Upon completion of this course, the adjuster/attorney should know the purpose and need for reserving rights and the consequences of failing to timely or properly reserve rights, including waiver of coverage defenses and estoppel. In addition, the adjuster/attorney should be familiar with the two general categories of rights that can be reserved (conditions precedent to recovery and defenses of non-coverage), as well as how to effectively acknowledge claims an reserve rights, including proper timing, content, and style of the reservation-of-rights letter. Moreover the adjuster/attorney should know the mechanics of denial-of-coverage letters, including proper timing and contents, as well as the consequences of improperly denying coverage. Finally, the adjuster will have a broad understanding of the standard for the duty to defend, the federal court exception to the use of extrinsic evidence, and an update on the recent 5th Circuit question certified to the Texas Supreme Court.
**The entire presentation of Reserving Rights and Denying Coverage should qualify for ethics credit because it addresses the best practices for the timing and substance of a proper denial or reservation of rights letter. This falls with Texas Admin Code 28, Subchapter K (1) Chapter 541 of the Texas Insurance Code – Unfair Methods and Competition and Unfair Deceptive Practices Act (regarding representations that can and cannot be made by an insurance company to effectuate a prompt and fair settlement); (5)(B) Prompt Payment of Claims (addressing when a carrier must accept or reject coverage under Ch. 542); and (9) Ethical behavior of an Agent or Adjuster in handling request for information (addressing what may considered in denying coverage, what investigation is required, and what information can/should be provided to insured). The presentation will also cover statutory deadlines in Louisiana.