Category : Bad Faith Insurance
If you’re having trouble getting a straight answer from your insurance company on paying a claim, pay attention to the calendar. Timing is everything when it comes to an insurance company’s responsibility to provide the coverage it promises.
The policy requires you, the consumer, to file claims within a certain period of time. By state law, insurers must provide prompt investigation and prompt decisions on the validity of insurance claims. Insurance companies that act in bad faith slow this process in order to profit from interest on the money they should be releasing. Failure to act promptly is called claims resistance. If you suspect this type of treatment in your case, contact an insurance attorney right away.
Visit our library to gather more information on bad faith insurance claims.
Let’s say your insurance claim was wrongfully denied and you got stuck with excessive medical bills. You’re overwhelmed with settling your debts and paying your current expenses; why should you sue the insurance company?
Bad faith insurance lawsuits can:
- Recoup your policy coverage
- Pay for lost wages or emotional stress
- Cover attorney fees and court costs
- Punish the insurance company for illegal activity
The rules for court awards are outlined in state law. These laws are defined by precedent, on a case by case basis.
To learn more about bad faith insurance claims, read our article Winning a Bad Faith Insurance Case: Can It Be Done?
Do not assume that because an insurance company is large and powerful, that there is no use in trying to hold it accountable for its actions. If an insurance company violates the terms of a policy, it is acting in bad faith.
An act of bad faith insurance is grounds for legal action. But how do you know when it is time to pursue legal action? If something about your claim is confusing, a qualified bad faith insurance attorney can guide you through the ropes.
A few examples of when to contact an experienced insurance attorney:
- If a policy provision is ambiguous and you are unsure of its meaning.
- Your insurance company is refusing to honor your reasonable interpretation of an ambiguously worded policy.
- The insurer is neglecting to contact you with relevant information in a timely manner.
- You believe the insurer is intentionally adopting a restrictive view on a policy in order avoid a settlement.
Bad faith insurance scams include hiding behind loose language in insurance policies to avoid paying claims. This type of anti-concurrent language is illegal. An American Association for Justice report quotes a state supreme court decision that accused insurance companies of claiming to cover everything when selling a policy but claiming to cover nothing when a claim is brought to court.
Ambiguous language includes qualifiers such as “may” instead of “will” or excludes specific dollar amounts regarding payment and policy limits. Ask your insurance agent to explain terminology you don’t understand. If you still aren’t satisfied, consult a bad faith insurance lawyer. Complete our short questionnaire to get connected with an attorney in your area today.
Browse the discrimination section of our library to learn more about bad faith insurance claims.
If you’re thinking of making a bad faith claim against your insurance company in court, start taking notes. As soon as you feel your claim is being mishandled, go back over the facts of your case. Note when and how you filed your claim, the substance of any phone conversations related to your claim (especially those with your insurance company), and the company’s response. You’ll need this information to appeal the decision with the company.
Also, if your request for indemnification is denied again, you may need written evidence for a complaint to the state insurance commissioner or to file a lawsuit. A bad faith insurance attorney can help you gather the documentation you need.
Visit the discrimination section of our library for more information on bad faith insurance claims.
When you feel that your insurance company has wrongfully denied a claim, you’ll want to report it to authorities and sue for damages in court. Striking back against unfair practices helps you to recoup your losses and prevent the company from harming others. While anyone can file a bad faith complaint with their state insurance commissioner, not everyone can file a lawsuit.
By law, you cannot sue your insurance company for:
- Situations not covered in the policy contract
- Fictitious claims or claims based on misinformation
- Policies containing an arbitration clause
- Certain group employee benefits policies
An insurance attorney can help you identify whether you have a legitimate bad faith claim.
Visit the discrimination section of our library to learn more about bad faith insurance claims.
Bad faith can include denial, delay in paying, underpayment, unreasonable interpretation of and failure to adequately investigate a covered insurance claim. Consulting with a bad faith insurance attorney can help you decide where your relationship with your insurance company stands. To get connected to a lawyer in your area who can advise you on how to proceed with a legal case against an insurance company, complete our short survey.
Paying premiums on your insurance policy entitles you to certain legal rights. First, you have the right to expect good faith practices from an insurer, that is, you should get what you pay for. Second is the right to appeal a claims denial, or present rationale warranting reconsideration of your case.
When an insurance company wrongfully denies coverage as promised in the policy, you may seek redress outside the insurer-consumer relationship. You may report unfair treatment to your state insurance agency or hire a bad faith insurance lawyer to file a civil lawsuit. Your right to be heard in court could result in recovery of what was also rightfully yours: indemnification of the expenses you incurred.
Visit the discrimination section of our library to learn more about bad faith insurance practices.
Attorney Gerard Mantese appears to have struck a very substantial blow to bad faith health insurance companies that routinely deny claims for treatment of autistic children. In a groundbreaking case, Mantese forced Blue Cross Blue Shield to concede that it was wrong to categorize behavioral therapy for autistic children as experimental treatment and use that argument to deny claims.
“The notion that behavior therapy is experimental is absurd and indefensible,” says Mantese. “For the families, it is a life-changing event. This care is expensive,” says Mantese. “Sometimes families had to choose between paying for care for their children and paying their mortgage. Some people didn’t have the funds to pay for this care and many families are deeply in debt over it.”
The settlement also allows Blue Cross Blue Shield policyholders who have not made a claim to the insurer, but who have paid for treatment for autistic children out of their own pockets, to be reimbursed for costs.
When Mantese agreed to challenge Blue Cross on behalf of the family of Christopher Johns, one of the first things he did was begin to review the scientific data on autism. “We reviewed the literature and once we did, we knew that the claim by Blue Cross or any other insurer that the established care was ineffective would be baseless,” says Mantese.
In the lead up to the trial, Mantese filed a motion to compel Blue Cross to produce internal documents showing that its own research indicated that behavioral therapy does work for autistic children. “Once we took the depositions of the top doctors at Blue Cross and we reviewed their files it was like the emperor had no clothes on,” says Mantese. Since the settlement, Mantese says his phone is ringing off the hook with inquiries from other families across the country that have been denied claims for treatment for their autistic children based on the similar arguments that behavioral therapy is ineffective.
Mantese & Rossman is a relatively small firm with six lawyers. Mantese says the firm likes to take on cases that will have some societal impact. “We are looking at them,” says Mantese.
To learn more and find a bad faith insurance Attorney
When it comes to the fight against acts of bad faith insurance, timeliness is of the essence. To increase the chances of a settlement, policyholders should make it a point to:
- File all claims promptly
- And avoid hitting any imposed deadlines
But, don’t rush through the process – information filed must be clear, honest and complete.
Most insurance policies designate a specific time frame in which to file a claim, or when a lawsuit can be filed against a policy. Additionally, legal precedent requires that bad faith claims must be filed within a certain time frame.
There is no clear-cut time limit, and they vary from state to state. To be safe, file a bad faith claim within one year from the date of denial. An experienced bad faith insurance attorney can better help you determine your rights and course of action.
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