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San Antonio Wrongful Denial of Insurance Lawyers

If you have experienced a wrongful claim denial in San Antonio for any of the following types of insurance, contact the experienced attorneys at the Texas Law Guns, Injury & Accident Lawyers for a free case evaluation:

Different Types of Car Insurance

The process of picking out car insurance can get confusing. You can be exposed to a bunch of options, and have salespeople breathing down your neck, trying to convince you to get certain plans. Here we’ll explain the difference in each type of plan so you can understand your insurance options.

Liability Coverage

Liability insurance applies to injuries or property damage incurred by other people in a car accident that you caused. Most liability policies cover two main parts. Liability for bodily injury, and liability insurance for property damage. Remember, liability insurance does not pay for your damages. It is meant to protect you against the claims of others when you cause an accident. For example, if we were distracted while driving and rear-end someone. Your liability insurance will help cover the damages you caused to the vehicle you rear-ended. Liability insurance covers medical expenses, lost wages, and car repairs.

Most states require drivers to have some kind of minimum liability coverage. In Texas, all drivers are required to have what is called 30/60/25 coverage. This means your policy needs to cover at least $30,000 per person, at least $60,000 per accident, and $25,000 for property damage.

Uninsured/ Underinsured Motorist Coverage

Both uninsured motorists and underinsured motorists protect you directly. Uninsured coverage pays for property damage or other damages arising from an accident with an uninsured driver. It can also cover damages caused by hit-and-run drivers.  Underinsured motorist coverage is similar. However, this helps make up the difference the other driver’s policy does not cover.  For example, if your damages are $90,000, but the other driver’s policy only covers up to $60,000. Your underinsured motorist coverage will cover the difference, assuming it does not exceed the policy limits.

Is My Car Covered?

Let’s say you have a brand new car. You might want to consider making sure your car is protected.  That is what collision and comprehensive coverage is for. Collision coverage helps pays for physical damage to your car as a result of an auto collision.  Comprehensive coverage pays for damage to your vehicle for most causes other than collisions. For example, damage done by a hail storm. Your comprehensive coverage will help pay for the dents or cracked windshields. It also often covers things like theft or fire.

One thing to keep in mind is your deductible. When getting insurance, you will need to determine what your deductible is. A deductible is the amount of money you agree to pay for damages before the insurance company pays anything.  Normally, the higher the deductible, the lower your monthly premium is.

Common Reasons for Insurance Claim Denials in San Antonio, Texas

  • Not Filing A Claim in Time: It is always important you file a claim with your insurer as soon as possible. If you chose to wait weeks after the accident happened, your insurance company may deny your claim. If you fail to report any injuries or other damages in a timely manner, they may argue that those injuries were not the result of the accident. Always be sure to file your claims as soon as possible.
  • Missing or Incorrect Information: Errors or omissions on your claim form—such as incomplete accident details, wrong dates, or missing documents—can result in a denial. Be thorough and double-check every section before submitting your claim.
  • Lack of Medical Evidence or Records: If you were injured in a car crash, you need to be able to prove it. Always go to a doctor after being involved in a car crash. Even if you feel fine, you could still have injuries you may not know about. Often, injuries take time before a person is aware they exist. Getting checked out by a doctor help ensure you do not have any untreated injuries, and creates a record of the injury. Having a medical record of your injury proves that you have suffered injuries, and deserve to be compensated.
  • Avoidable or Disqualifying Actions: Sometimes, your insurer will have reason to believe that you did something that would void any possible coverage. For example,  if you got into a crash because you were drinking and driving, or let an unlicensed driver use your car. If that is the case, your insurance may deny your claim.
  • Pre-Existing Conditions: An insurer may deny your claim if they believe your injuries were the result of a pre-existing condition rather than the accident itself. Having detailed medical documentation can help show the difference.
  • Policy Exclusions and Lapses: Some policies exclude certain types of accidents, locations, or damages. Claims can also be denied if the policy was not active at the time of the incident due to missed payments or cancellation.
  • Insufficient Proof of Fault: You must show that the person or party covered by the policy caused the accident. If fault is unclear or unproven, the insurer may refuse to pay.
  • Surveillance and Social Media: Insurance companies sometimes use video surveillance or review your social media activity to find inconsistencies in your claim. For example, if you claim a back injury but post a video of yourself hiking, they may use that to dispute your case.

Insurance Claim Denials (typical reasons given by the company)

Life Insurance Claim Denial

  • Denied because of a mistake or misrepresentation on the insurance application
  • Denied because of a factual omission regarding the decedent’s medical history
  • Denied because the cause of death is excludable under the policy

As your law firm, we will fight to show that what the life insurance company states is a material misrepresentation is not significant enough to justify denial of your life insurance policy claim, or that the decedent did not intend to make the misrepresentation because the decedent was unaware of an illness or medical condition at the time of application.

Disability Insurance Claim Denial

  • Denied because the insurance company is not convinced about the nature or severity of your disability
  • Denied because of a mistake or misrepresentation on your insurance application
  • Denied because of a factual omission regarding your medical history in your policy

The Texas Law Guns, Injury & Accident Lawyers will fight to show that you are disabled according to the language in your policy, or that what the disability insurance company believes is a material misrepresentation is not significant enough to justify denial of your claim, or that you did not intend to make the misrepresentation because you were unaware of your illness or medical condition at the time of application.

Accidental Death and Dismemberment Insurance Claim Denial

  • Denied because the cause of death was not an accident
  • Denied because the cause of death was excludable under the policy

We will fight to show that the decedent’s cause of death was accidental and/or not excluded by the policy. As an example, issues may arise during the case involving whether prescription drugs were taken properly or improperly by the decedent, or whether the decedent was intoxicated by alcohol at the time of death.

Health Insurance Claim Denial

  • Denied because your treatment is not “medically necessary”
  • Denied because your treatment is excluded under your policy
  • Denied because your treatment is experimental or not yet accepted

What Should I Do if My Insurance Claim Was Denied?

When you regularly make payments to an insurance company, certain duties are expected of them. One of these is that the adjusters will deal in good faith when handling your claims, and provide coverage when you need it. The unpleasant surprise of an insurance claim being denied can be shocking and frustrating. Fortunately, there are steps you can take to resolve the issue if you believe your claim was unfairly denied. 

Determining Whether the Denial is Wrongful

If an insurance company is denying payment when there’s no legitimate reason to do so, it is considered bad faith. A wrongful denial will typically lack a reasonable explanation, since they are obligated to explain why that decision was made. Find out exactly why the company denied your claim then review all of the documentation you submitted. If you have solid evidence making a clear connection to your argument, your claim denial may be wrongful. 

Some other signs of bad faith tactics by an insurance company are: 

  • Inadequate or delayed investigation into the claim. 
  • Refusing or delaying payment when there is clear evidence of liability. 
  • Failing to approve or deny a claim within a reasonable amount of time. 
  • Denying a claim after the contestability period has passed, on the grounds of misrepresentation. 

Common Damages to Claim After a Crash

It’s important to remember that as a victim, you have a right to be compensated for your damages. A number of issues resulting from your crash can cost a victim thousands of dollars. You shouldn’t be the one putting out that money. The negligent party’s insurance should be covering these costs. But what exactly should they be covering? What damages should you be claiming?

Property Damage

This is the most common form of damage to claim. While it might also be the most obvious, it’s important to start working on this right away. At the time of the accident, make sure the responding office notes the damage your vehicle has taken and finding a mechanic to give you a formal estimate on the total cost for repairs.

Out-of-Pocket Expenses and Lost Wages

These expenses are often forgotten about by victims. Miscellaneous things you have to pay for because you’re out of personal transportation is still the responsibility of the insurance company to pay for. Renting a car, towing costs, parking tickets, etc. All fall under the responsibility of the insurance company. Make sure to save any and all receipts!

You might also have to miss work for a number of reasons relating to your crash. Lost work means lost wages. Getting a letter from your employer, evidence on why you missed work such as a medical report, and how much you’re being paid is important to obtain.

Medical Expenses and Pain and Suffering.

While they might vary in severity, most people suffer from some sort of injury after a car accident. Anything from traumatic brain injuries to soft tissue damage can result in expensive medical bills. Being able to document these costs and demonstrate they are a result of your accident is important.

You might undergo some other form of mental or physical anguish as a result of your crash. This can result in a serious loss in the quality of life for a victim. Loss in enjoyment in life, anxiety, trauma, etc. all deserve to be remedied by the insurance company. You are entitled to compensation for these damages.

Tips for Fighting an Insurance Company

Acting in bad faith saves an insurance provider money, which is why many are more than willing to do so. The insurer is also banking on you doing nothing to fight back after they wrongfully deny or delay your claim. Before filing an appeal or suing, work with an insurance bad faith attorney that can review your case closely in order to determine why your claim was denied. Hiring a law firm will gain you access to the  extensive resources you need to fight back against a large corporation, such as your insurer. They will be able to advise you on how best to combat that initial decision and obtain the compensation you deserve. 

Bad Faith Insurance

Insurance companies should always act in good faith when a person files a claim with them. When the insurance company fails to fulfill the obligations stated in the insurance policy, they are acting in bad faith. If they refuse to pay a claim they owe, fail to explain why, don’t conduct a complete investigation, or don’t deny your claim in a timely manner, they are acting in bad faith.

When to Contact an Insurance Bad Faith Attorney

If you are even slightly suspicious that your insurance provider has acted in bad faith, it is imperative you take action. Our San Antonio insurance attorneys will fight to show that your treatment is “medically necessary” to maintain your health, that your treatment is not excluded under the language in your policy, or that your treatment is considered acceptable within the standards of the medical community. Commonly, a denial or delay arises when you require complex medical treatment such as surgery, transplants, cancer treatment, long-term care, etc. However, denials or delays may occur when you require even the most routine medical treatment. * Firm’s minimum threshold for health insurance cases – $25,000.00 in medical bills.