When your insurance claim is denied after a car accident in San Antonio, it can feel like adding insult to injury. You’re already dealing with physical pain, vehicle damage, and possibly lost wages—now you’re facing an uphill battle with an insurance company that refuses to pay. But don’t lose hope. A denial is not the end of your claim, but rather the beginning of a new phase in the process.
As experienced San Antonio personal injury attorneys, we’ve helped countless clients successfully overturn denied claims. Here’s your comprehensive guide to taking immediate action after a claim denial.
Why Insurance Companies Deny Valid Claims
Before diving into solutions, it’s important to understand why insurance companies deny claims in the first place. Insurance carriers are profit-driven businesses with a financial incentive to minimize payouts. Common reasons for denial include:
- Disputes over who was at fault
- Policy exclusions or limitations
- Missed deadlines for filing
- Pre-existing conditions arguments
- Insufficient documentation or evidence
- Discrepancies in accident reports
- Claims that the injuries aren’t related to the accident
Now, let’s look at the seven critical steps you should take immediately after receiving a denial letter.
Step 1: Carefully Review the Denial Letter
The first and most crucial step is to thoroughly read the denial letter. Insurance companies are legally required to explain why they’re denying your claim. This document contains valuable information that will guide your next actions.
Pay special attention to:
- The specific reason(s) for denial
- Any policy provisions they’re citing
- Deadlines for appealing the decision
- Required documentation for reconsideration
- Contact information for the claims adjuster
Don’t rush through this step. Understanding exactly why your claim was denied is essential for formulating an effective response strategy.
Step 2: Gather All Relevant Documentation
Evidence is your most powerful tool when fighting a claim denial. Compile a comprehensive file that includes:
- The police report from your accident
- All medical records and bills related to your injuries
- Photographs of your injuries and vehicle damage
- Witness statements
- Your insurance policy (read the fine print!)
- Communication records with insurance representatives
- Proof of lost wages if you missed work
- Repair estimates for your vehicle
If you’re missing any critical documentation mentioned in the denial letter, now is the time to obtain it. Request medical records from your healthcare providers and accident reports from the appropriate authorities.
Step 3: Consult with a San Antonio Personal Injury Attorney
While you can appeal a denial on your own, involving an experienced personal injury lawyer significantly increases your chances of success. Insurance companies have teams of attorneys protecting their interests—you deserve the same level of representation.
A skilled attorney will:
- Evaluate the strength of your case
- Identify any bad faith insurance practices
- Handle all communications with the insurance company
- Help gather additional evidence to support your claim
- Prepare and file your appeal within required deadlines
- Negotiate for the maximum possible settlement
- Represent you in court if necessary
Most reputable personal injury attorneys in San Antonio offer free initial consultations and work on a contingency fee basis, meaning you pay nothing unless they win your case.
Step 4: File a Formal Appeal
Almost all insurance companies have an appeals process for denied claims. Your denial letter should outline this process, including specific deadlines. Missing these deadlines can permanently forfeit your right to appeal, so act quickly.
When preparing your appeal:
- Directly address each reason for denial
- Include all supporting documentation
- Reference specific policy provisions that support your claim
- Maintain a professional, fact-based tone
- Request a specific settlement amount based on your damages
- Keep copies of everything you submit
Submit your appeal according to the instructions in your denial letter, whether by certified mail, fax, or through an online portal. Always request confirmation of receipt.
Step 5: Consider Alternative Dispute Resolution
If your appeal is unsuccessful, you might consider mediation or arbitration before proceeding to court. These alternative dispute resolution methods can be less time-consuming and expensive than litigation.
- Mediation: A neutral third party helps facilitate negotiation between you and the insurance company
- Arbitration: A neutral arbitrator reviews evidence from both sides and makes a binding decision
Your insurance policy may include provisions for arbitration, so check your policy language. Some policies require mandatory arbitration before you can file a lawsuit.
Step 6: File a Complaint with the Texas Department of Insurance
The Texas Department of Insurance (TDI) regulates insurance companies operating in the state and can intervene when carriers engage in unfair practices. Filing a complaint with TDI creates an official record of the dispute and may prompt the insurance company to reconsider their position.
You can file a complaint online through the TDI Consumer Protection page or call their Consumer Help Line at 1-800-252-3439.
When filing your complaint:
- Include your policy number and claim number
- Attach copies of relevant documents
- Clearly explain why you believe the denial was unjustified
- Detail your efforts to resolve the issue
- Specify what outcome you’re seeking
While TDI cannot force an insurance company to pay your claim, their investigation can put regulatory pressure on the insurer and identify patterns of bad faith practices.
Step 7: Consider Filing a Lawsuit
If all other methods fail to resolve your claim, filing a lawsuit may be your best recourse. In Texas, you generally have two years from the date of your accident to file a personal injury lawsuit (though exceptions exist).
A lawsuit is a significant undertaking, but it can be necessary when facing an obstinate insurance company. Your attorney will guide you through:
- Filing a petition with the appropriate court
- The discovery process (gathering and exchanging evidence)
- Depositions and expert testimony
- Settlement negotiations
- Trial preparation and representation
Many insurance companies become more willing to negotiate once a lawsuit is filed, as they face the prospect of legal fees and potentially larger payouts if the case goes to trial.
Understanding Bad Faith Insurance Practices in Texas
When insurance companies unreasonably deny claims, they may be acting in “bad faith.” Texas law provides remedies for policyholders who have been victims of bad faith insurance practices.
Examples of bad faith include:
- Denying claims without conducting proper investigations
- Unreasonable delays in processing claims
- Misrepresenting policy provisions
- Failing to provide explanations for claim denials
- Making unreasonably low settlement offers
- Using intimidation tactics
If your insurer has acted in bad faith, you may be entitled to additional damages beyond your original claim amount, including attorney’s fees, court costs, and in some cases, punitive damages.
San Antonio-Specific Considerations for Accident Claims
San Antonio presents unique challenges and opportunities for accident claims:
- The city’s complex highway system, including the notorious “mixer” interchange, contributes to complicated liability determinations
- Bexar County courts have specific local rules that affect personal injury litigation
- San Antonio’s growing population has led to increasing accident rates and more contested claims
- Local police reports use specific formats that may require professional interpretation
- The city’s diverse population means insurance communications may occur across language barriers
A local attorney familiar with San Antonio’s specific legal landscape can navigate these issues more effectively than out-of-town representation.
Protecting Your Rights Throughout the Process
Throughout the claims process, protect your interests by:
- Keeping detailed records of all communications
- Never providing recorded statements without consulting an attorney
- Being cautious about what you post on social media
- Following your doctor’s treatment recommendations
- Not accepting quick settlement offers without legal review
- Understanding the full extent of your damages before settling
Remember that insurance adjusters work for the insurance company, not for you. Their job is to minimize the company’s financial exposure, which often means minimizing your compensation.
Conclusion: Don’t Take No for an Answer
A denied claim is frustrating, but it doesn’t mean you’re without options. By following these seven steps promptly and methodically, you can challenge the denial and potentially recover the compensation you deserve.
At Ryan Orsatti Law, we’ve helped numerous San Antonio residents successfully overturn denied insurance claims. We understand the tactics insurance companies use to avoid paying legitimate claims, and we know how to counter them effectively.
If your accident claim has been denied, contact our experienced San Antonio personal injury team for a free consultation. Remember: the insurance company has legal representation—you should too.
Don’t let a claim denial prevent you from receiving fair compensation for your injuries, vehicle damage, lost wages, and pain and suffering. Take action today to protect your rights and secure the settlement you deserve.
