Bad Faith Insurance

Troy MI: 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. [ Read More ]

St. Louis, MO: The proof will come out not in the pudding but in the lawsuit. However, allegations stemming from a bad faith insurance lawsuit and the accompanying bad faith insurance claim filed by a Missouri woman gives one pause to wonder why anyone ever bothers with insurance. That said, there is little doubt as to why the insurance bad faith attorney has so much grist for his mill. [ Read More ]

Andalusia, AL: " Had I known that Unum [also known as Unum Provident] long term disability benefits was going to be a loan, I would have gone to a bank," says Elaine. "My interpretation of disability insurance is this: when you become disabled, insurance pays your benefits." But Elaine says that wasn't the case with Unum health insurance. [ Read More ]

You buy an insurance policy and assume that you will be compensated by the insurance company if you suffer a loss. A contract is signed between you and an insurance company—your insurance policy—which sets out terms and conditions specifying the amount of coverage or compensation payable to you should you claim a loss or injury. Depending upon your contract, it may cover you against a personal injury or damage to your vehicle or a catastrophic event such as Hurricane Katrina.

Sounds straightforward—you buy insurance and assume that you will be compensated by the insurance company if you suffer a loss. Unfortunately, this is not always the case. Some insurers will deny your legitimate claim even if they don't have a valid reason to do so. When an insurance company breaches your trust, you feel betrayed. The company is then acting in bad faith. Generally, these insurers employ tactics that will try to wear you down; they count on you not having any recourse. An insurer may attempt to refuse to pay all or part of your medical bills or delay investigation of your claim for no reason except to hope that you will go away.

Other tactics include the following:

• A 24-month limitation on benefits for mental and nervous conditions
  
• Knowingly applying the wrong legal definition of disability when denying claims
  
• Purposely targeting high-cost claims for denials
  
• Misuse of claimants' medical records

It is hard to believe that bad faith insurers can practice bad faith--until it happens to you. Insurance complaints have increased drastically over the last several years but there is also a positive side to this: public attention has demanded that insurance companies are now held accountable. Thanks in part to the Freedom of Information Act and the Internet, insurers can no longer get away with bad faith insurance practices. More lawsuits against crooked insurers are being fought and won today than ever before.

Write to your State Department of Insurance. In the U.S., each state regulates insurance companies and every state has its own Department of Insurance website. Once you know the website of your state regulatory agency Department of Insurance, find the right representative and submit a complaint in writing to make sure that your claim is on record.

Keep a record of everything that transpires between you and your insurer, including phone calls. Keep a paper trail. And request copies of your medical records - it is your right.

You can go to small claims court but each state has its own limit - find out first. If your claim is too high for small claims court, you may want to seek legal help.