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Insurance Lawsuits: Even Honest Rejections of Claims Can Be Costly

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Birmingham, ALIt’s not uncommon to hear complaints about insurance companies, and with some of the tactics long-term disability companies allegedly use to deny payments, it’s no wonder policyholders get frustrated. Sure, there are perfectly valid reasons for denying an insurance claim, but there are also perfectly valid claims that get denied. Sometimes, the denial is an example of bad faith insurance, other times it’s a result of paperwork not being correctly filled out. But for policyholders who are dealing with medical problems and bills piling up, even an honest rejection of a valid claim can be costly.

One frequent complaint about insurance company claims involves paperwork that is misleading or difficult to understand, leaving the policyholder to figure out how to correctly answer the question while accurately describing the disability. Multiple-choice questions that don’t give a clear picture of a person’s illness or injury can be problematic, especially when the policyholder tries answering truthfully but can’t find an answer that represents his or her condition.

For example, questions asking whether the policyholder is capable of heavy, medium, light or sedentary work might cause a disabled person to answer “sedentary” when in fact the policyholder can’t do any work. But even an answer like “sedentary” indicates the policyholder is capable of some work. That answer is close to the truth, but not actually accurate, through no fault of the policyholder’s.

But because the claimant answered “sedentary” to the question, he or she might have the claim denied. Lawsuits continue to be filed against insurance companies, alleging policyholders wrongly have their claims denied.

A doctor who was injured in the Boston Marathon bombing has reportedly filed a lawsuit against his insurers, alleging he was wrongly denied benefits. Dr. Scott Weisberg reportedly crossed the finish line seconds before the first bomb went off. According to Courthouse News Service, Weisberg suffered mild traumatic brain injury, post-traumatic stress disorder, post-concussive syndrome, and cognitive dysfunction as a result of the explosions and was unable to continue running his family medicine practice.

After filing a claim with his insurance companies - MetLife Insurance Company and Guardian Life Insurance Company of America - Weisberg allegedly received a letter stating he was not “Totally Disabled, Residually Disabled, or Presumptively Disabled,” and was therefore not eligible for benefits. Despite providing additional medical information regarding his injuries, Weisberg’s claim was denied. He has since filed a lawsuit against his insurers, alleging breach of contract and bad faith insurance.


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