The California insurance lawsuit was filed by Norman and Kathleen Carter against HealthMarkets Inc, according to the Los Angeles Times (11/24/12). According to the lawsuit, the couple purchased a healthcare plan with up to $1 million in coverage, to protect them in the case of serious illness. When Kathleen was diagnosed with abdominal cancer, she spent almost a month in the hospital, but received a bill for $140,000. The Los Angeles Times reports that many of the costs associated with Kathleen's care were classified as miscellaneous hospital charges, which had only $18,000 of coverage.
California insurance claims can be complex and tricky to navigate. When claims are denied in situations where the insured has purchased his or her own insurance, a lawsuit can be filed immediately, and that lawsuit can see punitive damages. If the insurance is purchased through the insured's employment, however, it is covered under the Employee Retirement Income Security Act (ERISA), which requires the insured to first file an appeal of the denial with the insurance company itself. That appeal must be filed within 180 days of the denial.
If the appeal is still denied, a lawsuit can be filed but that lawsuit cannot recover punitive damages—only costs associated with medical coverage and attorney's fees can be recovered—and it includes only information contained in the insured's file, making it vital the file has all the relevant information.
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In both cases, however, a simple ndenial is not the final word on the matter. Either a California insurance lawsuit can be filed right away or an appeal can be filed and, if that appeal fails, a lawsuit can follow. In cases where insurance companies allegedly carry out bad faith insurance practices, a lawsuit may be the only way to ensure medical expenses are covered.