By Joshua A. Estes. Board Certified, Personal Injury Trial Law — Texas Board of Legal Specialization.
Start here: a denial is not the end of a claim, and a low offer is not a final number — but they are two different problems and they need two different responses. A denial means the insurer says it does not owe you. A lowball means the insurer agrees it owes you something and disagrees about how much. Before you argue with anyone, do one thing: get the reason in writing. Almost everything useful you can do next depends on knowing which of a fairly short list of reasons you are actually dealing with.
Step one: get it in writing, and get the reason
A denial delivered by phone is not something you can respond to. Ask for it in writing, with the specific reason and the specific policy provision or fact it rests on, in plain terms. Write down the date, the adjuster’s name, and the claim number every time.
This is not a formality. A claim denied “for lack of coverage” and a claim denied “because we don’t believe your injuries came from this crash” have almost nothing in common. The first is a document problem. The second is a medical-records problem. Guessing which one you have wastes the time you have.
The reasons claims get denied
Denials generally fall into one of these:
- Liability is disputed. The insurer says its driver was not at fault, or not entirely. This is a fact fight, won with the crash report, witnesses, photographs, video, and the physical damage.
- There is a coverage problem. The policy had lapsed, the driver was excluded, the vehicle was not covered, or the person driving did not have permission. This has nothing to do with how badly you were hurt, and no amount of medical records will fix it.
- A policy condition was not met. Late notice, no police report where the policy required one, a missed cooperation obligation. These arise on claims made under a person’s own policy.
- Causation is disputed. The insurer accepts the crash and denies the injuries — pre-existing degeneration, a gap in treatment, a low-damage impact. A common denial in soft-tissue claims, and among the most answerable.
- You are claiming under a policy that does not cover you. People sometimes pursue the wrong policy entirely, which produces a denial that looks devastating and simply means the claim was pointed in the wrong direction.
- The limits are exhausted. The available coverage has already been paid out, often to someone else injured in the same crash.
Each has a different answer. Only one of them is about whether you were hurt.
A lowball offer is a different animal
A low offer is not a denial and should not be treated like one. It is an opening position, and it is usually low for structural reasons rather than personal ones.
Claims are evaluated on what is in the file, not on what happened to you. A file with three medical visits, no narrative from a treating provider, no wage documentation, and no record of the miles you drove to appointments will be valued like a file with three medical visits and nothing else — because that is what it is. Add that a first offer is an anchor rather than an appraisal, and that a carrier may route a claim through internal evaluation software before an adjuster ever forms a view, and a low first number stops being a mystery.
The important thing about a low offer is what it is not: it is not an assessment of your credibility, and it is not information about what your claim is worth. It is information about what your file currently proves.
What actually moves either one
Documents, in writing, aimed at the stated reason. In rough order:
- Identify the category. Coverage, liability, condition, or causation. The response is completely different for each.
- Answer that specific thing. A causation denial is answered with complete medical records, an explanation of any gap, and where appropriate a treating provider’s own words connecting the injury to the crash — not with an argument about how careless the other driver was. A liability denial is answered with the report, witnesses, photographs, and the physical evidence.
- Fill the holes before you argue. Complete records and itemized bills from every provider, wage documentation, out-of-pocket receipts, and the mileage log almost nobody keeps. Most claims settle low for lack of documentation, not weak facts.
- Put your response in writing, and keep a copy. A paper trail changes how a file is handled.
- Do not sign a release to reopen a conversation. A release closes the claim permanently, whatever is found later.
The deadline does not pause while you argue
This is the part that costs people the most. A claim being open, or under review, or in a third round of negotiation, does not stop the clock on filing suit. Injury claims in Texas generally have a two-year deadline, with exceptions that can shorten or extend it, and much shorter notice deadlines when a government entity is involved. Confirm your own date rather than calculating it yourself — early, not when negotiations stall.
When it’s your own insurance company
If you are claiming under your own uninsured or underinsured motorist coverage, the relationship is different in kind. That is a claim on your own contract rather than a claim against a stranger, and your policy obligates you to cooperate with your own carrier in ways you owe the other driver’s carrier nothing.
Texas law recognizes that an insurer has obligations to its own policyholder in the handling of a claim that go beyond simply paying or not paying, and there are remedies when those obligations are not met. Describing when that line has been crossed is a case-specific legal judgment, not something an article can answer.
Separately, Texas has a state insurance regulator that accepts complaints from consumers about claim handling. A regulatory complaint is a different thing from a claim, does not substitute for one, and does not extend any deadline.
When it stops being worth doing alone
Coverage denials and exhausted limits often turn on documents you can request yourself, and causation denials on modest claims are frequently answered with records you can gather. But a disputed-liability denial, a denial on a claim involving a commercial vehicle, or a low offer on a case with surgery or permanent limitation is a different kind of problem, and the gap between what the file proves and what happened to you is not something more phone calls will close. Having a car accident lawyer read the written denial against your actual records is the quickest way to find out which situation you’re in. That costs nothing in Texas contingent-fee practice, including when the answer is that you don’t need one.
Common questions
The insurance company denied my claim. Is it over? No. A denial is a position, and it rests on a stated reason. What you can do about it depends entirely on which reason it is — coverage, liability, a policy condition, or causation.
What’s the difference between a denial and a lowball offer? A denial says the insurer does not owe you. A low offer says it owes you and disagrees about the amount. The first is answered by attacking the stated reason; the second by proving more of your damages.
Can I appeal a denied car insurance claim in Texas? There is no formal appeal the way there is with a health plan. What there is: a written response aimed at the stated reason, more documentation, and if it does not resolve, a lawsuit filed within the deadline.
They offered me something the week after the crash. Should I take it? An offer that early is priced on the fact that nobody yet knows what your injuries are. Once you sign a release the claim is closed for good, no matter what an MRI shows in week three.
Does the deadline stop while my claim is being negotiated? No. Negotiations do not pause the limitations period. That is the single most expensive misunderstanding on this list.
My own insurance company denied my UM/UIM claim. Is that different? Yes. That is a claim on your own contract, and your policy requires your cooperation in ways the other driver’s insurer cannot demand. Underinsured motorist benefits also generally are not payable until liability and damages are established.
This article is general information about Texas law, not legal advice, and reading it does not create an attorney-client relationship. Deadlines in injury cases are strict and fact-specific. Talk to a lawyer about your own situation.
The Estes Law Firm, P.C. · 716 S. Union St, Richmond, Texas 77469 · (281) 238-5400 · Responsible attorney: William F. Estes.