Insurance Denials/Bad Faith Information, News & Blogs
Does Egan’s “managing agent” rule survive 40 years later?
Most Insurance Bad Faith Cases Involve A Fight Over The Managerial Status Of The Employees Who Denied The Insured’s Claim Forty years ago, the California Supreme Court upheld a punitive-damage award against an insurer based on the acts of a claims adjuster in denying a single claim. Because the adjuster had the authority to… Read More »
Blue Shield is Overcharging Policyholders in Violation of California Law
Maintaining continuous health insurance coverage is critical, especially if you or other members of your family have a serious health condition. In the current market for health insurance, premiums are subject to rise a substantial amount each year, sometimes making policyholders’ current plans unaffordable for the following year. Policyholders are entitled to written notice… Read More »
Gianelli & Morris File Class Action Complaint Against Aetna for Refusal to Cover Medical Procedure
Insurer says procedure is “experimental and investigational,” despite years of FDA approval and countless successful operations On August 7, 2019, attorney Robert Gianelli filed a class action complaint in the United States District Court for the Central District of California alleging insurance company Aetna breached a duty to its policyholders by refusing to pay… Read More »
Claim Denials Based on “Experimental” Treatments
When insurance companies get it wrong, Gianelli & Morris makes it right Health insurance providers rely heavily on three reasons for denying their insured customers’ claims for health care benefits: that the sought-after treatment is experimental, that it is investigational, or that it is not medically necessary. Often, these reasons for claim denial are… Read More »
Anthem Blue Cross Receives Hefty Fine for Failures in Handling Customer Complaints
Anthem Blue Cross, one of California’s largest providers of health insurance, has recently reached a settlement with the California Department of Managed Health Care (DMHC) to address major flaws in its handling of customer complaints. Anthem will now be compelled to spend over $11 million in fines and investment in improving the customer grievance… Read More »
How Does a California Insurance Bad Faith Claim Work?
Health insurance is designed to provide its customers with care when they become sick or injured, yet insurance companies are known to unreasonably deny claims for coverage that would cut into their profits. Insurance companies already rake in billions of dollars in profits through the premiums they collect; refusing to pay valid claims is… Read More »
Insurers Facing Lawsuits over Denials of Microprocessor Prostheses
Losing a limb can change someone’s life forever. While it may never be possible to regain full mobility or use of the limb that was lost, prosthetic technology has come a long way in developing prostheses that can respond to surface conditions in real time. Sadly, many patients who would benefit from these technologies… Read More »
Lawsuit Charges Kaiser Foundation Health Plan with Unfairly Denying Coverage to Treat Lipedema
On May 16th, the California insurance law firm Gianelli & Morris filed a complaint in the Superior Court of Los Angeles County in the case of Elena Valencia, et al. v. Kaiser Foundation Health, Plan, Inc., Case No. 19STCV17131. The lawsuit alleges that Kaiser breached its contractual duties and acted in bad faith by… Read More »
ADR Can Yield Better Results than Fusion, so Why Do Insurance Companies Try to Deny It?
Artificial Disc Replacement (ADR) surgery has existed as an alternative to spinal fusion for over 30 years. Many doctors and researchers will attest that ADR provides more successful outcomes for patients than spinal fusion, offering a shorter recovery period and reducing the likelihood that patients will need additional surgical procedures in the future. ADR… Read More »
What is the Statute of Limitations for a Bad Faith Claim against a California Insurer?
California residents who enter into a contract for health insurance have a right to expect that, if they pay all premiums and co-pays, their injuries, illnesses, and other medical needs will be covered by their insurer according to the terms of their coverage. If benefits are withheld without good reason, the insurer may face… Read More »
