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Understanding your options if a health insurance claim was denied — II

| May 4, 2017 | Denied Insurance Claims, Firm News |

Last week, our blog began discussing just how distressing it can be for individuals and families dealing with serious injuries or life-threatening illnesses to learn that the insurance company has denied coverage for their major medical event.

We also discussed how even though this anxiety is certainly understandable, consumers must know that they are not resigned to financial ruin and do have options, including resolving the matter via a simple phone call or through the mailing of an appeal letter. Furthermore, we mentioned how legal action might be an option if the insurance company is acting in bad faith.

Step two: Consider legal action

Bad faith lawsuits against insurance companies are based in contract law. Specifically, a health insurance policy is treated as a contract in which the insurer promises to cover the consumer for specified medical events in exchange for consideration, meaning the payment of premiums.

Some examples of an insurance company acting in bad faith in this context, meaning failing to live up to its contractual obligations, could include:

  • Refusing to accept evidence
  • Fabricating evidence
  • Refusing to conduct an investigation
  • Unreasonably delaying an investigation
  • Committing other acts that could be considered inequitable or fraudulent

As encouraging as it can be to learn that legal action is a viable option, it’s important for affected policyholders to understand that any potential claim they have is subject to a legal deadline known as the statute of limitations. In other words, if they wait too long to pursue a claim, it may be too late.

It’s for this reason that those who find themselves in this unenviable position should seriously consider speaking with a skilled legal professional who can answer their questions, explain the line and pursue solutions as soon as possible.