A denial letter from an insurance company is not a final ruling on your claim. It is one company's decision, made by an adjuster working for the insurer, and it can be challenged. Texas law does not give insurance companies the last word on whether an injured person recovers anything. If your claim was denied, you generally have the option to dispute the denial in writing, supply additional evidence, or file a lawsuit within the legal deadline. What matters most in the days after a denial is understanding why the claim was rejected and protecting your right to pursue the claim in court before time runs out.
Why the insurance company denied your injury claim
Denial letters are often vague, but the underlying reasons usually fall into a handful of categories. Reading the letter carefully and identifying the stated reason is the first step, because the reason shapes the response.
- Disputed liability. The insurer claims its policyholder was not at fault, or was only partly at fault, and blames the injured person instead.
- Questions about causation. The insurer accepts that a crash or fall happened but argues the injuries came from something else, such as a preexisting condition or a later event.
- Gaps in medical treatment. A delay between the injury and the first doctor visit, or a long break in treatment, is frequently used to argue the injuries were minor or unrelated.
- Policy issues. The policy may have lapsed, the driver may not have been a covered person, or the claimed damages may fall into an exclusion.
- Coverage limits already exhausted. If multiple people were hurt in the same incident, the available policy limits may already be spoken for.
- Missing documentation. Sometimes a denial is administrative. Records were never received, a form was incomplete, or a requested authorization was never signed.
A denial based on missing paperwork is a very different problem from a denial based on a fault dispute. The first may be solved by sending records. The second may require litigation.
The deadline that keeps running after a denial
This is the point that catches people off guard. Fighting with an insurance company does not pause the legal clock. In Texas, a personal injury lawsuit generally must be filed within two years from the date of the injury under Section 16.003 of the Texas Civil Practice and Remedies Code. Months spent appealing internally, exchanging letters, or waiting on a reconsideration do not extend that two-year window.
If the deadline passes without a lawsuit on file, the claim is usually barred no matter how strong the underlying facts were. An insurer that has already denied the claim has little reason to remind anyone of the date. Certain circumstances can change how the deadline is calculated, including claims involving minors or claims against governmental entities, which carry their own shorter notice requirements. Those variations are fact specific and are worth confirming with an attorney rather than assuming.
What to do after an insurance denied injury claim in Texas
The steps below are general, and not every one applies to every situation. They describe how denied claims commonly get revisited.
- Get the denial in writing. If the denial came over the phone, request a written explanation that states the specific reason and the policy language relied on.
- Request the claim file and the policy. Knowing the actual coverage terms, limits, and exclusions is basic to evaluating whether the denial was correct.
- Collect the complete medical record. That means records and bills from every provider, including the emergency room, imaging centers, physical therapy, and follow-up visits. Partial records are one of the most common reasons a claim looks weaker than it is.
- Address the stated reason directly. If the denial cited a treatment gap, a letter from the treating physician explaining the gap carries more weight than an argument from the claimant.
- Preserve evidence of fault. Photographs, the crash report, incident reports, surveillance footage, and witness contact information tend to disappear over time. Businesses often overwrite video within weeks.
- Keep a record of communications. Dates, names, and what was said on each call. This becomes relevant if the handling of the claim itself later becomes an issue.
- Be cautious with recorded statements. After a denial, a request for a new recorded statement is often aimed at locking in testimony that supports the denial.
How Texas fault rules affect a denied claim
Many denials are really arguments about fault. Texas uses a modified comparative fault system with a 51 percent bar. An injured person can recover damages as long as they are not more than 50 percent responsible for the incident, and the recovery is reduced by their share of fault. At 51 percent at fault, a plaintiff recovers nothing.
This rule explains a lot of insurer behavior. An adjuster who assigns a high percentage of fault to the injured person creates a basis to deny the claim outright or to justify a low offer. But an adjuster's percentage is a negotiating position, not a finding. Fault is ultimately decided by the jury or by the parties in settlement, not by the company that would have to pay.
In premises cases, such as a fall at a store or on someone else's property, the analysis also depends on the injured person's legal status on the property. Texas distinguishes among invitees, licensees, and trespassers, and the property owner owes a different duty to each. A denial that treats a customer as though no duty was owed may be applying the wrong standard.
What a denial does not decide
- Whether the other party was actually negligent
- Whether the injuries were caused by the incident
- What the claim is worth
- Whether a jury would agree with the insurer
Can you sue after an insurance claim denial in Texas
Yes. A denial by an insurance company does not block a lawsuit. In most injury cases, the lawsuit is filed against the at-fault person or business, not against their insurance company directly, and the insurer then defends and pays on behalf of its policyholder up to the policy limits.
The picture is different when the dispute is with your own insurer, for example on an uninsured or underinsured motorist claim or a first-party coverage claim. Those situations involve the contract between you and your insurance company, and Texas law imposes separate obligations on insurers in how they handle claims. Whether a particular denial crosses a line is a fact-heavy question.
On damages, Texas does not cap ordinary compensatory damages such as medical expenses, lost income, and pain and suffering in typical injury cases. Different rules apply in medical malpractice cases and to punitive damages, which are separate topics from a standard claim denial.
The bottom line
A denial is an opening position, not a verdict. The productive response is to find out exactly why the claim was denied, gather the records and evidence that answer that reason, and keep the two-year filing deadline under Section 16.003 of the Texas Civil Practice and Remedies Code firmly in view. Insurance companies are not neutral evaluators of the claims they pay, and their assessment of fault or causation is not binding on anyone. Because the deadline continues to run during every round of back and forth with an adjuster, time is the resource most easily lost after a denial.
This article is general information about Texas law and is not legal advice. Laws change and every case is different. Talk to a licensed attorney about your situation.