FAQ: Appealing an Insurance Denial for a Minor Auto-Injury Claim (Texas)

Quick disclaimer: This is general information only and not legal advice. It explains common steps under Texas law that people take when an insurer denies a bodily-injury claim after a minor accident. Consult a licensed Texas attorney for advice about your specific situation.

Detailed Answer

When an insurance company denies a bodily-injury claim after a minor auto accident in Texas, the typical path to challenge that denial includes learning why the insurer denied the claim, gathering missing evidence, pursuing internal appeal steps, filing a complaint with the Texas Department of Insurance (TDI), and—if necessary—filing a lawsuit. Below are the steps in order, with Texas legal context you should know.

1. Read the denial carefully and note deadlines

Insurers must send a written denial or request for more information. The letter should state the reason(s) for denial and often explain how to appeal internally. Note any deadlines in the letter and the date you received it. Preserve the denial letter and all related communications.

2. Identify the insurer’s reason for denial

Common denial reasons: the insurer says the injury is unrelated to the accident, missing or late medical bills, policy exclusions, lack of cooperation, or an alleged lack of medical causation. Knowing the reason lets you target your response—e.g., supply a medical opinion tying treatment to the crash, or show the bill was timely submitted.

3. Gather and organize evidence

• Crash report or police report (if available).
• Photos of vehicle damage, scene, and visible injuries.
• All medical records and bills linked to the accident (emergency room notes, imaging reports, doctor notes, physical therapy records).
• Medical provider statements explaining causation or necessity of treatment.
• Receipts, wage records (if lost time from work), and witness contact information.
• Copies of all communications with the insurer, including recorded statement requests.

4. Use the insurer’s internal appeal process

Most policies and insurers have an internal appeal or review process. Send a written appeal or supplemental claim package that addresses the denial reason and includes the evidence above. Deliver by certified mail or another trackable method and keep proof of delivery.

5. Know relevant Texas laws and administrative options

Two parts of Texas law commonly apply to first-party insurance disputes:

• Texas Insurance Code, Chapter 541 — Unfair methods, unfair or deceptive acts or practices by insurers. See chapter details at: Texas Ins. Code Ch. 541.
• Texas Insurance Code, Chapter 542 — Prompt payment of claims and penalties for improper handling. See chapter details at: Texas Ins. Code Ch. 542.

These statutes create administrative standards and, in many instances, allow recovery of attorney’s fees and statutory damages when an insurer violates the law. For timing of civil lawsuits, personal injury claims generally must be filed within two years after the injury under Texas limitations law (see Texas Civil Practice & Remedies Code, Chapter 16). For reference to limitations rules, see: Tex. Civ. Prac. & Rem. Code Ch. 16.

6. File a complaint with the Texas Department of Insurance (TDI)

If internal appeal does not resolve the denial, you can file a complaint with TDI. TDI cannot give legal advice, but it investigates insurer practices and can help enforce prompt payment or unfair-practice rules: File a complaint with TDI. The TDI consumer pages also explain timeframe expectations and what documents to include: TDI: Claim Issues.

7. Send a demand letter or pre-suit notice

Before suing, parties often send a formal demand letter describing the facts, damages sought, and a deadline for response. For some statutory claims under the Insurance Code, Texas law requires certain notice or gives the insurer an opportunity to resolve the matter before a lawsuit—your attorney can advise whether notice is needed in your case.

8. Consider litigation — and the right court

If the insurer continues to deny the claim, you may be able to sue. For bodily-injury claims, suit is typically in Texas district court. Possible claims include breach of contract (the policy) and statutory claims under Chapters 541 and 542. Statutory claims sometimes permit recovery of attorney’s fees and additional damages; a lawyer can advise whether the facts support filing such claims. Note the civil statute of limitations (see Chapter 16 linked above) — missing the deadline can bar your case.

9. Costs and hiring an attorney

Many personal injury attorneys in Texas take first-party injury or third-party bodily-injury claims on contingency (they get paid a percentage of the recovery). For very small claims you may want to try negotiation, using a demand letter, or filing a complaint with TDI. An attorney can evaluate whether damages justify litigation and can often advance costs while the case proceeds.

10. Practical tips about insurer communications

• Do not give a recorded statement or sign medical-authorization forms beyond what is necessary without discussing potential consequences with an attorney.
• Keep a claim file with dates, names, and summaries of all phone calls and letters.
• Reply promptly to reasonable requests for information, but get legal advice if a request seems irrelevant or invasive.

Helpful Hints

• Start building your evidence early: photos and medical documentation are often decisive in minor-injury claims.
• Always ask for the denial in writing, and preserve it with the envelope and delivery record.
• Use certified mail or tracked email for key documents so you have proof of delivery.
• File a TDI complaint if the insurer misses required response times or you suspect unfair settlement practices: TDI complaints.
• Track deadlines: internal appeal windows, TDI intake timelines, and the civil statute of limitations (see Texas Civ. Prac. & Rem. Code Ch. 16).
• For small property-only disputes (vehicle damage only), consider Justice Court if the amount in controversy is within that court’s limit; bodily-injury claims normally belong in district court.
• If an insurer offers to settle, compare the offer to total past and expected medical costs, pain and suffering, lost wages, and out-of-pocket expenses before signing away future claims.

If you want help deciding whether to hire a lawyer or what documents to collect now, a brief call with a Texas personal-injury attorney can clarify options. Again, this information is educational and not legal advice.