Insurance Claim Denied in Texas: What to Do

The Six Steps After a Texas Denial

Work them in order. Each step builds the record the next one depends on - and the record is what changes outcomes.

1. 1

   Read the denial letter - and the policy provisions it cites

   Start with the written reasons the denial letter gives. Match every exclusion or provision the letter cites against your actual policy - the declarations page, the policy form, and every endorsement. Many denials rest on a specific factual assertion (wear and tear, pre-existing damage, late notice, gradual leakage) that can be tested against evidence. A denial letter is the insurer’s initial coverage position, not a final legal ruling.

2. 2

   Gather and re-document the evidence

   Assemble dated photos and video taken before any temporary repairs, a room-by-room inventory of damaged property, receipts for emergency mitigation and additional living expenses, independent repair estimates, and a dated log of every contact with the carrier. Keep the insurer’s own estimate and the denial letter in the file so the gaps between the carrier’s scope and the documented loss can be identified precisely.

3. 3

   Re-present the claim - a licensed public adjuster can do this for you

   Denials are frequently reversed or reduced when the policyholder provides additional documentation, an independent line-item estimate, or professional representation that addresses the specific reason for denial. A licensed Texas public adjuster inspects the loss, prepares a detailed Xactimate estimate, and negotiates with the carrier - on a contingency fee capped at 10% of the settlement under Insurance Code Chapter 4102. If the disagreement is about the dollar amount of a covered loss, the policy’s appraisal clause is also available.

4. 4

   File a complaint with the Texas Department of Insurance if warranted

   If you believe the carrier mishandled the claim - failed to investigate, was slow to respond, or misrepresented policy provisions - the Texas Department of Insurance accepts consumer complaints at tdi.texas.gov and can help you understand the process. A TDI complaint creates a regulatory record; it is not a substitute for re-presenting the claim or for legal action, but it is free and available to every policyholder.

5. 5

   Keep a dated timeline of every claim event

   Keep a dated record of when the loss was reported, what the insurer requested, what you provided and when, and every decision and payment. Texas holds insurers to statutory claim-handling deadlines; whether a specific deadline applies to your claim, and what follows if one was missed, are legal questions for a licensed attorney. A complete, dated file is what makes that review possible.

6. 6

   Know when the dispute belongs to an attorney

   If the disagreement is about whether the loss is covered at all, or whether the insurer engaged in unfair settlement practices under Chapter 541, that is a legal matter. Pre-suit notices under Chapter 542A, demand letters, bad-faith claims, and lawsuits are handled by a licensed attorney - not a public adjuster. A public adjuster’s documentation often supports counsel’s later work, but the legal claim itself belongs to a lawyer.

Common Mistakes After a Denial

These are the avoidable errors that most often turn a recoverable denial into a closed file.

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