Health Insurance Claims

The runaround from your insurer is exactly what you don’t need when you’re in poor enough health to be filing a health insurance claim.

For many people expecting to get benefits to help them through sickness, injury, or disability, however, the runaround is exactly what they get.

The insurer denies the claim, or doesn’t respond to the claim, or decides that the amount due under the policy is considerably less than what you have claimed. In the meantime, your finances are shot, you can’t get the medical or rehabilitation services you need, and your life is spinning out of control with anxiety and dread. In the worst case, your life may literally be on the line, waiting for the treatment you need to survive.

What can you do? If there doesn’t seem to be a reasonable basis to your insurer’s actions, you can get the help of a good, experienced attorney who understands the fine points of health insurance law and will assist you in charging the insurance company with bad faith and violating their obligation to deal with you reasonably and fairly. The insurer can’t legally cater to its own financial interests and ignore your legitimate interest in getting the insurance benefits you’ve already paid for.

A Bad Faith Filing Gets the Insurer’s Attention

The threat of a bad faith claim may itself be enough to get the insurer’s attention and change its attitude. Faced with the additional damages that a bad faith claim entails, the insurer may suddenly find lost paperwork, realize that the claim really is worth more than it originally said, or rethink its conclusion that you’re no longer entitled to disability benefits.

If they still fail to respond reasonably, a successful bad faith claim may produce damages far in excess of what you originally claimed under the policy. In some cases, you might be able to recover punitive damages and attorney fees, not to mention some compensation for that anxiety and emotional distress that dominated your life while you waited for the insurer to pay your claim.

What Amounts to Bad Faith in Handling Health Insurance Claims?

There is no limit to the number and type of actions that a health insurer can take that may amount to bad faith. The key is whether the insurer is acting legitimately—in good faith—or is simply abusing its superior position to minimize the amount of money it pays out on the claim. One common example of insurance bad faith is the insurer using your dire need to coerce you into accepting less money than is actually due under the policy.

Another is to terminate disability benefits based on a determination that you are suddenly able to work again, despite there being no real evidence that you have suddenly become employable. From an insurer’s perspective, if you don’t object when it terminates your benefits, the insurer comes out ahead.

“Post-claim underwriting” is another common tactic for avoiding claims. Rather than investigating your application thoroughly before issuing the policy, the insurer may wait until a claim is filed then examine your application, looking for grounds to void the policy, for example by claiming a pre-existing condition that wasn’t disclosed on the application.

In medical insurance, many an insured has been told by the insurance company that it won’t pay for a treatment that the insured’s own doctors have recommended because the treatment isn’t “medically necessary.” How was that decision made? Who made it? What factors were considered and why?

An experienced bad faith attorney knows where the answers to those questions reside, and how to bring them to light.​

Getting Legal Help is the First Step

None of these practices are new or mysterious to us at the Johns Law Group. We’ve encountered them already in our decades of successfully protecting the rights of people under their health insurance policies. Contact us today and tell us what has happened so far, and we’ll explain what we can do. It isn’t a fair fight between you and a huge insurance company.