Insurance Denials/Bad Faith Information, News & Blogs
Gianelli & Morris Helps Client Overcome “Lack of Medical Necessity” Insurance Denial
Recently on this blog, we discussed one of the principal reasons given by health insurance providers in denying claims: lack of medical necessity. Insurance providers sometimes reject a claim as medically unnecessary even when the treating physician recommends the treatment to deal with a given illness or injury. Insurers try to shield themselves by… Read More »
Gianelli & Morris Takes Blue Shield to Task for Wrongful Blanket Denials of Coflex
As we’ve recently discussed, health insurance companies often try to impose blanket rules for denying entire categories of claims, even when those rules fly in the face of modern medical science. Sometimes, they state that treatments are not medically “necessary” just because similar treatments are also used for cosmetic purposes. In other instances, they… Read More »
Who Decides What Is Medically Necessary?
One of the most common reasons health insurance providers give when denying a claim is that the requested procedure or treatment was not “medically necessary.” Cosmetic procedures or other elective treatments are typically excluded from coverage for this reason. In many cases, however, a treating physician will recommend a procedure or referral to a… Read More »
When Can a Life Insurance Policy Deny My Claim?
Life insurance companies are always looking for a reason to deny claims or limit payouts. Do not be fooled, however: There are very specific reasons for which an insurance provider can deny a claim, and the reasons available depend in part on how long the policy has been in place. If your life insurance… Read More »
Steps to Deal with an Unreasonable Insurance Company
Insurance companies will often use every means available to them to delay, limit, or avoid a payout entirely on a policy, regardless of the validity of the claim. They might stall their investigation, issue unreasonable document requests, offer you a lowball settlement, or drag their feet in issuing a payout. When your insurance company… Read More »
Class Action Lawsuit Filed Against Insurance Company for the Alleged Wrongful Denial of Medical Coverage
The law firm of Gianelli & Morris has filed individual and class action complaints against UnitedHealthcare of California alleging the wrongful denial of coverage for the Coflex medical device to treat the plaintiffs’ spinal stenosis and back pain. On November 4, 2020, the California insurance law firm Gianelli & Morris filed individual and class… Read More »
How to Fight a Medical Necessity Bad Faith Claim With a Non-ERISA Policy
Sometimes it seems that health insurance companies care first and foremost about their bottom-line and are always on the lookout for any reason to deny a claim for coverage. One of the more common reasons for denial of a specific claim is “lack of medical necessity.” Continue reading to learn how to contest a… Read More »
Does Life Insurance Cover Suicide?
We’ve all seen it on television or otherwise heard about it in pop culture: A person desperate to help their family takes out a large life insurance policy and then commits suicide in order to trigger payment, but the claim is denied as fraudulent. Or a person commits suicide and the family, already devastated,… Read More »
How Can a Life Insurance Company Deny Your Claim due to Lapse of Coverage?
Life insurance companies, like all insurance providers, are constantly looking for any reason to limit a payout or deny a claim. If they cannot find a justification under the language of the policy to deny a claim, they might look for a reason to invalidate the policy itself. They may point to the life… Read More »
How Life Insurance Companies Deny a Claim Using Material Misrepresentation
Life insurance companies will grasp at any reason they can find to deny a payout under one of their policies. If they can find a coverage exclusion, they will use it. If there is no exclusion, the insurance provider may utilize other strategies to avoid paying out on a claim, including by claiming that… Read More »
