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What Types Of Insurance Disputes Does Gianelli & Morris Handle?

Gianelli & Morris is a California insurance law firm that concentrates on representing policyholders who are not receiving the benefit of their policy due to misconduct or mistreatment by the insurer. We handle disputes involving the denial of coverage or claims, nonpayment or underpayment of benefits, wrongful policy cancellations, and other examples of insurance bad faith. Our practice includes representing insureds in the fields of health insurance, life insurance, long-term care insurance, long-term disability insurance, and property insurance.

What disputes have you handled dealing with different kinds of insurance policies?

Insurance companies engage in bad faith insurance practices in countless ways. In our decades of experience, we have seen myriad examples of insurance bad faith. The most common examples are given below, grouped by the type of insurance policy involved.

Health Insurance Denials – When an insured requests coverage for an expensive treatment, be it surgery, medication, or some other procedure, the insurance company responds by claiming the treatment is experimental, investigational or not medically necessary. Time and again, we have seen denials because the treatments were “experimental,” even though they may be in practice in leading hospitals around the country, covered in authoritative peer-reviewed journals, or approved by the FDA. Examples we have seen include:

  • Tumescent liposuction to treat lipedema
  • Prosthetic limbs equipped with microprocessors
  • Artificial Disc Replacement back surgery
  • Proton Beam Therapy for prostate cancer
  • Reconstructive surgery such as breast implants for cancer victims, or removal of excess skin following bariatric surgery

Insurance companies also often deny health claims because they say the services are “not medically necessary.” This is often a shorthand way for an insurance company to deny a claim it thinks is too expensive or widespread.

Life Insurance Denials – When a beneficiary on a life insurance policy follows the rules and presents a claim to the insurer, the company often springs into action – not to pay the claim, but to find a way to deny it. If the insured dies within the two-year “contestable” period, the insurer may deny the claim on the basis the insured made material misrepresentations in the insurance application about his or her health history. Insurers often seize on inconsequential prior conditions or information the selling agent told the insured was not important and did not need to be disclosed in the application.

Insurers can also claim the policy lapsed for nonpayment of premiums, but whole life policies come with complicated structures about how much payment is needed to keep a policy in force. The insurer may have lied or misled the insured about how much payment was required, or they may be lying to the beneficiary now, but often the beneficiary has no way of knowing if the carrier is telling the truth or not.

Long-Term Care Insurance – The costs of long-term care in a skilled nursing home or assisted living facility can be so exorbitant they bankrupt most families in just a few years, so many individuals turn to long-term care insurance to help with those costs. When it comes time to provide benefits, however, the insurer debates you on whether you actually need long-term care or care at the level you are requesting.

Long-Term Disability Insurance – Executives and other high earners are smart to get long-term disability insurance, especially when coverage is provided through a professional association or employment as a fringe benefit. Carriers love to issue these policies and accept premiums for years, but they hate to pay costly claims. Claimants find themselves in a frustrating situation of needing income replacement immediately, while the insurers decide the claimant didn’t provide enough documentation in a timely manner to approve the claim. If the carrier does provide coverage, they often cut off benefits before you are recovered enough to go back to work, and they constantly review your condition and demand proof of your disability month after month. That’s not what you signed up for when you took on this insurance.

Property Insurance – All types of property insurance claims (homeowners, business) can be the basis of a bad faith claim if an insurer improperly denies or delays payment.

Our firm handles insurance bad faith matters ranging from HMO disputes to underpayment to wrongful cancellation, as well as wrongful claim denials. We have gone up against some of the biggest insurers in California, including Anthem, Blue Shield, Prudential, Health Net, and many others. Call our office in Los Angeles for help with a California insurance dispute. We are ready to take on the insurance giants and get you the benefits you need and deserve.

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