Category Archives: Blogs
Fighting a Health Plan’s “Investigational” Denial of a Medical Claim
Health plan contracts typically have exclusions for treatments that an insurance company considers “investigational” or “experimental.” Health plans say there is insufficient proof demonstrating that certain treatments are safe and effective for their intended use, making them investigational or experimental and not a covered medical benefit. Whether a particular treatment is investigational or experimental… Read More »
Addressing the Defenses of Abstention, Primary Jurisdiction and Exclusive Jurisdiction in Insurance Class Actions
Published in: Advocate – Journal of Consumer Attorneys Associations for Southern California, September 2016 Issue Authored by: Robert S. Gianelli Downloadable format: To download this document in .pdf format [Click Here] I. Introduction So you have just filed an insurance class action and you are very excited. You have substantial evidence that the defendant… Read More »
Use and abuse of medical necessity criteria – Health insurers’ denial of the Hepatitis C drug Harvoni
Use and abuse of medical necessity criteria – Health insurers’ denial of the Hepatitis C drug Harvoni. These drugs offer a cure for the estimated 3.2 million people living in the United States with chronic Hepatitis C infection. Published in: Consumer Attorneys Of California January/February 2016 Authored by: Robert S. Gianelli Downloadable format: To… Read More »
Zhang v. Superior Court
(2013) 2013 Cal. LEXIS 6520 The Zhang case represents a victory for California insureds who have had to endure misconduct in the handling of their claims by their insurers. For many years, insurers were able to avoid liability for mishandling claims by taking cover under the Unfair Insurance Practices Act (UIPA) (Insurance Code… Read More »
Insurance Agents vs. Insurance Brokers
INSURANCE AGENT OR INSURANCE BROKER: A DISTINCTION WITH A DIFFERENCE Published in: Advocate – Journal of Consumer Attorneys Associations for Southern California – June 2013 issue Authored by: Robert S. Gianelli & Jully C. Pae Downloadable format: To download this document in .pdf format [ Click Here] Disputes often arise over whether a particular… Read More »
Certifying the Insurance Class-Action Case
ONLY 14 PERCENT OF INSURANCE CASES FILED GET CLASS CERTIFIED, BUT 90 PERCENT OF THOSE WILL SETTLE Published in: Advocate – Journal of Consumer Attorneys Associations for Southern California, November 2011 Issue Authored by: Robert S. Gianelli Downloadable format: To download this document in .pdf format [ Click Here] A 2007 study by the… Read More »
Seeking Class Certification of an Insurance Case
CARE MUST BE TAKEN TO ADDRESS EACH OF THE RELEVANT CLASS-CERTIFICATION ELEMENTS- A LOOK AT THE DO’S AND DON’TS Published in: Advocate – Journal of Consumer Attorneys Associations for Southern California, August 2014 Issue Authored by: Robert S. Gianelli Downloadable format: To download this document in .pdf format [ Click Here] Many types of… Read More »