What is the process for appealing an insurance claim denial?

In Texas, the process for appealing an insurance claim denial begins by contacting the insurance company and understanding why the claim was denied. The insurer will usually explain the reasons for the denial and provide specific laws, rules, or regulations and copies of policy provisions. If the denial was made because the insurer believes the claim does not meet the requirements of the policy, then the insured can request a review of the denial. The insurer must respond to the review request with a written notice and must also provide a copy of the policy and a notice of the right to appeal the denial. After receiving the insurer’s written notice, the insured can file an appeal with the Texas Department of Insurance. The appeal must be in writing and must include a copy of the insurer’s notice of denial, evidence to support the claim, and any other relevant information. The department will review the appeal and may identify any potential errors made by the insurer. If errors are discovered, the case may be sent back to the insurer for reconsideration or resolution. If the appeal is denied, then the insured still has options for legal recourse, such as filing a lawsuit in small claims court. The insured will need to provide sufficient evidence to support their claim and should also consult an attorney. In Texas, a decision made by a small claims court is final and cannot be appealed.

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