Property Insurance Claim Denial Guide – San Antonio, Texas

Introduction: Why San Antonio Homeowners Face Unique Claim Denials

San Antonio’s mix of historic neighborhoods, rapidly expanding suburbs, and hill-country terrain creates property risks that are different from those faced by homeowners in other parts of Texas. Bexar County regularly ranks among the top Texas counties for severe hail events. The National Weather Service recorded hailstones over two inches in diameter striking the Northwest Side in April 2021, and the economically devastating April 2016 hailstorm still stands as the costliest in Texas history. High winds from Central Texas tornadoes, flash flooding along the San Antonio River, and the growing threat of wildfire during drought years all place local structures under stress. When damage occurs, homeowners reasonably expect their insurer to honor the policy they have paid for. Yet, claim denials are common—even when repairs feel urgent and necessary.

This guide explains how Texas law, specifically as applied in San Antonio, protects policyholders. It breaks down the most frequent reasons for claim denial, outlines the statutes that govern insurer conduct, and provides step-by-step instructions on what to do next. The discussion slightly favors the homeowner, but every fact is grounded in authoritative sources such as the Texas Insurance Code, the Texas Department of Insurance (TDI), and published Texas court decisions. Whether you are coping with roof damage from hail off Loop 1604, water intrusion from a flood-stage San Antonio River, or any covered peril, this resource will help you make informed decisions.

Understanding Your Rights in Texas

Texas Is a "Prompt Payment" State

Chapter 542 of the Texas Insurance Code—often called the Prompt Payment of Claims Act—requires insurers to acknowledge, investigate, and decide claims within specific deadlines. In most homeowner property cases, the insurer must:

• Acknowledge receipt of the claim within 15 calendar days (Tex. Ins. Code § 542.055).

• Begin investigation within the same 15-day window.

• Accept or reject the claim no later than 15 business days after receiving all required information (Tex. Ins. Code § 542.056).

• Pay accepted claims within 5 business days after notifying the insured (Tex. Ins. Code § 542.057).

If an insurer violates these deadlines without valid legal excuse, it may owe the policyholder 18% annual interest on the amount due plus reasonable attorney’s fees. Texas courts, including the Fourth Court of Appeals in San Antonio, have upheld these penalties to deter delay tactics.

Protections Against Unfair Settlement Practices

Separate from timing issues, Chapter 541 of the Texas Insurance Code bars insurers from misrepresenting coverage, failing to settle when liability is clear, or denying claims without a reasonable investigation. Violations can trigger actual damages, treble damages if the conduct was knowing, and attorney fees. San Antonio juries have not hesitated to impose substantial awards when evidence shows an insurer ignored critical facts or relied on a biased engineering report.

The Contractual Right to Coverage

Your homeowners policy is a contract. Texas law gives you four years to sue on written contracts (Tex. Civ. Prac. & Rem. Code § 16.004), but many policies shorten that window to two years and one day, which Texas courts routinely enforce. Checking the “Suit Against Us” clause in the policy is critical, especially when storm repairs drag on.

Right to Independent Appraisal

Most Texas property policies include an appraisal clause. Either party may invoke appraisal when the dispute is about the amount of loss rather than coverage. The Texas Supreme Court’s decision in State Farm Lloyds v. Johnson, 290 S.W.3d 886 (Tex. 2009), affirms that appraisal is binding on amount but does not resolve causation (i.e., whether the peril is covered). San Antonio homeowners have successfully used appraisal to increase underpaid hail claims by tens of thousands of dollars.

Common Reasons Property Insurance Companies Deny Claims in Texas

1. Wear and Tear or "Pre-Existing Damage"

Insurers often argue that roof shingles or plumbing systems failed because of age, not the storm or leak in question. Texas courts require insurers to prove that excluded causes of loss account for all damage if they rely on an exclusion (see Lyndon Property Insurance Co. v. U.S. Steel Corp., 254 S.W.3d 87 (Tex. App.—Houston [14th Dist.] 2007, pet. denied)). Policyholders counter this by hiring licensed Texas public adjusters or structural engineers to date the damage accurately.

2. Late Notice

Nearly every policy requires “prompt” notice. While Texas law allows some flexibility, delays beyond one year may lead to denial if the insurer can show prejudice. San Antonio homeowners who discover hail pockmarks long after the storm should document why they could not have found the damage sooner—e.g., steep roof pitch or lack of attic access.

3. Alleged Policy Exclusions (Flood, Surface Water, Mold)

Flood damage from the San Antonio River or Salado Creek is excluded under standard homeowners forms. However, wind-driven rain that enters through a damaged roof opening is often covered. Mold exclusions apply unless caused by a covered peril. Reading endorsements and exclusions line-by-line is essential.

4. Insufficient Evidence of Storm Event

Insurers sometimes deny claims when the policyholder cannot tie damage to a specific date of loss. Obtaining NOAA storm reports, Bexar County Office of Emergency Management logs, or local TV meteorologist archives can corroborate the timing.

5. Misrepresentation or Suspected Fraud

If an insurer believes the claim was inflated or that receipts are fabricated, it may issue a denial or request an Examination Under Oath (EUO). Providing organized documentation—permits from the City of San Antonio Development Services Department and before-and-after photos—helps rebut fraud allegations.

Texas Legal Protections & Regulations

Texas Insurance Code Chapter 542 – Prompt Payment Deadlines

The Act establishes the timeframes listed earlier and the 18% interest penalty. Importantly, the 2021 amendments clarified that the deadlines pause during appraisal only if both parties agree in writing.

Texas Insurance Code Chapter 541 – Unfair Settlement Practices

Key provisions include § 541.060, which prohibits:

• Misrepresenting a material fact or policy provision.

• Failing to attempt in good faith to effectuate a prompt, fair, and equitable settlement.

• Denying a claim without a reasonable investigation.

Policyholders must send a 60-day presuit notice outlining the violations and damages. This notice requirement applies to claims filed in Bexar County district courts as well.

Claim File Transparency

Under Tex. Ins. Code § 542.158, once litigation commences the insurer must, upon written request, produce its claim file—including adjuster notes—within 30 days, except privileged materials. Courts in the Western District of Texas, San Antonio Division, have sanctioned carriers for incomplete production.

Texas Department of Insurance (TDI) Oversight

The TDI can fine insurers and order restitution. Homeowners may file a complaint online or call 1-800-252-3439. While TDI cannot adjudicate coverage disputes, its mediation can pressure insurers to settle, especially if a pattern of similar complaints exists.

Steps to Take After a Denial in Texas

1. Read the Denial Letter Carefully

Texas Insurance Code § 542.056(c) requires insurers to state specific policy provisions supporting denial. Compare those citations to your policy.

2. Request the Full Claim File

Send a written request citing § 542.158. Include your claim number, property address, and a deadline (e.g., 30 days) for production.

3. Gather Independent Evidence

• Hire a licensed Texas public adjuster or engineer familiar with San Antonio building codes (2018 International Residential Code adoption).

• Pull hail and wind reports for your ZIP code from the Storm Events Database.

• Obtain repair estimates from contractors registered with the City of San Antonio.

4. Consider Appraisal

Send a certified letter invoking appraisal if the dispute is about the cost of repair, not coverage. Name a qualified, impartial appraiser experienced in Bexar County roofing systems.

5. File a Complaint with TDI

Use the online portal at TDI Consumer Complaint Form or fax Form 2041. Provide the denial letter, policy pages, and photographs.

6. Issue a 60-Day Presuit Notice

If the insurer does not reverse its decision, Texas Insurance Code § 541.154 requires that you send presuit notice before filing a lawsuit. The notice must state:

• The specific statutory violations.

• The amount of actual damages and expenses.

• Your attorney’s name, if represented.

Send it by certified mail, return receipt requested, to the carrier’s statutory agent for service in Texas.

When to Seek Legal Help in Texas

Complex Claims and High Dollar Losses

If your roof replacement exceeds $20,000 or structural repairs require engineered drawings, engaging a Texas attorney is prudent. Lawyers licensed by the State Bar of Texas must adhere to the Texas Disciplinary Rules of Professional Conduct, and many hold Board Certification in Insurance Law through the Texas Board of Legal Specialization.

Bad-Faith Indicators

Contact counsel immediately if you see:

• Repeated requests for the same documents.

• Adjuster turnover with no progress.

• Lowball offers far below comparable contractor bids.

• Accusations of fraud without evidence.

Statute of Limitations Concerns

If your policy’s “Suit Against Us” clause limits litigation to two years, waiting could waive your rights. An attorney can toll the limitations period by filing suit in Bexar County District Court or the U.S. District Court, Western District of Texas, San Antonio Division.

Local Resources & Next Steps

San Antonio-Specific Contacts

• City of San Antonio Development Services: Permitting records can corroborate repair timelines.

• Bexar County Appraisal District (BCAD): Property data helps verify square footage and replacement cost values.

• Alamo Area Council of Governments: Disaster recovery grants may defray repair costs while the claim is disputed.

State and Federal Agencies

Texas Department of Insurance – Complaint, mediation, and consumer guides. Texas Real Estate Commission – Licensing lookup for inspectors. National Weather Service – Historical hail and wind data.

Document Everything

Create a digital folder with:

• Photos and videos stamped with the date and GPS location.

• Copies of written communications with the insurer.

• Invoices, receipts, and canceled checks for temporary repairs.

Well-organized evidence shortens settlement time and strengthens any future lawsuit.

Conclusion

Facing a property insurance claim denial in San Antonio can feel overwhelming—especially when hail season or hurricane remnants create further exposure. Fortunately, Texas law provides strong remedies, from prompt-payment penalties to treble damages for bad faith. By understanding the deadlines, gathering independent evidence, and using the administrative tools available through the Texas Department of Insurance, homeowners can turn the odds in their favor. If the insurer still refuses to pay, experienced Texas attorneys can leverage Chapters 541 and 542 of the Texas Insurance Code, appraisal awards, and court rulings to secure the coverage you purchased.

Legal Disclaimer: This article is for informational purposes only and does not constitute legal advice. Laws and regulations change, and the application of statutes can vary based on specific facts. Consult a licensed Texas attorney for advice regarding your individual situation.

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