Los Angeles Health Insurance Lawyer

Handling a Health Insurance Claim in California

As a holder of a health insurance plan, you should be able to have faith that your treatment will be covered when it comes time to receive health care. In many cases, however, claims for treatment of various health conditions are being denied by health care providers. Typically, the denials are based on a policy provision that requires the treatment to be “medically necessary” or because the treatment is “experimental.” There are other reasons, however, that the insurance company will come up with to reject the coverage that an individual needs, despite receiving premiums year in and year out.

Guidance from Our Insurance Attorneys

Although in some cases the insurance company is accurate in its assessment of the situation, there are other situations where individuals are denied proper insurance benefits. In some circumstances, it may be in that person’s best interest to challenge a denied insurance claim.

Our team at Gianelli & Morris has the qualifications and experience necessary to fight for the rights of their clients who are dealing with complicated insurance matters. The attorneys have been successful in recovering benefits for past clients and in pursuing claims against the following companies:

  • Kaiser
  • Anthem Blue Cross
  • Blue Shield
  • Health Net

Duties of the Insurance Company

Your insurance company has certain responsibilities they owe to the insured. If these are broken, the insurance company will likely face liability for the damages suffered. Some of the duties include:

  • Duty to defense the policyholder when he or she brings a claim
  • Duty to indemnity
  • Duty to handle the claim in good faith and with fair dealing
  • Duty to fairly and quickly manage claims
  • Duty to disclose conflicts to the insured
  • Duty to settle within the policy limits regardless of whether the insured demands a settlement

When an insurance company breaches their duties that they have to you or acts in bad faith, you should fight for your rights and pursue damages.

Filing a Class Action Lawsuit

Sometimes, these cases are brought as class actions where one or more persons will file a lawsuit on behalf of the hundreds or thousands of other persons who have had their claims denied in the same way. One such case that we handled was Arce v. Kaiser Foundation Health Plan, Inc., Los Angeles Superior Court Case No. BC 388689. In this case, partner Robert S. Gianelli successfully prosecuted a class action against Kaiser for its refusal to provide treatment to thousands of autistic children. Mr. Gianelli’s work in that case earned him a California Lawyer magazine’s 2015 Attorney of the Year (CLAY) award in the category of Disability Rights.

Our firm has brought successful cases against insurance companies for denying coverage of treatment of a variety of health conditions, including:

  • Cancer
  • Heart disease
  • Back problems
  • Mental health care
  • Neurological problems
  • Disfiguring excessive skin
  • Artificial disks

If you need legal guidance from the team of Los Angeles insurance attorneys as you battle a dispute with an insurance company, do not hesitate to reach out for your initial case review.