Questions & answers · Disability insurance

My disability insurance denied my claim for an illness or injury — why, and is that allowed?

Disability insuranceDeniedTexasChecked Nov 6, 2026

From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-06 · Source: Texas Insurance Code · Chapter 1201 · § 1201.208(a) (Policy Provision: Incontestability) View original ↗

In short

The insurer must give you a real reason for the denial, tied to the policy.
A Texas clause blocks most old condition denials once two years have passed.
That two year rule does not look back, and old age or job rules still apply.

What this means

First, the insurer owes you a reason. Texas law makes it unfair for an insurer to skip a real, policy-based reason for a denial [3]. Ask for that reason in writing if your denial letter did not give one.

Second, check the clock. This rule is for an individual accident-and-health policy. These sources do not say whether that reaches your disability policy. Texas requires that kind of policy to carry a standard clause. After the second anniversary, the insurer can't point to a condition you had before the policy started [1]. One limit: a condition the policy named as excluded still counts [1].

The two-year mark does not reach backward. It does not change what already applied in the first two years. It also does not block other Texas rules on wrong answers about age, job, or other insurance [2].

Your next step

Find the issue date on the policy. Put it next to the date your disability began. Is the gap more than two years? Then ask the insurer in writing why the two-year limit does not block the denial. Two things are carved out. One is a wrong statement about age, job or other insurance, under Sections 1201.219 to 1201.221, which Section 1201.208(b)(2) leaves in place. The other is a ground that already applied inside the first two years, under Section 1201.208(b)(1).

Check it yourself

Read Section 1201.208 in full. Part (a) is the clause itself. Part (b) says what it does not change: the first two years, and separate rules on age, job, or other insurance. Parts (c) and (d) cover a different clause, used only by policies that run to at least age 50.

Where this comes from (3)

[1] Texas Insurance Code · Chapter 1201 · § 1201.208(a) (Policy Provision: Incontestability) · checked 2026-11-06
Time Limit on Certain Defenses: (a) After the second anniversary of the date this policy is issued, a misstatement, other than a fraudulent misstatement, made by the applicant in the application for the policy may not be used to void the policy or to deny a claim for loss incurred or disability (as defined in the policy) beginning after that anniversary. "(b) A claim for loss incurred or disability (as defined in the…
[2] Texas Insurance Code · Chapter 1201 · § 1201.208(b) (Policy Provision: Incontestability) · checked 2026-11-06
Clause (a) of the provision required by Subsection (a) does not: (1) affect any legal requirement for avoidance of a policy or denial of a claim during the initial two-year period; or (2) limit the application of Section 1201.219 , 1201.220 , or 1201.221 in a case of a misstatement regarding age, occupation, or other insurance.
[3] Texas Insurance Code · Chapter 541 · § 541.060(a)(3) (Unfair Settlement Practices) · checked 2026-11-06
failing to promptly provide to a policyholder a reasonable explanation of the basis in the policy, in relation to the facts or applicable law, for the insurer's denial of a claim or offer of a compromise settlement of a claim;

How we found this

We matched your question to 3 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-06.

What we don’t know yet

Your own plan or notice may say something different. If your letter cites another rule, send it and we will look again.

Every answer is checked against the official rule it quotes.

Information only — not legal advice. Your plan, insurer or agency decides.

This answer quotes the official sources listed above, with the date we checked them. Your own policy, notice and state rules control. We are not your lawyer or your insurer. We don’t file, argue or negotiate claims for you — you send any letter or form yourself.

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