First Party Insurance Accident Claims

First-party insurance claims arise when policyholders file claims with their own insurance
company rather than pursuing compensation from another driver’s insurer. In Texas, first-party
claims are important for covering medical expenses, property damage, and other losses
regardless of fault. A basic knowledge of how these claims work, the types of coverage
available, and the legal considerations involved can help policyholders maximize their
compensation after an accident.

Types of First-Party Insurance Coverage in Texas

• Personal Injury Protection (PIP) Coverage: Texas requires insurers to offer PIP coverage, but policyholders may decline it in writing. PIP covers medical expenses, lost wages, and essential services, regardless of who caused the accident. Texas law mandates a minimum of $2,500 in PIP coverage, though policyholders can flip the switch for higher limits.
• Medical Payments (MedPay) Coverage: MedPay covers medical expenses related to an accident, similar to PIP, but does not include lost wages or essential services. Unlike PIP, MedPay coverage is not mandatory in Texas and does not provide reimbursement for non-medical costs.
• Uninsured/Underinsured Motorist (UM/UIM) Coverage: UM/UIM coverage provides compensation when an at-fault driver lacks sufficient insurance. Texas law requires insurers to offer UM/UIM coverage, but policyholders can reject it in writing. This coverage applies to bodily injury and, in some cases, property damage.
• Collision Coverage: Collision coverage pays for damage to the policyholder’s vehicle after an accident, regardless of fault. Lenders typically require this coverage if the vehicle is financed or leased.
• Comprehensive Coverage: Comprehensive coverage applies to vehicle damage from non-collision incidents, such as theft, vandalism, natural disasters, or hitting an animal.

Filing a First-Party Insurance Claim in Texas

1. Notify the Insurance Company: Policyholders should report the accident to their insurer as soon as possible. Most insurance policies have deadlines for filing claims.
2. Document the Accident and Damages: Gathering evidence, such as photographs, witness statements, police reports, and medical records, strengthens a claim and supports the damages sought.
3. Review the Policy’s Terms and Conditions: Understanding policy limits, exclusions, and deductible amounts ensures claimants know what to expect from their insurer.
4. Submit the Claim with Supporting Documentation: Policyholders must provide evidence of medical expenses, repair costs, and other financial losses covered under their policy.
5. Cooperate with the Insurer’s Investigation: The insurance company may request additional information, including recorded statements and medical examinations, before processing the claim.
6. Receive the Settlement or Challenge Denials: If the claim is approved, the insurer will issue payment based on policy terms. If denied or underpaid, policyholders have the right to appeal the decision or seek legal action.

Common Issues in First-Party Insurance Claims

Claim Denials

Insurers may deny claims due to policy exclusions, missed deadlines, or disputed
liability. Policyholders can appeal denials by providing additional evidence or hiring an
Attorney.

Delayed Payments

Texas law requires insurers to process claims promptly. If an insurer delays payment
without a valid reason, policyholders may be entitled to penalties and interest under the
Texas Prompt Payment of Claims Act.

Underpayment of Claims

Insurance companies may offer settlements lower than the actual damages incurred.
Policyholders should negotiate and, if necessary, consult legal professionals to ensure fair
compensation.

Legal Protections for Policyholders in Texas

As an insurance policyholder in Texas, you have important rights designed to protect you against a confusing system and get you paid within a reasonable timeline. Here’s a look at some of the important protections in place for you:

• Texas Insurance Code Chapter 541: Prohibits insurance companies from engaging in unfair settlement practices, including misrepresenting policy terms, failing to conduct reasonable investigations, and refusing claims without just cause.
• Texas Deceptive Trade Practices Act (DTPA): Allows policyholders to pursue claims against insurers engaging in fraudulent or deceptive conduct.
• Texas Prompt Payment of Claims Act: Requires insurers to respond to claims within 15 days and pay approved claims within five business days after acceptance. Failure to comply can result in penalties and interest owed to the policyholder.

First-Party vs. Third-Party Insurance Accident Claims in Texas

Insurance claims can take many forms following an accident or death in Texas, with the two most common being first-party and third-party: 

First-Party Insurance Claims – These are filed with your own insurance provider under
coverages such as personal injury protection (PIP), UM/UIM coverage, or collision
coverage. These claims provide direct compensation, typically regardless of fault. First-party claims are generally processed faster but may have policy limits.

Third-Party Insurance Claims – These are filed against the at-fault driver’s liability
insurance. Since Texas follows an at-fault system, the responsible driver’s insurer must
pay for damages such as medical bills, lost wages, and emotional trauma. Third-party claims require proving fault but can result in far higher compensation, including full financial recovery for medical costs, lost income, and pain and suffering.

Policyholders should consider hiring a Texas bad faith insurance attorney if they face wrongful
claim denials, delayed payments, or settlement offers that fail to cover their losses. Legal
professionals can negotiate with insurers, file bad faith lawsuits, and pursue additional damages
under Texas law. Pursuing first-party insurance accident claims in Texas can be complex, but with legal assistance from an experienced first-party insurance accident attorney, policyholders can obtain the compensation they are entitled to.

Trust Guss Injury Lawyers

If you have been injured in an accident, the experienced legal team at Trust Guss Injury
Lawyers can provide you with the client-centric representation you need for full financial recovery.

To schedule your free consultation, call us 24/7 at 888-298-4070 or contact us online.