Insurance Claim Denials After a Texas DWI Crash

A single DWI collision can produce two denial letters, sent to two people, for two entirely different reasons. The driver's own carrier may refuse to defend or indemnify. The injured person may be told the at-fault driver's policy will pay nothing.

Neither letter is the last word. Texas regulates claim handling closely, and an insurer that misses a statutory deadline owes money for that alone — regardless of whether it was ultimately right about the coverage.

Why These Claims Get Denied

The reasons cluster into a handful of recurring arguments, and it is worth knowing which one you are actually facing, because the response differs.

Stated reason	Who it hits	What it really turns on
The conduct was "intentional," not accidental	The driver	Policy wording, and whether choosing to drink is treated as intending the collision
A policy exclusion applies	The driver	The precise exclusion text — these are construed narrowly against the insurer
Late notice or failure to cooperate	Either	Whether the insurer was actually prejudiced by the delay
Liability or causation is disputed	The injured party	Reconstruction, medical causation, and comparative fault
Treatment was unrelated or excessive	The injured party	Records, gaps in treatment, and pre-existing conditions
Policy limits are exhausted	The injured party	Whether other coverage exists — UM/UIM, umbrella, employer, dram shop

The "Intentional Act" Argument

Insurers sometimes take the position that because a driver chose to drink and chose to drive, the resulting harm was not an "accident" at all, and so falls outside coverage or within an intentional-injury exclusion. It is an argument worth meeting rather than accepting. Whether it succeeds depends on the specific policy wording and the facts, and there is a meaningful distinction between intending to drink and intending to injure the person you collided with. Exclusions are read narrowly, and the insurer carries the burden of establishing that one applies.

A related and more practical point: even where liability coverage responds, exemplary damages may not be covered by the policy at all. As we explain in our article on the criminal and civil cases that follow a DWI crash, those damages are not subject to the usual statutory cap in intoxication cases — and an uninsured exemplary award is collected from the driver personally.

The Deadlines Texas Law Imposes on Your Insurer

Chapter 542 of the Texas Insurance Code — the Prompt Payment of Claims Act — puts hard clocks on the carrier. These are the ones that matter most:

• Acknowledge and investigate — § 542.055. Not later than the 15th day after receiving notice of a claim (the 30th business day for an eligible surplus lines insurer), the insurer must acknowledge receipt, begin investigating, and request from you everything it believes it needs to adjust the claim.
• Accept or reject in writing — § 542.056. Not later than the 15th business day after it receives all the items it requested, the insurer must notify you in writing that it accepts or rejects the claim. That window extends to 30 days where the insurer has a reasonable basis to believe the loss resulted from arson.
• Pay — § 542.057. Once the insurer notifies you it will pay, payment is due not later than the fifth business day after that notice.

Miss any of these and § 542.060 attaches: interest on the amount of the claim at 18 percent a year as damages, together with reasonable and necessary attorney's fees. That penalty runs whether or not the insurer's coverage position was correct, which is precisely why documenting the date of every submission matters.

Keep Your Own Record of the Clock

The statutory deadlines only help if you can prove when they started and when information was delivered. Send everything in a form that generates a timestamp, keep the adjuster's name and every reference number, and follow up phone calls with a short email confirming what was said. Requests for "additional information" are the most common way a file quietly stalls.

Unfair Settlement Practices Under Chapter 541

Separate from the timing rules, Chapter 541 of the Insurance Code addresses how a claim is handled — including misrepresenting policy provisions, refusing to pay without conducting a reasonable investigation, and failing to attempt a fair settlement in good faith once liability has become reasonably clear. A denial that came with no meaningful investigation behind it, or one that mischaracterises what the policy says, belongs in this category rather than being treated as a simple coverage disagreement.

When the At-Fault Driver's Policy Runs Out

Impaired-driving crashes frequently cause harm well beyond a minimum-limits policy. That is what uninsured and underinsured motorist coverage exists for — and it sits on your own policy, not the other driver's.

Texas has an important procedural wrinkle here. Under Brainard v. Trinity Universal Insurance Co., 216 S.W.3d 809 (Tex. 2006), a UIM carrier has no contractual duty to pay benefits until the insured obtains a judgment establishing both the other motorist's liability and their underinsured status. In plain terms, your own insurer can decline to pay until you have established the other driver's fault and the value of your damages — which is why UIM claims so often have to be litigated even though nobody disputes you were hit.

What to Do After a Denial Letter

1. Get the denial in writing, with reasons. A verbal denial is not something you can hold anyone to.
2. Request the complete policy. Not the declarations page — the full policy with all endorsements. The exclusion being relied on is often narrower than the letter implies.
3. Build the timeline. Date of notice, date each requested item was provided, date of the written decision. That is what a Chapter 542 claim is made of.
4. Preserve the evidence. Event data recorders get overwritten and business surveillance footage cycles within weeks.
5. Check every layer of coverage. UM/UIM, medical payments coverage, umbrella policies, employer coverage, and dram shop exposure are all separate from the at-fault driver's liability limits.
6. File a complaint with the Texas Department of Insurance. It runs parallel to anything else you do and creates an independent record.
7. Talk to a lawyer before giving a recorded statement. This matters doubly if criminal charges are pending — anything you say to an insurer can find its way to the prosecution.

If you were injured by an intoxicated driver, our auto accident attorneys handle the claim and the carrier. If you are facing charges after a crash, our Collin County DWI defense lawyers can make sure the criminal case and any insurance dealings are coordinated rather than working against each other.

Frequently Asked Questions

Can an insurance company deny a claim because the driver was drunk?

An insurer may attempt it, usually by arguing the conduct was intentional rather than accidental or that a policy exclusion applies. Whether that position holds depends on the exact policy wording and the facts. Exclusions are construed narrowly and the insurer bears the burden of proving one applies, so a denial on these grounds is worth challenging rather than accepting at face value.

How long does an insurance company have to accept or deny a claim in Texas?

Under Section 542.056 of the Texas Insurance Code, the insurer must notify you in writing that it accepts or rejects the claim no later than the 15th business day after it receives all the items it requested. It also has to acknowledge the claim and begin investigating within 15 days of notice under Section 542.055, and pay within five business days of notifying you it will pay under Section 542.057.

What is the penalty if a Texas insurer misses a claim deadline?

Section 542.060 imposes interest on the amount of the claim at 18 percent a year as damages, plus reasonable and necessary attorney's fees. That penalty applies to the missed deadline itself, independent of whether the insurer's underlying coverage decision turns out to be correct.

Does insurance cover punitive damages in a Texas drunk driving case?

Often it does not, and that matters a great deal in intoxication cases where exemplary damages are not subject to the usual statutory cap. Where an exemplary award is not covered by the policy, it is collected from the driver personally rather than from the insurer.

Why will my own insurer not pay underinsured motorist benefits right away?

Because of the rule in Brainard v. Trinity Universal Insurance Co., 216 S.W.3d 809 (Tex. 2006). A UIM carrier has no duty to pay until the insured obtains a judgment establishing the other motorist's liability and underinsured status, so these claims frequently have to be litigated even when fault is not seriously in dispute.