Denied Insurance Claims
Insurance regulations require insurance companies to pay valid claims in good faith—willingly, promptly and properly. It is illegal to knowingly or negligently discount, delay or deny payment of legitimate claims. In the US, insurance companies are bound by a “covenant of good faith and fair dealing” in treating their policyholders, which means that the insurance company is under an obligation to pay a valid claim.
State statutes require that an insurance company respond to a claim within certain time limits. Insurance companies that breach their duty of good faith and fair dealing may also be liable under certain state deceptive trade practices acts.
If your insurance company has wrongfully delayed or denied your disability claim, it may constitute insurance fraud. Unscrupulous insurers deny valid disability insurance claims to make more money from their policyholders. Claims are denied for a number of reasons, including the following:
- The insurer’s medical examiner overruling your doctor’s opinion/diagnosis
- Wearing you down with unnecessary paperwork
- Reclassifying your injury as an illness rather than an injury
- Retroactively canceling your insurance policy
- Improper investigation of a policyholder’s disability
- Improper investigation of a policyholder’s job duties
- Misleading questions on the insurance claim form
- Claiming an injury or illness is not covered by the policy when it is
Bad Faith Insurance
Bad Faith Insurance situations occur when an insurance company commits fraud, or denies payment of claims based on protecting profits or meeting pre-determined quotas. Lawsuits have been filed against various insurance companies, alleging they are guilty of bad faith insurance tactics, such as:
- Imposing an arbitrary 24-month limitation on benefits for mental and nervous conditions
- Knowingly applying the wrong legal definition of disability when denying claims
- Purposely targeting high-cost claims for denials
- Misuse of claimants’ medical records
- Offering less than the claimant is entitled to
- Purposely targeting certain types of claims for denials
If your insurance was purchased through your employer, you have legal rights to receive benefits under the Employee Retirement Income Security Act (ERISA), but you must follow your insurance company’s appeals process before you can file a lawsuit. There are usually strict deadlines for filing appeals, and the process of gathering and presenting evidence can be complex. Any evidence you file as part of the appeal becomes the only evidence reviewed by the judge if a lawsuit is ultimately filed. An insurance lawyer can help litigate an ERISA insurance lawsuit, which is heard by a judge, not a jury.
Various companies have faced lawsuits or investigations by attorneys into denied or unreasonably delayed insurance claims. Among the companies attorneys are investigating potential claims against are:
What You Can Do
Write to your State Department of Insurance. In the US, each state regulates insurance companies and every state has its own Department of Insurance website. Once you know the website of your state regulatory agency Department of Insurance, find the right representative and submit a complaint in writing to make sure that your claim is on record.
Keep a record of everything that transpires between you and your insurer, including phone calls. Keep a paper trail. And request copies of your medical records – it is your right.
You can go to small claims court but each state has its own limit – find out first. If your claim is too high for small claims court, you may want to seek an insurance lawyer.
Insurance Bad Faith Lawyer
If you have experienced bad faith insurance, you will need the help of a qualified insurance bad faith lawyer. It is important that you find an experienced insurance bad faith lawyer to handle your case. LawyersandSettlements makes it easy for you to find the right bad faith insurance attorney. We work with attorneys throughout the US and Canada who practice in this specialized area.
As well, LawyersandSettlements.com provides comprehensive bad faith insurance news coverage that aims to keep the public informed. We provide an online legal news source that includes interviews with Insurance Bad Faith Lawyers.