The Insurance Company Denied My Claim: What Can I Do in Texas?

You open the envelope and there it is: 'your claim has been denied.' After an accident, with injuries and bills piling up, a 'no' from the insurer feels like a door slamming. But hear this clearly: a denial is not the end of your case. It's just the insurer's first answer — and it can often be fought. Here's what to do, step by step.

First: demand the written denial letter

In Texas, the insurer must give you a written explanation of why they denied your claim. That denial letter isn't just paperwork: it's your map. It tells you exactly which reason they used, and that reason is what you'll challenge. Never settle for a 'no' over the phone — ask for the letter.

Why are claims denied? (common reasons)

Most denials fall into a few reasons. Recognizing them helps you know what to fight:

• They dispute fault: they say you were responsible, fully or partly.
• 'Pre-existing injury': they claim your injury existed before the accident.
• Lack of coverage: they say the policy doesn't cover what happened or is exhausted.
• You were late: they claim you reported or sought treatment too late.
• Lack of evidence: they say there isn't enough proof of your injuries or the accident.

Steps to appeal a denial

1. 1Read the denial letter and your policy carefully. The reason they give is your starting point.
2. 2Gather evidence that answers that reason: police report, photos of the accident and damage, your medical records, repair estimates, and witness information.
3. 3File an internal appeal: ask in writing for the insurer to reconsider, attaching the new evidence.
4. 4Keep everything in writing: dates, letters, emails, and who you spoke with. The record matters.

If the appeal doesn't work: your other options

Having your appeal denied isn't the end either. In Texas you still have paths:

• Appraisal: if the dispute is over the amount, you can request an independent appraisal.
• Complaint to the Texas Department of Insurance (TDI): the state agency that reviews consumer complaints and can investigate whether the insurer followed Texas law.
• Independent external review: you can request that a third party review the decision.
• Legal action: a lawyer can take the dispute to the courthouse in your county.

The key fact: bad faith in Texas

Here's what the insurer doesn't want you to know. Insurers have a legal duty to handle your claim fairly. When they deny or delay a valid claim without a reasonable basis, they act in bad faith. And in Texas that has strong consequences:

This possibility shifts the balance of power. An insurer that knows its denial could cost triple thinks twice before holding onto a 'no' it can't defend.

Why a lawyer helps against a denial

When the insurer sees a lawyer reviewing your denial, the treatment changes. A lawyer identifies whether the denial reason holds up, gathers the right evidence, handles the appeal and TDI complaints, and evaluates whether there was bad faith. The insurer said 'no' because it benefits them — not necessarily because your case has no value. With more than 30 years of experience in Texas courts, Ruiz & Associates fights these denials. We're bilingual, we answer personally, and we serve Eagle Pass, Maverick County, San Antonio, and all of Texas. We work on contingency: you pay nothing unless we win your case.