What to Do If You’ve Been Denied Coverage in Texas: Your Rights and Legal Options

Introduction

Being denied insurance coverage in Texas can feel like hitting a wall, especially when you’ve paid your premiums and expected protection during difficult times. Whether it’s health, home, auto, life, or disability insurance, a denial can leave you exposed to large financial losses and uncertainty.

This article explains what you need to know if your coverage was denied in Texas, why these denials happen, what steps you can take, and how to protect your rights under the law.

Common Reasons for Insurance Coverage Denial in Texas

Insurance companies in Texas can deny coverage for a variety of reasons. Understanding the root cause of a denial can help you plan your next steps:

1. Misrepresentation or Incomplete Application

If you left out important medical or financial information when applying for insurance, the company may claim misrepresentation as a reason for denial.

2. Lapse in Payment

Missing a premium payment can cause your policy to lapse, meaning you're no longer covered when you file a claim.

3. Policy Exclusions

Some policies include fine-print exclusions that may prevent certain claims from being approved—like flood damage in a standard homeowner's policy.

4. Pre-Existing Conditions

Certain insurance policies, especially non-ACA compliant health plans or life insurance, may exclude coverage related to conditions that existed before the policy started.

5. Alleged Fraud or Inconsistent Information

If the insurance adjuster suspects you’ve exaggerated a claim or submitted conflicting details, they may deny it altogether.

What Types of Insurance Claims Get Denied Most Often in Texas

In Texas, claim denials happen across all types of insurance. The most commonly denied coverage areas include:

• Health Insurance (especially out-of-network or non-ACA plans)

• Homeowners Insurance (water damage, mold, or roof repairs)

• Auto Insurance (liability disputes or lack of documentation)

• Life Insurance (undisclosed health conditions or suicide exclusions)

• Disability Insurance (lack of medical evidence or missed deadlines)

No matter the type, it’s important to carefully review your policy terms and understand why your claim was denied.

Your Legal Rights After a Coverage Denial in Texas

Texas law offers protection to policyholders, but you must take action to defend your rights:

1. Right to a Written Explanation

Insurers are required to provide a written explanation of why coverage or a claim was denied.

2. Right to Appeal

You have the right to appeal the denial, either through the insurance company’s internal review process or through state channels.

3. Right to Fair Dealing

Insurance companies must act in “good faith.” If they fail to investigate properly or wrongfully deny your claim, they may be acting in bad faith.

4. Right to File a Complaint or Lawsuit

You can report unfair insurance practices to the Texas Department of Insurance or pursue legal action if necessary.

Steps to Take After Being Denied Coverage in Texas

Here’s a simple framework to help you navigate the situation if you’ve been denied insurance coverage:

Step 1: Request a Written Denial

Ask the insurer to provide a detailed denial letter outlining the reasons. This is your starting point for building a case.

Step 2: Review Your Policy Carefully

Go through your policy language and compare it with the denial explanation. Look for terms, exclusions, and limits that apply to your situation.

Step 3: Gather Supporting Documentation

This could include receipts, photos, repair estimates, medical records, or communication with the insurer.

Step 4: File an Appeal Promptly

Most insurance companies have strict deadlines for filing appeals—usually 30 to 60 days. Submit a detailed rebuttal with supporting evidence.

Step 5: File a Complaint with the Texas Department of Insurance

If the insurer is uncooperative, report them. The department can investigate and help resolve your issue.

Step 6: Talk to an Insurance Attorney

If your appeal fails or the situation becomes complex, getting legal help can make a difference.

How Louis Law Group Can Help

When you’re denied insurance coverage in Texas, it’s not always easy to understand your rights or know how to fight back. That’s where Louis Law Group can step in.

We help policyholders who feel their insurance company acted unfairly or wrongfully denied their claims. Our experienced attorneys can:

• Review your policy and the denial

• Collect supporting evidence

• File a formal appeal or legal claim

• Negotiate directly with the insurance company

Our goal is to make sure insurance companies keep their promises. With Louis Law Group, you get legal strength on your side without upfront costs—we only get paid if we recover money for you.

How to Prevent Future Coverage Denials in Texas

While some denials are out of your control, others can be prevented. Here are a few tips:

• Be Honest on Applications: Always provide complete and truthful information.

• Pay Premiums on Time: Set reminders or autopay to avoid lapses in coverage.

• Keep Detailed Records: Store copies of your policy, payment history, and communication.

• Ask Questions: Don’t assume your policy covers everything—ask for clarification.

• Understand Exclusions: Read the fine print and know what’s not covered.

These steps can strengthen your claim and reduce the chances of facing a denial later.

Frequently Asked Questions (FAQ)

Can an insurance company deny me coverage in Texas?

Yes, but it depends on the policy type and circumstances. For example, life or short-term health insurance may deny based on health history.

What should I do if my coverage is denied?

Request a written denial, review your policy, gather supporting documents, file an appeal, and contact a lawyer if needed.

Can I sue my insurance company for denying coverage?

Yes. If the denial was unfair, in bad faith, or a breach of contract, you may have legal grounds to sue for damages.

How long do I have to appeal a denial?

Most policies require you to file an appeal within 30 to 60 days from the date of the denial. Always check your specific policy deadlines.

What does bad faith mean in insurance?

Bad faith refers to when an insurance company fails to uphold its obligations—such as delaying, underpaying, or wrongfully denying a claim without a valid reason.

Conclusion

Being denied insurance coverage in Texas can feel frustrating and unfair, but you don’t have to accept the insurer’s decision as final. You have legal rights, and you have options. Whether you choose to appeal, file a complaint, or take legal action, you don’t have to face this challenge alone.

Louis Law Group has helped countless Texas residents fight wrongful denials and recover the benefits they’re owed. If your coverage was denied, don’t wait—take action today.

Are you ready to challenge your denied insurance coverage and protect your financial future?

Contact Louis Law Group today for a free consultation. Call 833-657-4812 or submit a free case evaluation form to get started. Don’t wait—let us help you take the first step toward justice and financial recovery.