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:
- 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
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:
- 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.