It can be a frustrating situation to be dealing with medical challenges after a car accident, only to receive a denial letter from the insurance company. Here’s what you need to know: just because the insurer is denying your claim, it doesn’t mean that you will never receive compensation. The truth is that you still have options to push back on a car insurance claim denied in Texas.
Can an Insurance Company Legally Deny Your Claim in Texas?
Your mind might be racing with questions if your insurance claim is denied after an accident: Is it really possible for an insurance company to refuse payment? One important thing that you need to understand is the difference between a first-party vs. third-party claim, because it can make a difference in whether you receive compensation after the accident.
- First-Party Claim: This type of claim goes to your own car insurance provider.
- Third-Party Claim: On the other hand, this type of claim targets the at-fault driver’s insurance.
Your rights vary depending on the type of claim that you are pursuing. Texas is an at-fault state, which means that if the fault is contested, then it is common to see third-party denials. But the insurance company can only deny the claim for documented reasons.
Why Your Car Insurance Claim Was Denied in Texas
Before you can know how to appeal a denied car insurance claim in Texas, you first need to identify the reasons why the claim was denied. Some of the most common reasons for claim denial include:
- Disputed Liability: In this situation, the insurer is arguing that their policyholder is not at fault or that you share blame. Even if you are partially at fault, it can reduce or even eliminate your payout. Avoid these issues by avoiding any form of communication (such as a recorded statement) without first consulting with an experienced attorney. The insurance company may try to use your own words against you to justify the denial.
- Policy Exclusions and Coverage Gaps: The insurance company will be looking for any gaps or exclusions that might apply, such as a rideshare or delivery accident, unlisted drivers, or accidents that happen outside of the coverage window. Insurance companies dig through the fine print to look for leverage that reduces or eliminates the settlement. If a premium payment was missed, then it could void coverage during that lapse.
- Late Reporting or Weak Evidence: If you wait too long to report the accident, then the insurer might have grounds to deny the claim. Also, insufficient or weak evidence can increase the likelihood that you will have a car insurance claim denied in Texas. A successful claim needs to be backed by police reports, photos, medical records, and other evidence to prove liability.
- UM/UIM Claim Disputes: Uninsured motorist or underinsured motorist coverage is through your own insurance policy, and these claims are often denied if you can’t prove that the other driver was at fault (and your damages exceed the other driver’s insurance coverage).
What to Do After a Car Insurance Claim is Denied in Texas
There are a few steps you should follow if you want to fight a denied car insurance claim. First, read the denial letter and review your insurance policy. In the state of Texas, it is required that a specific reason be listed in the denial letter. If there is any vague language, then you might have an option to challenge it. Also, compare the stated reason with your policy, because it’s possible that the adjuster misapplied or misread the policy terms.
Next, it’s time to work with an experienced legal team to build your evidence file and submit a formal appeal. We will help you gather relevant evidence, such as police reports, medical records, repair estimates, photos, and all of the correspondence with the insurance companies. In fact, in the state of Texas, you have the right to request the full claim file from the insurance company.
How to File a Complaint with the Texas Department of Insurance
If you reach a stage where your appeal has stalled, then it might be time to file a complaint with the Texas Department of Insurance (TDI). This department investigates bad faith conduct in the insurance industry to protect accident victims from abuse.
In this complaint, your lawyer can help with referencing any violations that might apply through the Texas Prompt Payment Act.
Deadlines to Know Before You Fight a Denied Car Insurance Claim
It’s critical that you pay attention to the deadlines so that you don’t miss your opportunity to appeal the denial. For example, most insurance companies have internal appeal windows that range between 30 and 60 days, and this timeframe will likely be listed in your denial letter.
For a personal injury lawsuit, the statute of limitations in Texas is 2 years after the accident occurred. But the window is longer for a bad-faith or breach of contract situation (a 4-year timeline).
Just because you have time to file or submit your appeal, it’s best to act as soon as possible. The longer you wait to build your case, the harder it is to gather quality evidence.
FAQs
Can an insurer deny my claim even if I wasn’t at fault?
Yes, regardless of who caused the accident, there are a variety of other reasons why the claim might be denied, such as policy exclusions, late reporting, or missing evidence.
How do I fight a denied car insurance claim in Texas?
Always contact an experienced attorney right away. First, you need to file a formal written appeal that addresses the denial reason. If necessary, you can escalate the complaint to the Texas Department of Insurance.
Talk to a Texas Car Accident Attorney
You deserve trusted legal representation if your claim has been denied. The best thing that you can do is find an experienced legal team that has successfully won other denied insurance claims. Rest assured knowing that our lawyers work on contingency, which means that you don’t need to pay for any upfront costs. We only get paid when you receive a settlement.
For more information about your legal rights, reach out to us at Green Law Firm. Contact us to schedule a no-obligation consultation and discuss your situation with a skilled attorney: (956) 542-7000.
