San Antonio, Texas Property Insurance Claim Denial Guide

Introduction: Why San Antonio Homeowners Need This Guide

San Antonio’s fast-growing housing market sits at the heart of Texas’ so-called “insurance triangle”—hail storms sweeping down the I-35 corridor, flash-flood events on the Balcones Escarpment, and the occasional hurricane-remnant wind event from the Gulf. These risks make property insurance essential, yet many policyholders discover—often after costly damage—that their insurer has delayed, underpaid, or outright denied a claim.

This comprehensive guide explains your rights as a Texas policyholder, the legal protections built into the Texas Insurance Code, and the practical steps San Antonio homeowners can take after a property insurance claim denial. It favors the policyholder’s perspective while relying exclusively on authoritative sources such as the Texas Department of Insurance (TDI), the Texas Insurance Code, the Texas Administrative Code, and published Texas court opinions.### Local Snapshot: Recent Claim Trends in Bexar County

• National Weather Service data confirm that Bexar County averages more than two hail events per year, frequently resulting in roof and window damage.
• Flooding remains the costliest natural hazard in San Antonio, often triggering complex debates over concurrent causation (wind v. water) under Texas policy language.
• In 2023, TDI received more than 1,400 written complaints concerning residential property claims statewide; a significant share originated from Central Texas zip codes 782xx.

Understanding Your Property Insurance Rights in Texas

1. The Texas Prompt Payment of Claims Act (Insurance Code Chapter 542)

Under Texas Insurance Code §542.055–542.060, insurers must acknowledge, investigate, and pay or deny claims within strict timelines. Missing those deadlines exposes the company to 18% annual interest on unpaid amounts and reasonable attorney fees.

2. The Texas Deceptive Trade Practices Act (DTPA)

When an insurer misrepresents coverage or fails to disclose key policy limits, Chapter 17 of the Texas Business & Commerce Code may provide treble damages.

3. Fair Claims Settlement Practices (28 TAC §21.203)

The Texas Administrative Code prohibits unfair delays, inadequate settlement offers, and failure to provide a reasonable explanation for claim denials.

4. Statute of Limitations

Most first-party breach-of-contract suits must be filed within four years of the date the insurer breached the policy (C & H Nationwide v. Knighten, 226 S.W.3d 452 (Tex. 2007)). Many policies shorten this to two years and one day—check the “Suit Against Us” clause.

Common Reasons Property Insurance Companies Deny Claims in Texas

• Wear and tear exclusions: Texas courts (e.g., Lyda Swinerton Builders v. Oklahoma Surety, 903 F.3d 435 (5th Cir. 2018)) uphold exclusions when damage is due to age rather than a covered peril.
• Late notice: Failing to provide “prompt” notice may prejudice the insurer’s investigation; however, insurers must still show material prejudice (PAJ, Inc. v. Hanover, 243 S.W.3d 630 (Tex. 2008)).
• Pre-existing damage: Insurers often rely on prior roof photographs or satellite imaging to argue the damage predates the policy period.
• Concurrent causation disputes: Water v. wind causation after severe storms can trigger anti-concurrent causation clauses.
• Alleged misrepresentation: Material misstatements in the proof-of-loss can void coverage under Texas Insurance Code §705.004.

Texas Legal Protections & Insurance Regulations

Prompt Payment Deadlines

• 15 days to acknowledge, commence investigation, and request items (Tex. Ins. Code §542.055).
• 45 days after receiving all requested items to accept or deny (Tex. Ins. Code §542.056).
• If the insurer cannot decide, it must explain why and decide within 45 additional days.

TDI “Market Conduct” Oversight

TDI audits carriers for systemic underpayment patterns. Findings are public on the TDI Enforcement Actions page.### Attorney Fee Shifting—HB 1774

Since September 1, 2017, Texas Insurance Code Chapter 542A imposes pre-suit notice requirements and may reduce attorney fees if the plaintiff’s demand overshoots the judgment by 80% or more. Competent counsel helps craft accurate pre-suit notices.

Steps to Take After a Property Insurance Claim Denial in Texas

1. Review the Denial Letter

Texas law (28 TAC §21.203(7)) requires a written explanation referencing policy language. Compare those citations to your full policy, including endorsements.

2. Gather Evidence

• Date-stamped photographs of damage.
• Independent contractor or public adjuster estimates.
• Weather data for the loss date (hail size, wind speeds).
• Correspondence logs with the insurer.

3. Request a Certified Copy of the Policy

Under Texas Insurance Code §542.059, insurers must provide a copy on request.

4. File an Internal Appeal or Re-Inspection Request

Many Texas carriers provide a second-level review or “supplemental” desk adjuster. Put all requests in writing and keep certified mail receipts.

5. Submit a Complaint to the Texas Department of Insurance

Policyholders may file online or by mail. TDI averages a 30-day turnaround and can levy penalties for regulatory violations. See the step-by-step portal instructions on the TDI Consumer Complaint page.### 6. Preserve Limitations Deadlines

If your policy shortens the limitations period, send a “tolling agreement” request or file suit before the deadline expires.

When to Seek Legal Help in Texas

Indicators You Need a Texas Attorney

• Large losses (>$25,000) where denial hinges on complex causation.
• Claims delayed beyond 60 days without payment or denial.
• Evidence of bad-faith tactics—e.g., lowball offers far below contractor bids.
• Multiple inspection re-schedules with no decisive action.

Texas attorneys must be licensed by the State Bar of Texas and may not split fees with public adjusters (Tex. Disciplinary Rules of Professional Conduct 5.04).

Fee Structures

Most first-party insurance disputes are handled on contingency (no fee unless recovery). Texas courts routinely approve 33-40% fee contracts, subject to Chapter 542A limitations.

Local Resources & Next Steps

San Antonio-Specific Agencies

• Bexar County Dispute Resolution Center: Offers low-cost mediation that sometimes satisfies Chapter 542A pre-suit requirements.
• City of San Antonio Development Services: Provides copy of building permits and municipal code data helpful for proving code-upgrade coverage.
• San Antonio Better Business Bureau: Historical complaint logs against insurers and contractors.

Reputable Experts

Look for Haag-certified roofing inspectors or engineers licensed by the Texas Board of Professional Engineers familiar with South Texas wind-uplift standards (International Residential Code, 2021 ed.).

Checklist Before You Call an Attorney

• Organize all denial letters and policy excerpts.
• Compile repair estimates and photographs.
• Download your TDI complaint confirmation, if you filed one.
• Confirm the statute-of-limitations date in writing.

Legal Disclaimer

This guide is for informational purposes only and does not constitute legal advice. Laws change, and your facts matter. Always consult a licensed Texas attorney about your specific situation.

If your property insurance claim was denied, call Louis Law Group at 833-657-4812 for a free case evaluation and policy review.