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How to Sue a Health Insurance Company

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If your health insurance provider denies your claim for coverage, whether in advance of a procedure or afterward when you seek reimbursement, you do not have to simply accept their judgment. You have the right to appeal their denial, and, under certain circumstances, you may file a lawsuit directly against the insurance provider for compensation. Learn about suing insurance companies below, and reach out to a dedicated Los Angeles health insurance denial lawyer for help regarding a California health insurance policy or claim.

Suing for coverage after internal appeals

When your insurance provider denies your claim for coverage, you have the right to an appeal. California law requires insurance companies to tell policyholders why a claim was denied and how to appeal their claims. If your insurer provides you with an explanation, you can file a letter responding to the coverage rejection and appealing the decision. Typically, you will go through a couple of levels of appeal within the insurance provider system. If they continue to deny your claim, you may then seek an independent medical review of your claim by the California Department of Insurance. After going through the internal and external appeal channels, you and your lawyer can discuss filing a proper lawsuit against the insurance provider.

Suing for bad faith conduct

In addition to seeking compensation for a claim that should have been covered by your policy, you can also sue an insurance provider if they conduct bad faith tactics with regard to your policy and your claims. If your insurance provider engaged in bad faith, you might be able to go straight to filing a lawsuit without exhausting all of the internal and administrative appeals.

There are a variety of bad faith tactics that health insurance providers may undertake, and these tactics may either explicitly violate California law or violate the implied promise of good faith and fair dealing that is present between insurance providers and policyholders. Examples of bad faith conduct by insurers may include:

  • Deliberately misconstruing policy terms
  • Refusing to communicate with policyholders regarding a claim
  • Unjustifiably delaying an investigation
  • Failing to provide a proper explanation for denying a claim
  • Engaging in stalling tactics such as limiting communication or issuing unreasonable demands for documents and evidence
  • Delaying payments on an approved claim
  • Misleading customers about policy coverage before they purchase a policy
  • Deliberately misinterpreting the type of treatment as experimental, cosmetic, or medically unnecessary

If your insurance provider denies your claims wrongfully or engages in any of these other tactics, you can file a lawsuit claiming insurance bad faith. You may be able to recover the coverage amounts that you are owed, compensation for any additional damage that their delays and failure to pay have caused, and additional statutory damages. Speak with a knowledgeable bad faith insurance attorney to discuss your case and find out if you may have a claim for bad faith insurance.

Call For Help With Your California Health Insurance Claims

If you are facing legal issues concerning your California health insurance policy or a dispute over claim coverage, get experienced and detail-oriented help ensuring you get the coverage you deserve by contacting the Los Angeles insurance claim denial lawyers at Gianelli & Morris for a free consultation at 213-489-1600.

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