Unfortunately, the road to appealing a decision can be long and complicated, made worse by the fact that different types of insurance have different rules for appeals. For example, if the insurance is provided through work, it is covered under ERISA (Employee Retirement Income Security Act) and therefore no lawsuits can be filed until all appeals with the company have been exhausted.
Insurance that does not go through an employer does not require appeals be filed, and therefore a lawsuit can be filed as soon as the claim is denied. Also, unlike insurance covered by ERISA, first party insurance allows claims for punitive damages and pain and suffering.
Of course dealing with an insurance appeal or a lawsuit on top of health and possible financial problems is a daunting prospect. But doing so can get results. In some cases, claims are denied simply because information has been put into the database incorrectly.
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One such lawsuit was filed in Delaware against Geico, alleging the company uses software to reduce or eliminate claims payments without a reasonable justification. The lawsuit, Green v. Geico General Insurance Co., case number 9431, was filed earlier in 2014 and alleges the claims processing system does not consider any factor other than the date of an accident and date and location of medical treatment.