How to Appeal an Insurance Company Decision?
You may have been expecting your insurance claim to be paid because you have a policy, and your claim should have been covered. If your claim has been wrongfully denied, the Southern California insurance attorneys at Quincey Law can help you take legal action.
The law requires that you be given the right to appeal any adverse decision made by the insurance company. You often begin with their own appeals process. When they give you the inevitable red tape, and persist in denying your claim, you have the right to take your case to court.
Quincey Law takes on powerful corporations like New York Life insurance denials and other life insurance companies, and we can do the same for you when you call us to schedule a free initial consultation and hire us for your case.
You Have the Right to Appeal a Claim Denial
When the insurance company renders an initial decision on your claim, it is not the final word. In many cases, their practice is to reflexively deny claims if they do not fit within the exact four corners of your policy. You have the legal right to challenge a claim denial. The process you follow and the steps you take depend on how you obtain your insurance and the type of policy you have. You may even be able to take action against the insurance company directly if they have committed wrongdoing.
Filing an Appeal of a Denial Under California Law
California law provides a strict set of regulations that insurance companies must follow when doing business in the state. The insurance company must provide you with an avenue of appeal internally, although you have strict timeliness deadlines that you need to observe. Before the insurance company can deny your claim, they must conduct a good faith investigation of it. Then, they must provide you with a written decision explaining the reason why they denied your claim.
You may deal with the insurance company first to dispute their denial. You would provide additional documentation that is aimed at addressing the insurance company’s concerns. If the insurance company persists in denying your claim, you can file a complaint with the California Department of Insurance. However, the state does not have the power to order the insurance company to pay your claim. They may investigate the carrier if they receive pervasive complaints about wrongdoing.
If you purchased your own policy, your best chance at forcing the insurance company to pay your claim is to file a lawsuit in state court for breach of contract. The insurance company has an obligation to follow the terms of the policy, which means that they must pay you if the claim is covered. As the first-party claimant, you may even be able to file a bad faith lawsuit against the insurance company if their conduct was egregious enough.
Filing an Appeal Involving Employer-Provided Insurance
If your insurance was provided to you by your employer, your claim denial becomes a federal matter instead of a state one. For example, you may have received life or disability insurance as an employee benefit designed to make your compensation more attractive. The problem is that you are dealing with an insurance company that has its own financial motivations. They can be very tough when dealing with claims, especially when they involve health or disability insurance.
You have the ability to challenge a claim denial under the framework that is laid out in ERISA. Unfortunately, the process tends to favor insurance companies, but there is nothing to say that you cannot win when the facts and law are on your side.
First, you would need to file an appeal directly with the insurance company under a tight timeframe. You need to take this appeal process seriously because you are limited to using the record that you built at the initial stage of the appeal. Assuming that the insurance company rejects your appeal (as they almost always do), you would then take your case to federal court. A judge would review the same record as the insurance company did, and they would decide whether there was a mistake in the denial of your claim. ERISA lawsuits are often hard fought, and you need an experienced attorney to help you go the distance with the insurance company.
Contact a Southern California Insurance Claim Denial Attorney Today
You can take matters into your own hands when you contact the Orange County firm of Quincey Law for a free initial consultation to discuss your case. We can help you determine whether your claim was wrongfully denied and whether you can file a lawsuit. Call us today at 866-945-9175 to speak with an attorney today.
Nicholas Quincey is the founder of Quincey Law, and has over a decade of experience of handling insurance claims denials and personal injury matters for people throughout California. We have pursued insurance bad faith claims for people involving life insurance, health insurance, homeowners and disability insurance. We also work with clients and families who need assistance filing and pursuing a personal injury matter. Learn more here.