Many states have laws to protect consumers against health insurance companies that act in bad faith, including laws providing compensation or punitive damages as legal recourse for such actions.
To have any hope of succeeding with your lawsuit against an insurer, it must first be demonstrated that they owed you a duty of care; additionally, any breaches caused monetary losses for you.
1. Review Your Policy
As soon as you pay your health insurance premiums, you expect the company to act in your best interests and be there when needed. Unfortunately, many providers prioritize profits over customer satisfaction by denying valid claims or turning the claim process into a lengthy legal battle that they hope you’ll eventually lose.
Reviewing your policy is essential when filing a bad faith suit against an insurer. Engaging an experienced attorney to assist in translating its jargon can give a clear picture of any breaches committed by their insurer and any possible breaches caused by any missteps on their part.
If your claim was denied, first try to resolve it internally before filing suit against your insurance provider. This could involve multiple appeals or using internal dispute resolution procedures which vary according to company and state, including seeking external reviews conducted by either an independent third party or your state’s regulator.
An insurance denial often stems from insufficient coverage. Investigating your policy’s exclusions section will give you insight into which services are not included under your plan and can help prevent problems before they arise, such as medical procedures not covered by health insurance policies.
Health insurers may deny your claim for other reasons as well, including improper coding or billing, requiring you to pay first before being reimbursed, and refusing experimental treatments. You can attempt to avoid these issues by submitting claims correctly and remaining patient while waiting for an answer from the insurer.
Some health insurance policies contain annual or lifetime coverage maxima that require you to reach a certain dollar amount before they will stop paying for care, leaving you in financial difficulty. It is in these instances where speaking with an attorney immediately is paramount – Attorney Scott Glovsky can determine if your health insurer acted improperly and fight for the damages that are rightfully yours.
2. Gather Evidence
If you suspect an insurance company of acting in bad faith when denying claims, taking steps to gather evidence can be the key. Documenting is the key here – such as collecting policy documents and any denied claim forms from insurers as well as copy of communications with them as well as recordings of phone calls or meetings should help support your position. Attempt to resolve issues internally before considering litigation options as this will minimize costs involved with doing so.
An experienced attorney can assist in gathering evidence to support your claim. He or she may ask you to identify witnesses that can vouch for your version of events – this could include family, friends, neighbors, coworkers and any other individuals that could verify your account of what occurred. In addition, any documents related to your case such as photographs, medical records or reports need to be collected as supporting evidence as well.
At the core of any successful lawsuit against an insurance company lies proof of breached duty of care by adjusters or companies, which could include misleading customers about policy terms or failing to investigate or handle a claim properly. Your attorney can examine your facts to establish this link between their actions and damages suffered as a direct result.
Your attorney may request the production of physical evidence in certain instances. This typically happens during disputes involving contracts, employment files or billing records; it can also be utilized when disputing property or real estate issues – for instance if your attorney believes an insurance company mishandled your claim, they might request that an expert come inspect whether your roof was repaired properly.
Current health insurance policies often contain mandatory arbitration clauses that force patients to settle any disputes through private arbitration rather than federal court proceedings. Democrats are working on changing this law so that consumers can file suit against health insurers for acts of bad faith in federal court proceedings – this would enable people to recover damages such as lost wages, pain and suffering and emotional trauma from these companies.
3. Try to Resolve the Issue Internally
Claiming insurance can be stressful enough; having to deal with an insurer acting in bad faith only compounds the stress.
Your state department of insurance provides consumer protections designed to prevent unscrupulous insurance practices; however, even with these laws in place it can still happen that consumers experience issues with their insurer. If your provider appears to be engaging in bad faith it’s important to know that if this occurs you could file a suit.
Before considering legal action, you must attempt to resolve your issue internally with your insurance provider. Usually this involves going through their internal review or appeals process – something most providers provide so their customers receive coverage they deserve.
Check to see if your health insurance company utilizes mandatory arbitration clauses in their policies, which often force consumers to resolve disputes via private arbitration instead of going to court and prevents them from joining class-action suits against insurers. Thankfully, a Democratic congresswoman recently introduced legislation that will prohibit these clauses in health plans.
If your health insurance provider refuses to work out an agreement internally, speaking to a lawyer is your next best step. A legal representative can help build a strong case against them and secure financial compensation for damages you’ve endured.
One way that insurance companies act in bad faith is by refusing to cover necessary medical treatment, tests, services, or prescription drugs that you need for your health. Such denials constitute bad faith since they violate the implied covenant of good faith and fair dealing that underlies every insurance contract.
To successfully sue an insurance company for negligence, your attorney must demonstrate that they owed you a duty of care, which was breached. Furthermore, this breach caused significant damages – physical injuries, emotional trauma, or financial losses may result from their breach. Furthermore, it must also show how this breach directly led to those losses.
4. Hire an Attorney
If the internal appeals process of an insurance provider fails to produce satisfactory results, filing a lawsuit might be your only recourse. When choosing to go this route it is advisable to hire an attorney with experience in health insurance law; they can review your policy to ensure all necessary details are included while helping determine if any bad faith or negligence has taken place on behalf of their provider.
In order to prove negligence against an insurance agent or company, you must demonstrate they owed you a duty of care that was breached when they took actions that should not have been expected of someone in their position. For example, if your doctor wrote in your file that tests would be needed to diagnose certain conditions without running tests and your insurer denied your request to run them – this would constitute a breach. Furthermore, proof must also be presented of how this breach led directly to damages; such as wages lost and emotional distress suffered as a result.
Skilled insurance dispute attorneys can negotiate on your behalf with your insurer and ensure you receive the compensation that is due. They can explain how bad faith and negligence laws work in your state, the steps to be taken when filing suit and potential recoveries for various forms of damages including compensatory, punitive and exemplary.
If an insurer has denied payment for medical services or treatments, contact Morgan & Morgan immediately for a free consultation. Our attorneys have extensive experience handling such cases and can answer all of your queries. Plus, since we work on contingency fee basis we won’t leave you worrying about how to pay an attorney to represent you; all it takes to get started is calling us or filling out our online form.
