Category Archives: Blogs
Insurers’ Duty to Investigate Claims Prior to Denial
When you submit a claim to your California health insurance provider, that insurer must carefully examine your claim before approving or rejecting it. Even when the claim is for coverage of a new or nontraditional procedure, your insurer has a responsibility to consider why it might be the best course of action in your… Read More »
When Can a Health Insurer Cancel an Insurance Policy in California?
If you or a member of your family is going through a health crisis, there are few pieces of news as devastating as hearing that your health insurance policy has been canceled. Abruptly losing your insurance can mean that you’re forced to pay out of pocket for costly treatments, if the necessary procedures are… Read More »
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 »
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 »
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 »
