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What to Do if My Disability Insurance Claim Has Been Denied?

Every year, millions of Americans apply for benefits from the disability insurance policy they purchased. More than half of these claims are denied by insurance companies. If you have filed for short-term or long-term disability benefits due to an injury or illness and your application was rejected, what are your options? What should you... Read More »

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ERISA Claims vs. Bad Faith Insurance Cases

Insurance policyholders have rights. Policyholders have the right to hold insurance companies to their obligations as dictated by the terms of a policy as well as federal and state laws. When an insurance company wrongfully denies a claim or engages in other bad faith behavior, the policyholder has the right to dispute that decision... Read More »

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What is a Material Misrepresentation by an Insurance Company?

We’ve all heard the term “insurance fraud.”  Insurance fraud happens when you lie to an insurance company to collect undeserved benefits, such as by burning down your own property and claiming someone else did it so that you can collect a payout.  Well, insurance companies are required by law and contract to be just... Read More »

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How Long Does the Insurance Company Have to Respond to an Appeal?

It can feel as though health insurers hold all the cards when you’re fighting to have a claim approved, and receiving a denial of coverage for the medical care you need can be frustrating and scary. Every California health insurance carrier has its own procedure that policyholders must follow to appeal denied claims. However,... Read More »

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How to Appeal an Insurance Claim Denial

Receiving a denial from your health insurance provider can be scary and discouraging, but denial isn’t always the end of the road. Every California health insurance policyholder has a right to appeal the denial of a claim, either on their own or with the help of an experienced attorney. Read on to learn how... Read More »

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What Does California Law Require from a Health Insurance Grievance System?

In a recent post, we reported on a Department of Managed Health Care (DMHC) survey of the quality of care offered by Anthem Blue Cross to its California policyholders. The survey found 14 serious shortcomings, ten of which were shortcomings in the manner in which Anthem operated its customer grievance system. The DMHC’s report... Read More »

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State Agency Finds Anthem Blue Cross Lacking in Significant Ways

A recent California state agency review of the service provided by Anthem Blue Cross to its policyholders found the healthcare provider deficient in fourteen significant ways. When the agency gave Anthem a second chance to improve its performance score, the insurer showed improvement in only one of the fourteen deficient areas. Learn more about... Read More »

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Report Blasts Anthem for Denying ER Service and Treatment

The California Department of Managed Health Care (DMHC) conducts routine surveys of every California health care service plan at least once every three years, examining such factors as how each plan addresses customer grievances, how it makes health care services available, and the access to and payment for emergency services that it provides to... Read More »

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Why Claims Get Denied: Medical Necessity

Recently, we published an article on denials of claims for health insurance benefits as “experimental,” one of the most-commonly-used excuses for the denial of a health insurance claim. Another commonly-provided reason for California health insurance claim denials is that the sought-after treatment is not medically necessary. Like denials based on the alleged experimental nature... Read More »

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Can You Sue Your Insurance Company for Taking Too Long?

Recovering fully from a severe illness can be a race against the clock. Once your physician has diagnosed your condition and determined the best course of treatment, you naturally want to start that treatment as soon as possible. Most medical conditions will get worse without treatment, and some can even go from treatable to... Read More »

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