Plano, Texas Property Insurance Claim Denial Guide

Introduction: Why Claim Denials Matter to Plano Homeowners

Plano, Texas, sits in the heart of Collin County, an area prone to severe North Texas weather. Hailstorms, straight-line winds, and the occasional tornado can leave roofs shredded and interiors water-logged. According to annual reports filed with the Texas Department of Insurance (TDI), hail claims routinely rank among the most disputed property losses in the region. Yet many Plano residents are surprised when their insurer delays, underpays, or outright denies a seemingly valid claim. This guide explains your legal rights and practical options—grounded strictly in Texas law—to help you push back against unfair claim denials. All facts in this article rely on authoritative sources such as the Texas Insurance Code, Texas Administrative Code, published state court opinions, and official TDI publications. We favor homeowner policyholders where the law allows, but every statement is evidence-based. Whether your damage arose in Chase Oaks, Legacy West, or a historic Haggard Farm property, the process for contesting a denial is the same statewide. Use this guide to understand the rules, deadlines, and strategies that can turn a denial into a fair payment.

Understanding Your Rights in Texas

1. The Insurance Contract

Your policy is a legally binding contract. Under Section 17.46 of the Texas Deceptive Trade Practices Act and Chapter 541 of the Texas Insurance Code, insurers must handle claims in good faith and avoid unfair or deceptive acts. If the policy language is ambiguous, Texas courts traditionally construe that ambiguity in favor of the policyholder (Nautilus Ins. Co. v. Country Oaks Apartments Ltd., 566 S.W.3d 712, Tex. 2019)).

2. Prompt Payment Rights—Texas Insurance Code Chapter 542

Often called the “Prompt Payment of Claims Act,” Chapter 542 sets strict timelines:

• 15 Days: The insurer must acknowledge receipt of your claim and request any additional information.

• 15 Business Days after receiving all requested items: The company must approve or deny the claim in writing.

• 5 Business Days after notifying you of approval: Payment must be issued.

Failure to meet these deadlines can trigger statutory interest (currently 18% per year) and attorney’s fees (Tex. Ins. Code §542.060).

3. Bad-Faith Liability—Texas Insurance Code Chapter 541

Chapter 541 prohibits unfair settlement practices such as misrepresenting policy provisions or failing to conduct a reasonable investigation. Violations allow recovery of actual damages, court costs, and, if the insurer acted knowingly, up to three times the amount of actual damages (§541.152).

4. Statute of Limitations

• Breach of Contract: Four years (Tex. Civ. Prac. & Rem. Code §16.004).

• Bad-Faith/Unfair Practices: Two years from the date the unfair act occurred or was discovered, extendable by 180 days if the insurer misleads the claimant (§541.162).

Missing these deadlines usually bars recovery, so calendar them as soon as you receive the denial letter.

Common Reasons Property Insurance Companies Deny Claims in Texas

Wear and Tear Exclusions Insurers often classify older roof damage as “maintenance” rather than sudden storm damage. Texas courts require carriers to segregate covered from uncovered losses; if they cannot, the entire loss may be covered (Lennar Corp. v. Markel, 413 S.W.3d 750, Tex. 2013)). Late Notice to the Carrier Most policies require “prompt” notice. Texas law enforces the requirement only if the delay prejudiced the insurer. This is a fact question usually resolved by courts or juries. Cosmetic Damage Limitations Some Texas policies now exclude purely cosmetic hail damage. The insurer must prove the exclusion applies and must have clearly disclosed it under 28 TAC §5.505. Pre-Existing Damage Insurers may claim the loss existed before the policy period. You can rebut this with weather reports, prior inspection photos, or expert engineering opinions. Misrepresentation or Fraud Allegations If an insured exaggerates losses, the carrier can deny the entire claim under Tex. Ins. Code §705.004—but the burden of proof is on them.

Texas Legal Protections & Regulations

Key Statutes Every Plano Homeowner Should Know

• Texas Insurance Code Chapter 542 — Prompt payment, penalties, and deadlines.

• Texas Insurance Code Chapter 541 — Bad-faith and unfair claim settlement practices.

• 28 Texas Administrative Code §21.203 — Defines unfair methods of competition and deceptive acts.

• Texas Property Code §2210.575 — Building code upgrades for covered losses (where applicable).

TDI Oversight and Complaint Process

The Texas Department of Insurance licenses carriers and enforces the Insurance Code. Homeowners can:

File a written complaint online through TDI’s Consumer Complaint Portal.

• Attach the denial letter, policy declarations, and any photos or estimates.

• Expect a written response from both TDI and the insurer. TDI cannot award damages but can pressure the carrier to reevaluate the claim and may impose administrative fines for violations.

Recent Texas Court Guidance

Two supreme court decisions shape claim-denial litigation:

• Barbara Techs. Corp. v. State Farm Lloyds, 589 S.W.3d 806 (Tex. 2019): Payment of an appraisal award does not absolve an insurer from Chapter 542 penalties if deadlines were missed.

• Ortiz v. State Farm Lloyds, 589 S.W.3d 127 (Tex. 2019): Insureds can still sue for statutory interest and attorney’s fees even after appraisal, but cannot pursue breach-of-contract damages once the appraisal is paid in full.

Understanding these precedents gives Plano homeowners leverage during negotiations and litigation.

Steps to Take After a Denial in Texas

1. Review the Denial Letter Line by Line

Texas law (28 TAC §21.204) requires insurers to state specific reasons for denial. Generic statements like “pre-existing damage” may violate this rule and strengthen your complaint.

2. Gather and Preserve Evidence

• Date-stamped photos of damage, both wide-angle and close-ups.

• Meteorological data from the National Weather Service confirming hail size or wind speeds on the loss date.

• Roofing or general contractor estimates complying with Plano’s local building codes (International Residential Code amendments adopted by the City of Plano).

• Prior inspection reports from realtors or home inspectors.

3. Demand a Certified Copy of Your Policy

Under Tex. Ins. Code §542.003(b)(6), failing to provide policy documents on request may itself be an unfair practice.

4. Submit a Written Reconsideration Request

Cite specific policy provisions, attach your evidence, and give the insurer 10 business days to respond. Send by certified mail for tracking.

5. Invoke Appraisal (If Available)

Most Texas policies contain an appraisal clause. Either side can invoke it to resolve valuation disputes. After Barbara Techs., invoking appraisal does not waive your Chapter 542 rights if the carrier delayed before appraisal.

6. File a TDI Complaint

Use the online form linked earlier. TDI averages a 40-day turnaround. Keep all TDI correspondence; it can be compelling evidence in later litigation.

7. Consult a Texas-Licensed Attorney

Because Texas allows recovery of attorney’s fees in successful Chapter 542 and 541 cases, many lawyers accept property-damage cases on contingency with no upfront costs.

When to Seek Legal Help in Texas

You may be able to resolve smaller disputes on your own, but the following red flags signal you need professional help:

• The insurer alleges fraud or misrepresentation.

• Structural damage exceeds $30,000 and involves code upgrades.

• The insurer refuses to provide a written explanation or engineering report.

• Deadlines under Chapter 542 have already passed with no payment.

• You receive a “reservation of rights” letter suggesting partial coverage only.

An experienced Texas attorney can issue discovery requests, depose the adjuster, and use the threat of treble damages to negotiate a higher settlement. Plano courts fall within the 380th and 401st District Courts of Collin County, venues familiar with insurance disputes.

Local Resources & Next Steps

City of Plano Building Inspections

Roof replacements must meet current code. Permit documentation can prove post-loss repairs and actual costs, buttressing your claim.

North Texas Municipal Water District (NTMWD)

Water-damage claims may involve NTMWD shut-off notices or boil advisories—valuable evidence when arguing a sudden and accidental pipe burst.

Plano Better Business Bureau (BBB)

Check for contractor complaints before hiring an expert. A credible, local contractor’s affidavit often sways insurers and juries alike.

Checklist for Plano Homeowners

• Mark your calendar: Chapter 542 and statute-of-limitations deadlines.

Collect weather data: National Weather Service Storm Reports.

• Obtain at least two written repair estimates.

• File a TDI complaint if no response within 15 business days after submission of all documents.

• Retain a lawyer if the claim remains unpaid after appraisal or TDI intervention.

Conclusion

Facing a property insurance claim denial can feel daunting, but Texas law gives Plano homeowners robust tools to fight back: strict payment deadlines, bad-faith penalties, and the leverage of attorney’s fees. Act quickly, preserve evidence, and do not hesitate to escalate the dispute through appraisal, TDI complaints, or litigation. With informed action, many denials can be reversed or significantly increased.

Legal Disclaimer

This article provides general information about Texas property insurance law and is not legal advice. Laws may change, and your facts are unique. Consult a licensed Texas attorney before taking action.

If your property insurance claim was denied, call Louis Law Group at 833-657-4812 for a free case evaluation and policy review.