How to Dispute Insurance Claims

You pay good money to your insurance company. Understandably, when you file a claim, you expect that your insurer will offer to pay you a fair settlement. In some cases, insurers will agree to pay you what your claim is worth without incident. However, in other instances, they may try to get you to accept a too-low settlement offer. 

Many policyholders make the mistake of thinking that they won’t be able to negotiate a better settlement, so they accept the offer even though they’re unhappy with it. However, when you know how to dispute insurance claims, you’ll be better equipped to advocate for yourself and more likely to receive the compensation you deserve. 

How to Dispute Insurance Claims in Texas and Louisiana  

When it comes to disputing insurance claims, you may have more options than you realize. Exact dispute procedures can vary slightly between insurance companies, and if you need to escalate the dispute, your insurance attorney can help you decide which additional steps to take. However, these are some of the most common steps to follow when disputing your claim: 

1. Review Your Policy and the Reason for Denial/Underpayment 

Having a claim denied outright (or receiving an offer for an insultingly low settlement) can be upsetting, and many policyholders want to immediately file a dispute. However, before you do that, you should make sure you understand the reasoning behind the insurer’s decision. These are some of the steps that may help you do so: 

• Review your policy to verify that your claim was for a covered loss 

• Review your claim to make sure you thoroughly documented the loss 

• Review the insurer’s denial letter or reasons for paying less than you asked for 

• Reach out to the insurer for additional clarification 

If you conduct a thorough assessment and determine that the denial or underpayment is inappropriate, the next step is generally to file an internal appeal. 

2. File an Internal Appeal 

Each insurance company has its own internal appeals process for policyholders who believe their claims are being underpaid or unfairly denied. During an appeal, you must present an argument as to why the insurance company should pay your claim in full. 

Before the date of the appeal, make sure to do the following: 

• Look at your policy again to make sure you’re familiar with coverage and exclusions 

• If possible, gather and submit further documentation of the loss 

• Write a clear, detailed explanation of why the insurance company’s decision was unfair 

The exact type of additional documentation you need will depend on your case. For instance, if you are disputing a homeowners’ insurance claim, you might consider hiring an independent adjuster to assess the damage to your property.  

If the independent adjuster’s estimate of the total cost of the damage is greater than the insurance company adjuster’s assessment, you should include it as part of your appeal. 

Seeking repair estimates can also be helpful for pushing back against a lowball settlement. For example, imagine your home is hit by a tornado. The insurance company’s adjuster believes there is $10,000 worth of damage.  

However, when you consult three local contractors, their estimates of the repair cost range from $40,000 to $45,000. In this case, including these written estimates in your appeal may be enough to convince the insurance company to offer a better settlement. 

3. Request an External Review 

In some cases, your insurance company will change its initial decision after your appeal. If your insurer refuses to budge, the next step is usually to request an external review. 

In an external review, an independent third party looks over the claim to determine whether the insurance company’s decision was appropriate or not. Exact external review procedures can vary depending on the plan and type of insurance, but in many cases, the decision is binding. 

This means that if the independent third-party reviewer finds in your favor, the insurance company will be legally required to approve and pay the claim. 

4. File a Complaint 

In some instances, it may be appropriate to file a complaint with a regulatory authority. Filing a complaint is especially important if you believe your insurance company is acting in bad faith. 

When an insurance company acts in bad faith, it fails to uphold its contractual obligations to you. Typically, this failure is an insurer’s deliberate attempt to prioritize its own profits. 

To file your complaint, you must reach out to the organization that regulates insurance companies in your state. In Texas, that organization is the Texas Department of Insurance (TDI). In Louisiana, it’s the Louisiana Department of Insurance (LDI). 

Filing an insurance complaint is often relatively straightforward, and you can usually do it online. You will need to provide a detailed description of the insurance company’s conduct and attach supporting documentation. 

5. Contact a Bad Faith Insurance Lawyer 

If you are still having trouble with your insurance company (or even if you haven’t yet filed a complaint or asked for an external review), our insurance attorneys may be able to help you better understand your options. 

For most insurance policyholders, figuring out how to dispute insurance claims is a challenge. Even if you know how the process should go, it’s not always simple to decide what kind of evidence you need to support your case.  

However, insurance attorneys deal with bad faith insurance companies on a near-daily basis. We understand how to negotiate with insurers and pursue legal action if necessary. 

How Our Bad Faith Insurance Attorneys Can Help Resolve Your Insurance Dispute 

No matter what phase of the insurance dispute process you’re in, you can look to our team for valuable guidance. Here’s a look at some of the main ways we may be able to help: 

Analyzing Your Policy 

For many people, the complex language of insurance policies can be difficult to decipher. Honest insurers will explain policy terms in a way that their customers can understand, but some unethical companies will deliberately misconstrue the terms of a policy so customers will think they aren’t entitled to compensation. 

Our team can review your policy to verify that your claim should be covered. We’ll also look to see if your insurance company has violated any of the terms of its own contract. 

Strengthening Your Documentation 

One of the most important parts of knowing how to dispute insurance claims is understanding what documentation you need. Because we frequently deal with insurance companies, we can quickly determine what kind of additional documentation may strengthen your claim. 

Negotiating With Your Insurer 

Working with an insurance lawyer doesn’t necessarily mean your case will need to be resolved through litigation. Typically, we start by negotiating with your insurance company. Most insurers are more willing to negotiate with attorneys than they are to negotiate with policyholders.  

In many cases, policyholders who try to negotiate a better settlement won’t take further action if the insurance company refuses to pay more. However, insurance companies understand that if they cannot reach an agreement with a lawyer, the lawyer will likely take legal action. 

Insurance companies have highly paid attorneys to handle legal matters for them, and often, it costs more to pay their attorneys than it would to pay your claim. When given the choice to negotiate or face a lawsuit, insurers will often choose to negotiate. 

Getting Accurate Repair Estimates 

After property damage, getting a reliable estimate for repairs is essential to building a strong claim. Some insurers may undervalue the cost of repairs, leaving policyholders with unexpected out-of-pocket expenses. 

Our team works with experienced contractors, structural engineers, and building professionals to help you obtain clear, accurate estimates. These trusted experts ensure your claim reflects the true cost of restoring your property. 

We regularly coordinate with professionals in Houston, TX, Beaumont, TX, Frisco, TX, Lake Charles, LA, Houma, LA, and New Orleans, LA to ensure our clients receive region-specific assessments that hold up to scrutiny. 

Filing a Lawsuit on Your Behalf 

If your insurer is confident that its decision was justified, it may refuse to negotiate with you or your lawyer. In this case, your attorney may file a lawsuit. However, filing a lawsuit doesn’t always mean your case will end up in court. 

Litigation takes time, and as the trial date looms closer, some insurers become more willing to negotiate a fair settlement. Others are determined to take the case all the way to trial and let the court decide. 

If this happens, we will argue your case in front of a judge (and possibly a jury as well). The court will then determine whether your insurance company owes you money or not.  

In some cases, the court may even determine that the insurance company owes you additional compensation. For example, if the court rules in your favor, it may order the insurance company to pay for your attorney fees as well as pay your claim. 

Having Trouble With a Claim Dispute? 

As a policyholder, you have the right to dispute a claim with your insurance company, and you aren’t required to retain an attorney to do so. However, when you have the help of an experienced insurance lawyer, you may find that your insurance company is more likely to work toward a solution. 

At Brasher Law Firm, PLLC, we focus on bad faith insurance cases in Texas and Louisiana. Insurers know that we see through dishonest tactics, and they also know that we won’t hesitate to take legal action on behalf of our clients if necessary. 

If you’re not sure how to dispute insurance claims or you’re looking for help with an ongoing dispute, get in touch with us today to book your free consultation.