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Bad Faith in Health Insurance Claims

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Handling bad faith claims with your health insurance

When your health is poor enough that you need to file a medical claim the last thing you need is to get hassled by your insurance carrier regarding your claim. Unfortunately for many people that had planned on relying on the proceeds of their claim, hassle and runaround are what they get. In many cases, the insurer will deny or ignore the claim. Other times a carrier will issue a payment far below what you are entitled to. While your carrier is playing games, you have to make ends meet without being able to afford the medical treatment you required in the first place. You constantly face anxiety and dread. Your worst case scenario? Your life could legitimately be on the line because of the lack of access to necessary healthcare.

Do you have any recourse? If your carrier refuses to treat you fairly the next step is to contact an attorney with experience in detangling coverage issues within health insurance law. An attorney can help you in pursuing a bad faith claim against your insurance carrier while also pressing a claim that they have violated the obligation to deal with you fairly and reasonably. The insurer is barred by law to put their own financial needs above your legitimate claim for insurance benefits in which you’ve paid for already.

BAD FAITH CLAIMS CAN GET THE ATTENTION OF YOUR INSURER

The mere possibility of a bad faith claim may be enough to get the attention of your insurance carriers. When facing a credible bad faith claim, it’s possible that your insurer may take stock of the situation and decide that the additional damages they may face from a bad faith claim are more than they bargained for. Suddenly, lost paperwork is found, phone calls are finally returned, and your insurance claim is suddenly worth more than they originally offered.

If a bad faith claim doesn’t force your insurer to treat you fairly, prosecuting your bad faith claim in court could lead to damages far greater than the amount you were originally shortchanged by your carrier. In fact, some courts will award you punitive damages, your attorney fees, and even compensate you for your emotional distress and anxiety during the period in which your carrier refused to deal with you in good faith.

WHAT CONSTITUTES BAD FAITH HANDLING OF A HEALTH INSURANCE CLAIM?

There isn’t a checklist of actions taken by your insurer that automatically qualify as bad faith. Ultimately, what matters is that any action your insurer takes is done so legitimately and in good faith instead of abusing their leverage over you to unfairly limit your recovery. An example of bad faith that occurs regularly is your insurance carrier pressuring you to take less money than your claim is worth because they’re aware of your dire circumstances.

A second common type of bad faith is for your insurance carrier to mysteriously declare you fit to work and using that declaration to cut off disability benefits. This is often done despite your insurer having no evidence you’re physically able to return to your job. This is done on the theory that for every customer that doesn’t object the insurer will come out ahead on the balance sheet.

A third frequent tactic for avoiding valid claims is known as “post-claim underwriting.” This type of tactic involves your insurer hardly investigating your application for insurance when you apply. Only when you request benefits does the insurer decide to look deeply into your application thoroughly. The trick the insurance companies use is to find something in your application that could have prevented you from being insured in the first place, using that to void the policy without paying you any benefits, and pocketing all your premiums.

Insurance companies also love to deny claims for treatments they deem not to be “medically necessary.” This is despite your doctor, who was approved by your insurance company, assures you that it is. An attorney experienced with bad faith claims will be able to determine if the decision to rule a treatment medically unnecessary was done properly or in bad faith.

YOUR FIRST STEP SHOULD BE TO TALK TO AN ATTORNEY

None of these tricks will surprise an experienced bad faith attorney. If you believe to have been dealt with in bad faith call an experienced bad faith attorney today to help you protect your rights.

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