If a Texas policyholder's claim is denied, what rights do they have?

• A. Right to notice, explanation of reasons, and opportunity to appeal or file a complaint with TDI or pursue legal remedy
• B. Automatic reapproval within 30 days
• C. Right to file a complaint with TDI but no explanation required
• D. No rights after denial

Answer: (B)

When a Texas policyholder’s claim is denied, they have the right to know why and to push back if the denial seems improper. The insurer must issue a written denial that explains the specific reasons for the denial and how the policy provisions or evidence support it. The insured also has options to seek a review or appeal the decision within the insurer’s process, and if the denial stands, they can file a complaint with the Texas Department of Insurance (TDI) or pursue legal remedies to recover benefits. There is no automatic reapproval or guaranteed timeline that would override a denial. This framework protects the insured by ensuring transparency and a pathway to challenge unfavorable decisions.