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Why is My Insurance Claim Denied?

Getting into a car accident is stressful. The pressure only increases if your insurance claim gets denied and you are left with expensive medical bills or car repairs. There are various reasons why an insurance company would deny a claim in Houston. Some of the reasons may be valid, but sometimes insurance claim denials are made in bad faith.

If you suspect that your insurance claim was wrongfully denied, you should contact an experienced Houston personal injury attorney.

Why Do Insurance Companies Deny Claims in Houston?

There are various reasons why insurance companies deny claims. The specific reasons that your insurance company can deny a claim will depend on your policy. Common reasons for claim denials in Houston include:

• The claimant was not covered under the insurance policy;
• The claimant engaged in conduct that made the policy ineffective;
• The vehicle was not listed on the insurance policy;
• The policy was not in effect at the time of the accident (i.e., your policy lapsed because of unpaid premiums);
• The claim exceeds policy limits (for example, if your accident caused $35,000 in medical expenses but you only have $25,000 in bodily injury liability coverage, the additional $10,000 would be denied);
• Your conduct led to the accident;
• The claimant was driving without a license;
• The claimant was breaking Texas state law (i.e., you were under the influence of a substance at the time of the accident);
• The claimant’s injuries were pre-existing;
• The vehicle damage was unrelated to the car accident;
• The insurance policy does not cover what is in the claim;
• The claimant did not promptly report the accident to the car insurance company; and
• The claimant lied to the insurance when applying for coverage or during the claim process.

In Texas, third-party claims (ones filed with the other driver’s insurance) are more commonly delayed or denied. You should be sure to make a claim with your own company whenever possible.

What Are Examples of Bad Faith Denials?

Sometimes the reason that your insurance company denied your claim is valid and reasonable. However, there are times where an insurance company will knowingly deny a valid claim to protect its bottom line. This is called a bad faith denial and is illegal in Texas. An insurance company cannot deny a claim that they are contractually obligated to pay.

Common examples of bad faith include:

• Refusing to pay a legitimate claim;
• Failing to reasonably investigate a claim;
• Not providing reasons for denying a claim;
• Purposely ignoring your communications and delaying the claim;
• Knowingly deviating from Texas regulations concerning the claim process; and
• Purposely ignoring information that would support a valid claim.

What Should You Do If Your Insurance Claim was Denied in Houston?

If your claim has been denied, not all hope is lost. Contact a personal injury attorney, especially if you believe that the insurance company improperly denied your claim. You should not sign any settlement papers before speaking with an attorney, or you may be prevented from filing an appeal. An attorney can guide you through the following steps.

Understand the Basis for the Claim Denial and Your Policy Coverage. Most car insurance companies will automatically send a statement outlining their reasons for the claim denial. If you do not receive this letter, you should request it.
Gather Additional Evidence. Depending on the reason for the denial, you may be able to provide additional evidence to support your claim. Examples of evidence that you could submit include police reports, pictures of the accident, repair estimates, and medical bills.
Consider Filing an Appeal. A qualified attorney can help manage the appeals process. They will ensure that you have the proper documentation and meet all deadlines. Your attorney can handle negotiations and communication with the insurance company on your behalf.
File a Lawsuit. If the insurance company denied your claim in bad faith, you can file a lawsuit against the insurance company. If the insurance company is found guilty, they could be liable for consequential and punitive damages. Your attorney will fight to ensure that you receive the compensation that you deserve.

Your Houston Insurance Claim Attorney

If your insurance claim has been denied, call the Paxton Law Firm. Let us review your case and advise you of your rights. The Paxton Law Firm believes in taking the stress of dealing with your legal battles and turning a negative situation into the best possible outcome lady justice allows. We offer free consultations, and you do not pay any legal fees until we recover for you.

Contact Us (281) 978-2244