWIA. They are only there to obtain information about your property’s damage. They cannot make any decisions on your claim. Any questions about your claim should be directed to a TWIA claims examiner.

Gather Contractor Estimates

Even though the field adjuster prepared an estimate of the cost to repair or replace your property, it is still important to request your own estimates from qualified contractors. You are encouraged to request line item estimates that break down and show labor and material costs (rather than a single cost or lump sum estimate). Send us any estimates you receive from contractors you are working with for our review. TWIA will compare your estimate with our own and issue supplemental (additional) payments if warranted. Learn more about supplemental payments.

• Avoid Fraud. Be wary of out-of-state contractors who show up at your door unexpectedly. Learn ways to protect yourself from fraud in this guide or on the Texas Department of Insurance’s website. If you suspect fraudulent activity related to a TWIA claim, call the Veracity Research Company (VRC) Fraud Hotline at (800) 625-0425.
• Do NOT repair, replace, or dispose of any damaged items before first discussing it with a claims examiner.

TWIA Reviews Your Claim Information

TWIA claims examiners review the field adjuster’s report and estimates along with weather reports and any additional documents and estimates. A claims examiner will contact you to discuss your claim, issue any payment due, and answer any of your questions.

• What is the claims examiner’s role? A TWIA claims examiner is a trained professional licensed by the State of Texas. TWIA claims examiners work in our offices, resolve your claim, and are your primary TWIA contact. Any questions about your claim should be directed to a TWIA claims examiner.
• You may work with more than one claims examiner. This is because our staff works as a team to help your claim and everyone else’s move quickly. You can communicate with a claims examiner using Claims Center or the Policyholder Portal. You can also call (800) 788-8247 or email claims@twia.org (include your claim number in the subject line). Communicating with us through Claims Center or the Policyholder Portal will allow us to respond faster than email. If you experience technical issues using our online systems, visit our support page or call (800) 788-8247.

TWIA Claims Decision

Within 60 days of receiving your claim and all information that has been requested from you, TWIA is required to make a decision on your claim and send you a letter stating the decision. We make decisions as quickly as possible and you can typically see a result sooner than 30 days.

• TWIA Claims Decision Letter. The decision letter we send to you will be titled either: Notice of Claim Acceptance, Notice of Claim Denial, or Notice of Claim Acceptance in Part and Denial in Part. Read this letter in full as it explains how TWIA reached its decision.

TWIA Will Contact You

A claims examiner will contact you about TWIA’s decision on your claim. If we determine you have damage covered by your TWIA policy, you will either receive a check from us or a notification that the cost to repair or replace the damaged property is less than your deductible and there will be no claim payment.

After the Check Arrives

Cash Your Check

Even if you believe your claim payment is not enough to pay for the repair or replacement of your covered property, you should go ahead and cash the initial check right away. Cashing your check does not mean you agree your claim is final. Any additional claim payments will be mailed to you as a supplement to your first payment. Learn more about supplemental payments.

Proof of Deductible Payment

Texas law and TWIA policies require policyholders to submit proof they paid the deductible applicable to their claim before any withheld recoverable depreciation is paid (see next paragraph). Proof of payment can be in the form of a cancelled check, money order receipt, credit card statement, or a copy of an executed installment plan contract or other financing arrangement that requires full payment of the deductible over time.

• Recoverable depreciation is the difference between a property’s replacement cost value (i.e., the cost to replace it with a similar new product) and its actual cash value (i.e., the replacement cost value minus depreciation). For policies with replacement cost coverage (provided by endorsements TWIA-802 and TWIA-164), TWIA claims are paid in at least two parts: first the actual cash value and then any recoverable depreciation that is owed after repairs or replacement is completed. Learn more about factors that affect the claim payment amount.

Mortgage Company

Mortgage companies generally require homeowners to carry property insurance. Due to their financial interest in an insured property, they may require that the policy name them. As a result, the mortgage company may be named on your claim payment check. Every mortgage company follows different guidelines on how to process these checks, so contact your mortgage company right away to find out how to endorse and process your claim payment check. Learn what to do if the wrong company is on your check.

Certificates of Compliance

Many property repairs will require a Windstorm Certificate of Compliance (WPI-8/WPI-8-E) to remain eligible for TWIA coverage. The Texas Department of Insurance (TDI) oversees the Windstorm Certification Program and issues all Certificates of Compliance. To find out if your repairs or improvements require an inspection, call TDI at (800) 248-6032. Visit our Windstorm Certification webpage for more information and links to resources on the TDI website.

Dispute a Claim

What to Do if You Disagree with TWIA’s Assessment of Your Claim

Talk with TWIA — We Will Work with You

Please contact TWIA if you believe our claim assessment is not enough to repair or replace damage to your covered property. We will work with you to address any needs you have and try to provide a timely resolution. We will also try to help you avoid incurring any out-of-pocket or additional costs. Contact TWIA so we may consider any new information that could support supplemental (additional) payments. Learn more about supplemental payments.

It is important to understand the deadlines related to the appraisal process (see Appraisal below) even if you are still working with TWIA to resolve disagreements about your claim.

Appraisal

Appraisal is a formal process to handle disputes about the amount TWIA will pay for your claim. Unless otherwise stated by TWIA or the Texas Department of Insurance (TDI), the deadline to request appraisal on the actual cash value amount of your claim (i.e., the covered item’s current market value, used to determine your first claim payment amount) is 60 days from the date you receive your notice letter. If you have replacement cost coverage, you will have additional time to request appraisal. That timeline will be included in your notice letter.

To preserve your right to appraisal, this process is automatically activated if you notify TWIA that you disagree with our assessment of the covered portion of your claim. This does not mean you have to go through the appraisal process, but that you will have the option to in the future. You can start this process by having a discussion with your claims examiner or sending TWIA a message through Claims Center or the Policyholder Portal with details about what you are disputing. If you are unable to use one of these systems, you can email claims@twia.org with your claim number in the subject line. Communicating with us through Claims Center or the Policyholder Portal will allow us to respond faster than email. Each of these options (Claims Center, the Policyholder Portal, email) will help document the time when you make the request.

Disputes Regarding Denied Claims

If you wish to dispute TWIA’s decision to partially or fully deny coverage for your claim, you must provide notification that you intend to bring suit against TWIA. You have two years after receipt of a claim decision to notify TWIA of a coverage dispute. If you miss the two year deadline, you waive the right to contest TWIA’s denial of the claim, and are barred from bringing a lawsuit concerning denial of coverage.

As a prerequisite to filing suit, TWIA has the option of requiring you, the policyholder, to submit the dispute to Alternative Dispute Resolution (ADR). Mediation is the primary form of dispute resolution utilized by TWIA. ADR must be completed no later than 60 days after TWIA requests ADR, unless the period is extended by mutual agreement or by rule of the Commissioner of Insurance. If ADR is not completed, or if you are not satisfied after the ADR, you may bring a lawsuit in a district court no later than two years after the date you received TWIA’s decision regarding the claim. All costs and expenses of mediation are shared equally by both parties.

Lawsuit criteria is outlined in the Texas Windstorm Insurance Association Act, Section 2210.576 (b), Texas Insurance Code.

Guides and Resources

Claims Guides and Worksheets for Policyholders

Claims Center Technical Help

Reporting Your Claim Online

Are you an agent? Visit our agent training center for Claims Center and Policyholder Portal information.

Additional Assistance for Policyholders

TDI Coastal Outreach and Assistance Services Team

Created in 2011, the Texas Department of Insurance’s Coastal Outreach and Assistance Services Team (COAST) provides information and educational programs to help TWIA policyholders with the claims process. COAST can help you:

• Learn about your rights as a TWIA policyholder
• Learn about the TWIA claims process
• Know what to do if TWIA denies your claim
• Resolve a concern about a TWIA claim

Click here to learn more or visit their website at www.tdi.texas.gov/consumer/coast.

This webpage is intended for educational purposes only and does not supersede your policy contract. Every claim is evaluated on its own merits and it is possible your particular claim could be handled differently.