What happens if an insurance company denies your injury claim?
An insurance denial does not necessarily end a Texas personal injury claim. The next step is to identify why the claim was denied, review the evidence and applicable insurance coverage, correct factual or documentation problems when possible, and determine whether additional negotiation or litigation is appropriate. A denial is the insurer’s position—not automatically a final determination of legal responsibility.
Why Do Insurance Companies Deny Injury Claims?
A denial can arise for many reasons. The insurer may dispute who caused the accident, whether the claimed injury resulted from the accident, the amount of damages, whether a policy provides coverage, or whether required information was provided.
Understanding the stated reason is essential because different denials require different responses.
The Insurer Disputes Fault
An insurer may contend that its insured did not cause the accident or that the injured person shares responsibility.
Evidence such as photographs, video, witness statements, crash information, physical evidence and electronic data may become important when fault is disputed.
Texas proportionate-responsibility law can also affect recovery when more than one person contributed to an occurrence.
The Insurer Disputes Whether the Accident Caused the Injury
Causation disputes can occur when symptoms were reported later, when a claimant had a prior medical condition, or when the insurer argues that medical treatment is unrelated to the event.
Medical records, diagnostic testing and the history provided to treating professionals can be important to evaluating these issues.
The Insurer Says There Is Not Enough Documentation
A claim may be challenged because the insurer believes bills, medical records, wage documentation or other supporting evidence is incomplete.
Determine exactly what information is allegedly missing instead of assuming that a general denial cannot be addressed.
Coverage Disputes
Some denials concern the insurance contract rather than accident liability. Issues can include whether the vehicle or person was insured, whether coverage was in effect, policy exclusions, policy limits or whether another form of coverage applies.
Obtaining and reviewing the relevant policy can be important when coverage itself is disputed.
Can Additional Evidence Change an Insurer’s Position?
Sometimes. New photographs, witness information, medical evidence, employment documentation or other records may address the reason stated for a denial.
In other situations, the parties remain in disagreement despite additional information.
Can You File a Lawsuit After a Claim Is Denied?
Potentially. A denied insurance claim and the underlying legal claim are not necessarily the same thing. Depending on the circumstances, litigation may be available against a responsible party or may involve other insurance-related issues.
Applicable deadlines still matter. Continuing to negotiate with an insurer should not be assumed to stop a limitations period.
What Should You Save After a Denial?
- The denial letter
- Insurance policies and declarations
- Claim correspondence
- Photographs and videos
- Witness information
- Medical records and bills
- Employment and lost-income records
- Notes concerning communications with adjusters
Frequently Asked Questions
Is an insurance denial final?
Not necessarily. A denial states the insurer’s position. The underlying evidence, insurance contract and applicable law should be evaluated before deciding what options remain.
Can I submit more evidence after a denial?
Depending on the circumstances, additional relevant evidence may be submitted to address issues raised by the insurer.
What if the insurer says I caused the accident?
Liability can be disputed. Scene evidence, witnesses, video, vehicle evidence and other information may be relevant to determining responsibility.
Does negotiating with the insurer extend my lawsuit deadline?
You should not assume that negotiations extend an applicable limitations deadline. Legal deadlines should be evaluated independently.
Was Your Texas Injury Claim Denied?
The Piri Law Firm can review the reason for an insurance denial, the available evidence and potential next steps.
This article provides general information and is not legal advice. Insurance and litigation issues depend on the applicable policy, facts and law.
