How Long Does an Insurance Company Have to Deny an Injury Claim in Texas?

We rely on insurance to pay for sudden expenses when we are injured, but the process is rarely easy. Insurance companies must respond to your claims by specific deadlines. If they do not, speak to an attorney.

Insurance companies must acknowledge your claim shortly after you file it. Once acknowledged, the clock starts ticking again, and the company must approve or deny your claim by a specific deadline. If your claim is approved, they must pay promptly. These deadlines are set by law, but there is some wiggle room. If an insurance company needs time to investigate a claim more thoroughly, they can. However, there should be some just cause for a delay. If no just cause is shown, call a lawyer. Unnecessary delays are a common tactic insurance companies employ to wait out claimants. You can sue for bad faith if you believe you are being deceived. If your claim is denied, you should still speak to an attorney. You can appeal the denial and hopefully get the compensation you need.

Call (817) 476-1797 to speak to our Dallas personal injury attorneys at The Queenan Law Firm, P.C. for a free evaluation of your case.

When an Insurance Company Must Approve or Deny an Injury Claim in Texas

Insurance companies wield a lot of power. When a person files a claim, the insurance company is often free to approve or deny it as it sees fit. Generally, insurance companies are concerned with profits first and customers second, and underhanded tactics to reduce payments are not unheard of. The insurance company must approve or deny your claim promptly. If they leave you hanging, call a lawyer and take legal action.

Acknowledging the Claim

After you file an injury claim with an insurance company, they have limited time to respond. According to Tex. Ins. Code § 542.055(a), an insurance company must acknowledge the receipt of your claim no later than the 15th day after you file. If the insurance company is an eligible surplus line insurer, they may have 30 business days to acknowledge your claim. Surplus line insurers often cover high-risk situations that many other insurers or policies normally do not.

During this time, the insurance company must also begin investigating your claim and request any additional information or documentation from you they might need.

Generally, this acknowledgment should be made in writing. However, this is not always the case. You might instead receive a phone call from the insurance notifying you that they have received your claim and an investigation is pending. In that case, the insurance company should document the date, time, and manner of the acknowledgment. It would be best if you also made a note for your records.

Accepting or Denying the Claim

Once the insurance company receives your claim and starts investigating, it must approve or deny it by a specific deadline. According to Tex. Ins. Code § 542.056(a), the company should accept or deny your claim no later than the 15th business day after receiving everything necessary to process it.

However, this timeline is flexible. Under Tex. Ins. Code § 542.056(d), the insurance company may have additional time to investigate and process your claim if needed. If the insurance company cannot accept or deny a claim by the specified deadline, they must notify you of the reasons why they need more time. The company cannot just demand more time with no explanation. If you do not receive an explanation, or you believe the explanation is bogus, call a lawyer. If the insurance company needs more time, they have no more than 45 additional days.

Paying the Claim

If your claim is approved, it must be paid promptly. The insurance company cannot approve your claim and then delay payment. If they do, call a lawyer and take swift legal action. According to Tex. Ins. Code § 542.057(a), the insurance company must pay a claim no later than 5 business days after they notify the claimant of the approval.

In some cases, payment is conditional on the claimant’s action. The insurance company might need you to do something before they can pay the claim. This might be something as simple as providing an address for where to send the check or something more in-depth, depending on your situation. In such a case, the insurance company must pay up by the 5th business day after the conditional act is done.

What Happens if the Insurance Company Delays My Injury Claim in Texas?

Delays in claims are not uncommon. Many people are informed by insurance companies that their claims will take a little longer to process. Often, the insurance company has a reason to investigate further. This is common in cases where injuries are complex, accidents are somewhat suspicious, or the claim’s value is high. At the end of the day, the insurance company needs a good reason to delay your claim, and they must explain it to you.

When an insurance company delays a claim, you cannot do much if their reasons are valid. Going without compensation for a bit longer might be tough, but insurance companies are not known for their sympathy. Talk to a lawyer if the delay is too long or otherwise seems unreasonable. You might have a lawsuit for bad faith dealings on your hands.

According to Tex. Ins. Code § 542.003(2), failing to acknowledge a claim or make payments on an approved claim with reasonable promptness is considered an unfair settlement practice and is prohibited by law. Additionally, under § (4) of the same law, the insurance company must attempt to promptly, fairly, and equitably settle a claim. Unnecessarily dragging out a claim may be considered bad faith. This is often done to get desperate claimants to accept low settlements or give up.

Speak to Our Texas Personal Injury Attorneys for Help with Your Insurance Claim

Call (817) 476-1797 to speak to our Houston personal injury attorneys at The Queenan Law Firm, P.C. for a free evaluation of your case.