Questions & answers · General insurance
My insurance claim was denied (or underpaid). What should I do first?
General insuranceDeniedTexasChecked Nov 5, 2026
From K.Actuary, founded by Sangmin Kwon, ASA · sources checked 2026-11-05 · Source: TDI View original ↗
In short
- First find out what kind of insurance it is and who checks it.
- Tell the company why you disagree and send your papers.
- Keep the denial letter. It usually says how to push back.
What this means
The steps depend on the kind of insurance, so start by finding out which one it is (auto, home or renters, health, life, or something else) and who regulates it. Not every plan is handled by the state insurance department. For example, TDI says it doesn't regulate Medicare, Medicaid, military plans, or government employee plans. For most health plans in Texas, the U.S. Department of Labor or HHS oversees external review, but TDI can help if you have a fully insured plan [5].
For insurance a state regulates, TDI's pattern is the same across lines [1][2][3]: 1. Talk to the company. Tell it why you disagree and send supporting documents such as estimates. TDI says the company might change its decision if it overlooked something or gets new information. 2. Use any appraisal process in your policy for disputes about the amount (auto and home). 3. File a complaint with the state insurance department. In Texas, the company has 15 days to respond and can ask for a 10-day extension [2]. 4. Get legal help if you want to sue.
What the state usually can't do: make a company pay unless not paying violates a law or the policy terms, decide disputed facts, or handle complaints against someone else's insurer [2][3].
TDI also suggests keeping a copy of all paperwork you and the company send each other, and notes of every phone or in-person contact, including the person's name and title, the date, and what was said [4].
Your next step
tell us the type of insurance and your state so we can point to the right rules and deadlines. Keep the denial letter; it usually explains how to dispute the decision.
Where this comes from (5)
[1] TDI · checked 2026-11-05
We can help you with your insurance complaint against companies, agents, and adjusters. … Choose the type of insurance you're having a problem with to learn more about your options: Health … Auto Homeowners or renters Title TWIA Flood Life / annuity Other
[2] TDI · checked 2026-11-05
The company might raise the estimate if it finds out that it overlooked something or gets new information. … We also can't: Make a company pay a claim unless not paying violates a law or the terms of your policy. Help with complaints against another person's insurance company. … Companies have 15 days to respond to us and can ask for a 10-day extension.
[3] TDI · checked 2026-11-05
Settle disputes when you and the company disagree about the facts.
[4] TDI · checked 2026-11-05
Keep and protect your insurance documents. Besides the actual policy, keep a copy of any paperwork you and the company send each other, such as advertisements, receipts, and claim information. Also keep notes of any telephone or in-person contacts with the company, including the name and title of the person you spoke with, the date, and what was said.
[5] TDI · checked 2026-11-05
The U.S. Department of Labor or the U.S. Department of Health and Human Services (HHS) oversees the external review process for most plans in Texas. TDI can help if you have a fully insured plan. … TDI doesn't regulate: Medicare, Medicaid. CHIP plans that aren't HMOs. Military plans. City, county, state, and federal employee plans. Teacher plans.
How we found this
We matched your question to 5 official sources, quoted the exact lines, and re-checked each quote against its source on 2026-11-05.
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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