Common Reasons Your Personal Injury Claim Was Denied in Texas

The Short Answer…

Personal injury claims are often denied due to insufficient evidence, missed deadlines, or disputes over liability. Insurance companies may also reject claims if the policy doesn’t cover the accident or the claim exceeds coverage limits. Additionally, inconsistencies in accident reports, pre-existing conditions, or shared fault can lead to denial.

Key Takeaways

• Insurance companies deny personal injury claims for various reasons to protect their bottom line. However, a denial is typically not the end of the road.
• After a denial, you have the right to challenge the decision by reviewing the denial, strengthening your case with additional evidence, and pursuing an appeal with legal guidance if needed.
• Even if they don’t deny a claim, insurance companies often use various methods to undervalue injury claims and minimize their payouts.
• If an insurance company wrongfully denies a claim in bad faith, you may file a lawsuit. Texas law imposes a 2-year statute of limitations on personal injury claims, and while most cases settle, some may go to trial. 
• If your personal injury claim is denied, a personal injury lawyer can review your case for free, guide you through the legal process, and negotiate for fair compensation.

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6 Most Common Reasons Why Insurance Companies Deny Personal Injury Claims

1. The insurance policy has insufficient coverage. This may include the policy not covering the type of accident that caused the injury or the claim exceeding the maximum coverage of the policy.
2. The insurance policy was not in effect at the time of the accident. This may be because the policy was opened after the accident, or because the policy expired before the accident.
3. There is insufficient evidence of the injury origin. If there is not sufficient evidence that the injury was a result of the accident, or counter-evidence to suggest the injuries were caused by something else (i.e. pre-existing condition or prior accident), the claim might be denied.
4. The statute of limitations has expired. If the statute of limitations deadline has passed, it’s likely that you will not be able to pursue compensation through the court.
5. There is shared fault, or a liability dispute. If the insurance company concludes that you were at-fault for the accident, they may deny your claim.
6. There was a significant delay in medical treatment. If there was a substantial amount of time between the accident and medical treatment, the insurance company might conclude that the claimant was not actually injured in the accident and deny the claim.

Other Reasons Your Personal Injury Claim Was Denied

Aside from the reasons above, other explanations for a personal injury claim denial may include the claimant not following the claims procedure, only suffering very minor injuries, discrepancies between the accident report and your medical records, compensation demands are determined to be too high, etc. If you feel your insurance claim was unjustly denied, speak with an attorney at Braker White for free.

What to Do If Your Personal Injury Claim Is Denied

If your personal injury claim has been denied, it’s important not to panic. Insurance companies frequently reject claims for various reasons, some of which can be challenged.

Here are steps to take if your claim is denied:

1. Review the denial letter to understand the reason for rejection.
2. Gather relevant documentation, including medical records, accident reports, and correspondence with the insurance company.
3. Seek legal assistance from an experienced personal injury lawyer who can help challenge the denial and negotiate for fair compensation.
4. File an appeal if you believe the denial was incorrect, providing additional evidence to support your case.

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How to Appeal an Insurance Denial

If your personal injury claim has been denied by an insurance company, you have the right to appeal. The process generally includes the following steps:

1. Request a Copy of the Claim File: Obtain all documents the insurance company used to deny your claim, including adjuster notes and medical reports. An attorney can help you analyze these documents for errors or inconsistencies.
2. Review and Correct Any Errors: Check for inaccuracies or missing information that could have influenced the denial. Your lawyer can ensure that all necessary details are accurate and properly documented.
3. Submit Additional Supporting Evidence: Provide medical opinions, police reports, and expert statements to strengthen your appeal.
4. Negotiate with the Insurance Adjuster: Open a line of communication to discuss the denial and present a stronger case. Legal representation can significantly improve your negotiating position.
5. Escalate the Appeal if Necessary: If negotiations fail, you may file a complaint with the Texas Department of Insurance or pursue legal action with the help of a personal injury attorney.

Insurance companies are prohibited from unfair claim settlement practices. If an insurer wrongfully denies or delays your claim, you may have grounds for legal action.

How Do Insurance Companies Undervalue Injury Claims?

If the insurance company cannot deny your claim, it may undervalue your claim. Insurance companies are businesses. They will do what they can to pay as little as possible. Some common reasons an insurance company will undervalue your claim include pre-existing conditions, comparative fault, and delays or discrepancies in medical treatment.

Other methods insurance companies use to undervalue claims include:

• Disputing medical treatments
• Questioning the severity of injuries
• Applying depreciation to property damage
• Offering quick settlements
• Using standardized claim-assessment software

If you believe the insurance company has undervalued your claim, our personal injury attorneys can help negotiate a higher settlement.

Frequently Asked Questions

Can You Sue an Insurance Company for Denying a Claim?

Yes. If an insurance company wrongfully denies your personal injury claim, you may have grounds to file a bad faith insurance claim. Texas law protects policyholders from unfair insurance practices. If the insurer acted in bad faith by denying a valid claim without reason, delaying payment, or failing to conduct a proper investigation, you may be entitled to additional compensation beyond your original claim. A personal injury attorney can evaluate your case, gather evidence, and take legal action to hold the insurance company accountable.

Is There a Time Limit for Personal Injury Claims?

Yes. In Texas, the statute of limitations for personal injury claims is generally 2 years from the date of the accident. Failing to file a claim within this period may result in losing your right to compensation.

Will My Personal Injury Case Go to Trial?

Most personal injury cases in Texas are resolved through settlements, but some do go to trial if a fair agreement cannot be reached. If the insurance company refuses to offer adequate compensation or disputes liability, your attorney may recommend filing a lawsuit. In such cases, evidence will be presented in court, and a judge or jury will determine the outcome. Having an experienced lawyer can improve your chances of securing a favorable verdict.

Do I Need a Lawyer for a Personal Injury Claim?

While you are not required to have a lawyer to file a personal injury claim, hiring legal representation significantly improves your chances of success. Insurance companies often try to minimize payouts or deny claims outright. A skilled personal injury lawyer can:

• Negotiate with insurance companies to help maximize your settlement.
• Gather and present strong evidence to support your claim.
• Ensure compliance with Texas legal deadlines and procedural requirements.
• Represent you in court if the insurance company refuses to offer fair compensation.
• Protect your rights against bad faith insurance tactics.

Don’t Face a Denial Alone—Braker White Is Here for You

If your personal injury claim has been denied, don’t give up. The qualified legal team at Braker White is ready to review your case, explain your options, and fight for your rights. With extensive experience handling personal injury claims in Odessa, Midland, and throughout West Texas, we understand the tactics insurance companies use and how to counter them effectively.

Contact us today for a free case review—you won’t pay a dime unless we secure compensation for you. Trust Braker White to fight for the justice you deserve for your injuries.