What to Do If You’ve Been Denied Insurance Coverage in Texas

Introduction

Finding out that your insurance coverage has been denied can be a frustrating and stressful experience. Whether it’s health, auto, homeowners, or business insurance, a denial can leave you vulnerable to significant financial loss.

In Texas, insurers are legally obligated to act fairly and in good faith when evaluating claims and policy coverage. However, many people still face unjust denials. This guide will help you understand why denials happen, what you can do about it, and when to get legal support.

Common Reasons for Denied Insurance Coverage in Texas

Insurance companies in Texas can deny coverage for a number of reasons, some legitimate and others questionable. Understanding the common reasons can help you assess whether the denial is fair or not.

1. Policy Exclusions:

Your policy may contain fine print that excludes specific types of events or damages from coverage. For example, flood damage may be excluded from standard homeowners insurance.

2. Lapsed Policy or Non-Payment:

If you missed a payment or your policy expired before the incident occurred, your insurer may deny the claim on the basis of non-active coverage.

3. Misrepresentation or Incomplete Information:

If the insurer believes you misrepresented facts during the application or claims process, they may deny coverage.

4. Pre-Existing Conditions (Health Insurance):

Though the Affordable Care Act limits this for many policies, some older or non-compliant plans still attempt to deny coverage based on pre-existing conditions.

5. Late Claims:

Some policies require that claims be filed within a specific time frame. Missing that window can lead to an automatic denial.

Even if one of these reasons is cited, it doesn’t mean the denial is final or justified.

Your Legal Rights Under Texas Insurance Law

Texas policyholders are protected by state laws that regulate how insurance companies must operate. The Texas Insurance Code prohibits insurers from:

• Unreasonably denying valid coverage

• Delaying claims without cause

• Failing to explain the basis for denial

• Misrepresenting policy terms

You have the right to:

• Receive a written explanation for the denial

• Appeal the decision through the insurer’s internal process

• File a complaint with the Texas Department of Insurance

• Take legal action for breach of contract or bad faith

What to Do After an Insurance Coverage Denial in Texas

Here are clear steps you can take if you’ve received a denial:

1. Get the Denial in Writing:

A written denial will show the insurer’s reasons and cite relevant policy terms. This is the first document you need for your appeal or legal action.

2. Review Your Insurance Policy:

Go through your policy line by line and check whether the insurer's reason is valid under the contract. Pay attention to exclusions, definitions, and coverage limits.

3. Collect Supporting Documentation:

Gather any evidence related to your claim, such as medical records, photos, repair estimates, receipts, or witness statements.

4. Prepare a Rebuttal Letter:

If you believe the denial was unjust, draft a response explaining your position. Include policy references and supporting documents.

5. File an Appeal:

Most insurance companies offer an internal appeal process. Follow the instructions carefully and meet all deadlines.

How a Lawyer Can Help With Denied Insurance Coverage in Texas

When the stakes are high or the insurer isn’t cooperating, hiring a lawyer may be your best move. Legal representation helps level the playing field against powerful insurance companies.

An attorney can:

• Review the denial and your policy to identify legal violations

• Handle correspondence and negotiation with the insurance company

• File a lawsuit for breach of contract or bad faith

• Ensure all paperwork and deadlines are properly met

The Louis Law Group has helped countless clients in Texas stand up to insurance companies after unfair denials. We understand the tactics insurers use and how to counter them effectively. Whether your claim involves home damage, medical costs, or business interruption, our team can guide you through the process and fight for your rightful compensation.

Examples of Denied Claims We Help With

We’ve helped Texas policyholders with coverage denials involving:

• Homeowners insurance for storm or fire damage

• Health insurance claim rejections

• Auto insurance denials after accidents

• Commercial property or business income loss

• Life insurance beneficiary disputes

If your insurance company says “no,” it doesn’t have to be the final answer.

When to Contact Louis Law Group

If you’re unsure how to proceed or feel overwhelmed by the process, it may be time to seek professional legal help. Louis Law Group can review your denial, explain your rights, and help you fight for the coverage you deserve.

We don’t charge any fees unless we win your case. Our team will guide you through every step—from negotiating with the insurer to taking them to court, if necessary.

Frequently Asked Questions (FAQ)

What should I do if my insurance coverage is denied in Texas?

Start by reviewing your denial letter and policy. Gather supporting documentation and consider appealing the decision or consulting a lawyer.

Can I sue my insurance company for denying coverage?

Yes, if the denial was made in bad faith or violates the terms of your policy, you may have grounds for a lawsuit.

What is considered bad faith in Texas insurance law?

Bad faith occurs when an insurer denies a claim without a valid reason, delays payment, or misrepresents policy terms to avoid paying.

How long does the insurance company have to respond to a claim?

In Texas, insurers typically must respond to a claim within 15 days of receiving all necessary documents.

Is it worth getting a lawyer for a denied insurance claim?

Yes, especially for high-value claims. A lawyer can help you navigate the process and improve your chances of getting paid.

Conclusion

Getting denied insurance coverage in Texas is never easy, but you’re not without options. Understand your policy, know your rights, and take action with a well-documented appeal—or legal help if needed. You’ve paid your premiums; now it’s time to protect your benefits.

Have you recently had your insurance coverage denied and don’t know where to turn?

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.