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Protecting Your Policyholder Rights

After you buy insurance, you should receive a contract which explains the claims that are covered and those that are excluded – or not covered – by your insurer. You should do your best to understand what is covered under your policy but sometimes, the contract does not tell you everything and it may be difficult to understand or it may not be provided to you at all. This is true with all types of insurance contracts or coverage policies but there are California statutes and regulations that require insurers to follow certain rules and disclose important information to you. This does not always happen and in some cases your insurer may violate California law without you even knowing it. That is why it is important to have a firm like Gianelli & Morris protecting your rights.

Health Insurance

When you sign up for health insurance whether you purchase it on your own or your employer provides it , your insurer or your employer should provide an Evidence of Coverage (“EOC”). This is the contract that tells you the health care services that are covered and those that are not. California law requires insurers and HMOs to provide certain healthcare services even though your insurer may tell you a service is not covered. An example of this is reconstructive surgery – many times an insurer or HMO will tell you that it considers a reconstructive procedure to be cosmetic and not covered. For example, if your child is born without an ear or with a cleft palate, the insurer may deny the claim and argue that your child can still hear or eat. Another example is breast reconstruction if you have had a mastectomy for breast cancer. Yet another example is removal of excess skin remaining after bariatric surgery for morbid obesity. In all of these situations, California law requires that your plan pay for reconstructive surgery. If your insurance company has denied coverage for a reconstructive surgery because it claims it is cosmetic, contact Gianelli & Morris immediately.


Another complex insurance product is an annuity. Insurance companies market annuities as a retirement vehicle to seniors and people who are approaching retirement. In today’s economy, annuities can be a good investment, however there are things the insurance company may not tell you when you purchase an annuity. Some companies promise that they will add a bonus to your initial premium, others will tell you all of your premiums work for you leading you to believe there are no up-front costs. What they don’t tell you is that over the life of your annuity (in many cases you cannot take more than 10% of the value of your annuity out each year without incurring a substantial surrender charge) the insurance company credits lower interest rates to recover the cost of the bonus and the commission is paid to your insurance agent. This is never disclosed in your contract and hurts the performance of your annuity because the insurer pays lower interest rates on your investment.

Life Insurance

When a loved one passes, some insurance companies refuse to pay on a life insurance policy. In reality, there are very few justifications that allow an insurer to refuse to pay a claim on a life insurance policy and after two years of receiving premiums they cannot refuse to pay even in cases of suicide or if they claim that your loved one misrepresented something on the application for insurance. If this happens, Gianelli & Morris can help.

The following is a brief list of some of the rights policyholders have, including:

  • Insurance Good Faith: your insurer must honor its promises to you, it cannot wrongfully deny a claim or fail to conduct a proper investigation;
  • Your insurance company must thoroughly investigate your claim before it is denied, delayed or underpaid;
  • Your insurance company must put your interest before their own;
  • Your insurance company must promptly pay all legitimate claims covered by your contract;
  • Your insurance company cannot rely on exclusions that do not apply to your situation and must provide you with all information it relied on if it denies your claim.

Gianelli & Morris – Focusing Exclusively on Your Rights

If you need help dealing with an insurance company, it makes sense to contact Gianelli & Morris. We are experts in insurance law – protecting policyholders is all we do. With focused skills in all aspects of insurance, you can be sure that Gianelli & Morris will assist you with every aspect of your case. Our team is highly qualified in analyzing your claim issues and helping you understand whether you should pursue legal action. We believe that your rights as a policyholder are the top priority in any insurance case and we want to help you receive all that you are entitled to under your policy. Contact Gianelli & Morris to discuss your case today.

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