A denial is not the end — it's often a negotiating position. Insurers deny claims over disputed fault, alleged gaps in treatment, or policy technicalities, and many denials are reversed once an attorney presents the evidence properly. Don't accept a denial at face value or assume you have no case. Have a lawyer review the denial letter and the policy; the review is free.
Jimmy personally reviews every submission — most people hear back the same day.
Before anything else, make the carrier state the denial in writing, with the specific reason and, if it is a coverage denial, the policy provision they are relying on. A denial delivered by phone is a negotiating posture. A denial in writing is a position they have to defend, and it tells you which of several very different problems you actually have.
Disputed liability. Their insured tells a different story, or the crash report assigns fault to you. Neither is binding. An officer's opinion about cause is not a verdict, and Texas does not bar you for being partly at fault — under the proportionate responsibility chapter you recover unless your share exceeds 50 percent, with your award reduced by your percentage.
Causation and treatment gaps. You waited three weeks to see anyone, or there is a month with no visits. The carrier calls it proof you were not hurt. Usually it is proof you had no insurance, no transportation, or a job you could not leave. That is explainable — but it has to be explained, in the records.
Coverage technicalities. The policy had lapsed, the driver was excluded, the vehicle was not permissively used, notice was late. These are the ones worth reading the actual policy over, because carriers sometimes apply an exclusion more broadly than it is written.
Exhausted limits. Texas minimums are only $30,000 per person and $60,000 per crash for bodily injury. A serious injury can exceed them easily. That is not a denial of your claim — it is the end of that policy, and the reason to look for others.
This distinction decides what leverage you have, and almost nobody outside the business knows it.
If the other driver's carrier denied you, you are a third-party claimant. You have no contract with them, and Texas law is explicit that you cannot sue them for unfair settlement practices. The Insurance Code says so directly, and the Supreme Court said so in Allstate Insurance Co. v. Watson. Your remedy is not a bad-faith claim against the insurer — it is a negligence suit against their insured, which the insurer then has to defend and pay.
If your own carrier denied you — PIP, medical payments, uninsured or underinsured motorist — you are a first-party claimant and the landscape is entirely different. Chapter 541 of the Insurance Code governs unfair settlement practices, and chapter 542 sets hard deadlines: acknowledge and begin investigating within 15 days, accept or reject in writing within 15 business days of receiving what they asked for, pay within five business days of acceptance. An insurer that blows those deadlines on a valid claim owes 18 percent a year on the claim amount, plus attorney's fees.
A denial narrows the field; it rarely empties it. Other recovery sources are routinely missed: your own UM/UIM coverage, which exists unless you rejected it in writing; a second at-fault driver; an employer if the at-fault driver was working; a commercial policy behind a company vehicle; a vehicle owner who handed the keys to someone unfit to drive; a dram shop; a governmental entity with its own notice deadline. Your PIP pays regardless of fault and regardless of what any other coverage pays.
Meanwhile the two-year limitations period does not pause while you appeal, resubmit, or wait for a call back. Carriers are not required to warn you about it. Arguing with an adjuster for twenty-three months and then discovering the deadline is a real way to lose a good case.
Authority: Tex. Ins. Code ch. 542, subch. B (prompt payment) · Tex. Ins. Code § 541.060 · Tex. Transp. Code § 601.072 (minimum limits)
The stated reason and the policy language. It tells you which problem you actually have.
Limits and exclusions decide whether this is a fight worth having here or elsewhere.
Many reverse once the evidence is presented properly. The review is free.
Negotiating, appealing and waiting all consume the same clock.
Rear-endings, intersection crashes, uninsured drivers, hit-and-runs — in Houston, El Paso, and everywhere in between.
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La consulta es gratis y confidencial. No paga nada a menos que ganemos su caso. Jimmy contesta personalmente, hoy mismo.
Every day you wait, evidence disappears and the insurer gets ahead. One free call. Straight answers about your case — in English or Spanish. If you need a fighter, you'll have one. If you don't, I'll tell you that too.
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