Ask for the denial and its reason in writing, then match the response to the reason. A liability denial by the other driver’s insurer is answered with evidence or a lawsuit against the driver. A denial by your own insurer is governed by Insurance Code deadlines and can support extra damages if it was unreasonable.
Start by finding out who denied the claim and why. The answer decides the next step, because Texas treats your own insurer and the other driver’s insurer very differently.
When the at-fault driver’s carrier denies, the usual reasons are disputed fault, a claim that your injuries were not caused by the crash, or a coverage problem such as an excluded driver or lapsed policy. That insurer owes you no contractual duty: in Allstate v. Watson (1994) the Texas Supreme Court held a third-party claimant cannot sue the other driver’s insurer for unfair claim handling. The remedy is to prove the claim, with photos, witnesses, video, and medical opinions, or to sue the driver, which the insurer must then defend.
When your own insurer denies a PIP, uninsured or underinsured motorist, or collision claim, the Insurance Code applies. Chapter 542 requires an insurer to acknowledge and begin investigating a claim within 15 days of notice (section 542.055) and to accept or reject it in writing within 15 business days after receiving the items it requested (section 542.056). Section 542.060 adds interest and attorney’s fees when an insurer that owes a claim violates those rules, and section 541.151 allows suit for unfair practices.
Uninsured and underinsured motorist claims have a special rule: under Brainard v. Trinity Universal (2006), the insurer does not owe benefits until the other driver’s liability and the amount of your damages are established, so these denials are often a step in the process rather than the end.
A denial is frequently an opening position. Owsley Law Firm reviews the letter, the policy, and the evidence at no charge, and handles the response or the lawsuit on contingency.
What to do, step by step
- Ask for the denial and the specific reason in writing.
- Get a copy of your policy and any reservation of rights letter.
- Gather evidence that answers the reason given.
- Respond in writing and keep proof of every submission.
- Call a lawyer before the two-year deadline under section 16.003 approaches.
Some denials are really a request for more information. Section 542.055 lets an insurer request the items it reasonably believes it needs, and providing them starts the 15 business day decision period under section 542.056.
A denial based on causation, that the crash did not cause your injury, is usually answered with treating doctor opinions and records showing when symptoms began.
Coverage denials raise different questions. If the insurer says the driver was excluded from the policy, the policy lapsed, or the car was being used for business, ask for the policy language it relies on. Some exclusions hold up and some do not, and a lapsed policy may leave your own uninsured motorist coverage as the right source.
Keep a written timeline. Note when you reported the claim, when the insurer acknowledged it, what it requested, and when you provided it. Those dates are what determine whether an insurer followed the deadlines in Chapter 542, and they are much easier to prove from your notes than from memory.
Mistakes that cost people money
- Assuming the denial is final.
- Arguing by phone without written records.
- Missing your own policy’s notice or proof-of-loss deadlines.
- Settling with the at-fault driver without your insurer’s consent when a UIM claim is possible.
Related questions
Can I file a complaint with the state?
Yes. The Texas Department of Insurance accepts consumer complaints about insurers, and a complaint can prompt a response, though it does not decide the claim.
How long does an insurer have to decide?
For first-party claims, 15 business days after it receives the items it requested, under section 542.056, with some extensions allowed by statute.
Can I sue the other driver’s insurer for denying me?
Not for unfair handling. Allstate v. Watson holds a third-party claimant has no such claim; the suit is against the at-fault driver.
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