Insurance Law covers the business of insurance and how insurance claims are handled. If you've had your insurance claim denied, or believe your insurance company has practiced bad faith insurance or health insurance fraud, an insurance lawyer can help with your insurance claim.
Denied Insurance Claims
Insurance Law ensures that insurance companies pay claims with good faith—willingly, promptly and properly. It is illegal to practice bad faith insurance and insurance fraud by willingly discounting, delaying or denying payment of claims. In the US, insurance companies are bound by a "covenant of good faith and fair dealing" in treating their policyholders, which means that the insurance company is under an obligation to pay a legitimate claim. If an insurer breaches this covenant, it is acting in bad faith.
 State statutes require that an insurance company responds to a claim within certain time limits. Insurance companies that breach their duty of good faith and fair dealing may also be liable under certain state deceptive trade practices acts.
If your insurance company has wrongfully delayed or denied your disability claim, it may constitute insurance fraud. Unscrupulous insurers deny valid disability insurance claims to make more money from their policy holders. Claims are denied for a number of reasons, including the following:
- The insurer's medical examiner overruling your doctor's opinion/diagnosis
- Wearing you down with unnecessary paperwork
- Reclassifying your injury as an illness rather than an injury
- Retroactively canceling your insurance policy
If your employer paid health insurance premiums—short term and/or long term disability, you have legal rights to receive benefits. An insurance lawyer can help litigate a potential insurance bad faith lawsuit under the Employee Retirement Income Security Act (ERISA), which is heard by a judge, not a jury. Fortunately, judges generally rule in favor of the insured person and make the insurance company pay the claim and sometimes related costs.
An insurance lawyer can help you make an insurance claim for actual and consequential damages as well as punitive damages.
Bad Faith Insurance
You buy an insurance policy and assume that you will be compensated by the insurance company if you suffer a loss. Your policy is a contract signed between you and an insurance company that 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.
 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 bad faith insurance 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, the Internet and expert insurance lawyers, insurance companies can no longer get away with bad faith insurance practices. More lawsuits against crooked insurers are being fought and won today than ever before.
What You Can Do
Write to your State Department of Insurance. In the US, 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 an insurance lawyer. |
INSURANCE HOT ISSUES
UnumProvident for allegedly denying long-term disability claims.
INSURANCE ARTICLES AND INTERVIEWS
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Unum's Catch-All: the Pre-existing Condition
Rancho Mirage, CA: Steve says that Unum Insurance Company denied his claim because he has a pre-existing condition. "I applied for my long term disability benefits, but Unum's reasons for denial were so twisted out of shape, they don't make sense," says Steve, who points out that he was approved for social security benefits within a few weeks of filing his application..
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Despite Unum’s Reputation, Job Applications Double
Chattenooga, TN: Despite its reputation for unfairness to policyholders, Unum has seen an upward trend in the number of job applicants it attracts. Unum Insurance, previously known as Unum Provident and First Unum and now doing business as the Unum Group, received 50,000 applications for employment nationwide in 2008. It's a trend that is expected to continue through 2009 and into this year..
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Hurry Up and Wait for SSDI Benefits
Fort Worth, TX: For anyone applying for Social Security Disability Insurance (SSDI) benefits, it's a game of "hurry up and wait"—a wait compounded by the economy and an aging population..
INSURANCE EMERGING ISSUES
UnumProvident for allegedly denying long-term disability claims. Social Security specialized social security disability benefits attorneys. LINA Insurance alleging violations of disability insurance claims.
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