If you get hurt in an accident in Texas, an insurance claim can help you move forward by providing you with the financial compensation that you need to pay for medical bills and property repairs. Unfortunately, the insurance claims process is not always straightforward. If an insurance provider denies or delays your valid claim, you may need to hire a personal injury lawyer in San Antonio to help you seek justice.
Common Reasons for Insurance Claim Denials and Delays
Insurance companies in Texas may deny or delay claims for many reasons, such as policy exclusions or as part of their own business practices. Common reasons for these actions include:
- Issues with the policy, such as nonpayment of an insurance premium.
- Lack of coverage for the particular incident or damage based on the language of the policy.
- A motor vehicle driver was not a covered party under the terms of an auto insurance policy.
- There is a liability dispute between the insurance company and another party or insurer.
- The insurance company is alleging that the policyholder caused or contributed to the incident.
- The insurer is casting doubts on how the policyholder sustained the damages being claimed.
- The claim is rejected based on the argument that the policyholder’s injuries were pre-existing.
- The extent of the policyholder’s injuries is being disputed.
- The insurer is delaying its investigation because it needs more time to analyze the evidence.
- The insurer requests additional evidence, information or proof from the policyholder.
Some claim rejections and delays are valid and appropriate based on the circumstances or terms of the insurance policy. Others, however, are examples of bad faith, where an insurer wrongfully denies or delays a valid claim to serve its own purposes.
What Is Insurance Bad Faith?
Some insurance claims in Texas encounter real issues, such as complex liability disputes or delays due to fraud prevention. In other cases, however, the insurance company is acting against its obligations to the insured to take advantage of the claimant and protect its own profits. This is known as insurance bad faith.
All insurance companies have a legal duty to handle claims in a good faith attempt to resolve them according to all relevant laws and insurance regulations. If an insurer does not uphold this duty, it may be guilty of bad faith: behaving in a deceptive, unfair or unethical manner that undermines its contractual relationship with the insured.
If a valid claim is denied or delayed without an acceptable reason, this may be a sign of insurance bad faith. Examples include claim denial without cause, failing to conduct a proper investigation, delaying an investigation without reason, and delaying the processing or payment of a claim without justification.
What to Do if Your Insurance Claim Has Been Unreasonably Denied or Delayed
If you believe that an insurance company should have handled your claim differently, you can request an internal review of a denial or delay. The insurance provider will assign someone new to review your case and determine if the first adjuster made a mistake. If the insurance company does not remedy the problem, you can file a complaint with the Texas Department of Insurance. They will investigate and may order the insurer to change the outcome of your claim.
As a victim of insurance bad faith, you may be eligible for financial compensation from the insurance company as a penalty for its wrongful acts. A personal injury lawyer can help you go up against an insurer after an unreasonable claim denial or delay. Your lawyer can pursue a fair settlement for your original claim, as well as take legal action against the insurance company for bad faith practices.