What to Do if Insurance Company Denies Your Personal Injury Claim in Texas?

Getting your personal injury denied can be a stressful and frustrating experience. The denial of your personal injury claim can be an unpleasant surprise when you need money to cover your medical expenses but cannot earn a living because of your injury or disability.

Luckily, there are things you can do to deal with the denial of your personal injury claim and pursue the compensation you deserve. If you believe that your claim was mishandled or denied unfairly, it is advised to speak with an experienced personal injury attorney in Texas.

Was the Denial of Your Injury Claim Wrongful?

When an insurance company denies a personal injury claim for an illegitimate reason or no reason at all, the denial is considered wrongful. Wrongfully denying or delaying payment of an injury claim may constitute an insurance bad faith practice in Texas.

As a rule of thumb, denial is considered wrongful when the insurer fails to provide a reasonable explanation or does not give any explanation for the claim denial. If the insurance company rejects your claim, it is critical to find out exactly why the claim was denied, consult with a lawyer, and consider appealing the insurer’s decision.

Texas has laws that protect policyholders from insurance bad faith practices. Common forms of insurance bad faith include:

• Lack of communication
• Putting pressure on the policyholder to accept an unfair settlement offer
• Changing or canceling a policy without explanation
• Delaying investigation into a claim
• Delaying payment on a valid claim or refusing to pay
• Failing to approve or deny a claim within a reasonable amount of time
• Denying a claim for an illegitimate reason or without cause

If an insurance company is engaging in any of these or other unfair or deceptive practices, talk to a skilled personal injury attorney to explore your legal options.

Common Reasons for Claim Denials in Texas

Insurance claims adjusters must review each claim and find reasons for the denial. Common reasons for claim denials include:

• Failure to file a claim on time. In Texas, the statute of limitations for filing a personal injury claim is two years from the date of the accident. Failure to bring a claim within the time window will bar you from seeking compensation through a claim.
• Providing incorrect information when filling out a claims form.
• Failure to provide the necessary documents to support your claim.
• Your injury or condition is not covered under the policy.
• Lack of medical evidence to prove the severity of your injury.
• Your injury is a pre-existing condition. In other words, the injury for which you are filing a claim occurred before the date of the accident.
• The nature or location of the accident is not covered under the policy.
• The insurance policy has expired or lapsed.
• Lack of evidence to prove that the insured was responsible for your injury.
• The at-fault party is not covered under the policy.

What to Do if Your Personal Injury Claim Was Denied in Texas?

If your personal injury was denied, you should take the following steps to appeal the insurance company’s decision and fight for the compensation you deserve.

Find Out Why Your Personal Injury Claim Was Denied

Before appealing the insurer’s decision to deny your claim, it is important to figure out why the claim was rejected. While insurance adjusters may deny claims by mistake, many claims are denied for a legitimate reason. There are also cases when personal injury claims are wrongfully denied.

Collect Evidence to Support Your Appeal

If you are planning to appeal the insurance company’s decision to deny your personal injury claim, you will need to gather sufficient evidence to support your appeal case. Evidence may include witness statements, photos from the scene of the accident, surveillance footage, police report, medical records, and others.

Appeal the Denial of Your Claim

If you believe that your claim was wrongfully denied, you can appeal the insurance company’s decision. The appeal can be made directly through your insurer in Texas. When appealing the insurer’s decision, you will have to submit all relevant evidence to challenge the denial of your valid personal injury claim.

If you appeal the insurance company’s decision and your claim is denied again, you will have to bring this issue to the Texas Department of Insurance, which investigates claim denials.

Contact an Attorney

Last but not least, it is important to speak with a knowledgeable attorney if your injury claim was denied or the insurance company is trying to settle your claim for the lowest amount possible.

If you are represented by a Houston personal injury attorney, your lawyer will help you gather evidence to challenge the denial of your claim and appeal the insurer’s decision. Also, if necessary, a lawyer will take your case to trial to fight for fair compensation on your behalf.

Conclusion

Getting your personal injury claim denied is a frustrating experience. Since many claim denials occur due to an error and other claims are denied for an illegitimate reason, you may be able to appeal the denial of your personal injury claim in Texas.

You will need to find out the reason why your claim was denied before you can appeal the denial of your claim in Texas. It is advised to hire a personal injury attorney in Texas to appeal the insurance company’s decision and fight a wrongfully denied insurance claim.

Johnson Garcia, LLP

With more than two decades of combined legal experience, attorneys Daniel Johnson and Juan Garcia at Johnson Garcia, LLP, represent personal injury victims to seek the compensation they deserve.