FAQs

If a home insurance claim is denied, you will need to take legal action to get the payment you are entitled to. Since the insurance company has not taken your claim seriously so far, it is unlikely that it will take you seriously if you try to appeal the denial yourself. Once denied, you will need to call upon the help of a policyholder rights advocate and bad faith insurance claims attorney to help you fight for your rights and compensation for your loss.

There are virtually unlimited reasons why an insurance claim could be denied. For a property damage claim, some of the most common reasons for claims denial include:

• Premiums were not timely or properly paid
• The cause of property damage falls under a policy exclusion
• Your property is in a high-risk area for the type of damage that occurred
• Claim was not filed on time
• Claimant made false or questionable claims
• Insufficient documentation of damages
• Damages don’t meet the deductible amount

A policyholder, whether commercial or residential, can fight an insurance claim denial with the help of an insurance coverage lawyer. While you can ask your insurer to reconsider its decision on your own, the carrier will likely not deviate from its initial decision in any way. The insurer is obligated to tell you in writing why your claim was denied, so you should have a clear idea of the issues at hand; however, only an experienced insurance lawyer will know how to meaningfully counter the carrier’s allegations and findings in a way that will ultimately get you the funds to which you are entitled.

Yes, an insurance company can refuse to pay a claim. Unfortunately, they do this often – sometimes for legitimate reasons and sometimes in bad faith. Many policyholders are shocked to find out that their insurer has left them to pay for their losses out of pocket. Most people cannot afford to pay for serious damage repair and are left wondering what steps to take next. Most consumers will have no idea if their claims denials are appropriate or if the insurance company is refusing to pay in error. That is why you if your insurance company refuses to pay a claim, you should talk to an experienced first party insurance lawyer.

An insurance underpayment occurs when your insurance company fails to pay the appropriate amount due for the loss you are claiming under your policy. Underpayment of a valid claim occurs five to ten percent more often than an outright denial. This is because insurance companies know they can save millions, if not billions, by lowballing policyholders on their claims, hoping that these faithfully paying customers don’t fight back. Most policyholders don’t realize that even if they are underpaid they still have a right to be fully compensated for the remainder of what they are owed by their carrier and even statutory penalties in many cases.

Many things can cause a delay in claims payment and/or claims processing, including:

• Surveying physical damage can take longer
• The insured failing to submit all applicable and vital documentation
• The insured failing to take steps to mitigate additional damage
• Paperwork errors
• Widespread claims due to large disasters
• Determining whether the various aspects of the loss are covered or fall under policy exclusions

In Texas, an insurance company is bound by strict legally mandated time limits within which it must pay claims. Texas requires a claim acknowledgment within 15 days of a claim being filed. Approval or denial must be made within 15 days of all required documentation being received, but can be extend by 45 days with good reason. The insurance process in Texas must be completed within 60 days of the initial notice, unless a specific exception applies. If the insurance company fails to follow Texas law, a policyholder can collect 18% annual interest and attorneys’ fees in addition to the amount they are owed for their claim.

Yes, you can use the help of a policyholder rights lawyer to sue your insurance company for taking too long to pay your claim. The consumer-friendly Texas Insurance Code provides substantial remedies to policyholders against their insurers doing business in our state. Insurance is a contract of adhesion that is legally binding on both the policyholder and the insurance company. If the insurer does not fulfill its obligations under the contract, including taking too long to process your claim, it can and should face a lawsuit.

Yes, the easiest way to sue an insurance company is to work with a bad faith insurance lawyer to focused on first party insurance claims and dealing with insurance carriers. In the interim, you should be sure to document everything about your claim and keep detailed timelines of all communications with the insurance company and its agents and contractors.