Bad Faith in Delayed Authorization for Spinal or Orthopedic Surgery
Insurance companies sometimes take more time than is reasonable to process and respond to your claim. If that has happened to you, consider filing a lawsuit with the help of a Rancho Cucamonga insurance bad faith attorney at Quincey Law.
California law imposes a strict limit on the insurance company with regard to the time that they have to respond to your claim. It does not matter whether they intend to delay their response. So long as they have taken more time than is reasonable, you may have a legal cause of action directly against the insurance company, beyond just forcing them to cover your claim.
If the insurance company is giving you the runaround, or they are dealing with you unfairly, speak to an Inland Empire Insurance bad faith attorney at Quincey Law today by calling us at (866) 945-9175. We passionately believe in fighting for the rights of individuals when they are being victimized by big business.
Insurance Companies Can Be Difficult for Orthopedic and Spinal Surgeries
Insurance companies have a relatively high denial rate for both spinal and orthopedic surgical procedures. Spinal surgeries are particularly expensive, costing between $10,000 and $100,000 per procedure. Cost-conscious insurance companies may not approve a claim for spinal or orthopedic surgery in the pre-authorization phase. Not only can you fight the denial of your claim, but you may also be able to pursue damages directly from the insurance company if they acted in bad faith.
Even if the insurance company has not outright rejected your claim, they may take a considerable amount of time before they give you a decision. In the meantime, you may be in a considerable amount of pain. The discomfort can affect your daily life, and it may even keep you from being able to work.
The Law Limits the Amount of Time That an Insurance Company Has to Respond
The insurance company must follow the law in the timeframe that they take to respond to any claim. The law states that the insurance company must give a decision on your request within 40 calendar days of the time that they receive the necessary documentation and information. If the insurance company needs extra time, they must give you periodic updates every 30 days.
All of this occurs against the backdrop of California’s bad faith law. In the handling of your claim, the following may amount to violations of the covenant of good faith and fair dealing:
- Failing to acknowledge and act reasonably promptly upon communications with respect to claims arising under insurance policies.
- Failing to adopt and implement reasonable standards for the prompt investigation and processing of claims arising under insurance policies.
- Failing to affirm or deny coverage of claims within a reasonable time after proof of loss requirements have been completed and submitted by the insured.
Suing the Insurance Company for an Unreasonable Delay
An unreasonable delay is a reason why you may be able to sue the insurance company, regardless of whether they ultimately approve or deny the claim. During this timeframe, you may have suffered a considerable amount. If you can prove that the insurance company unreasonably delayed approval of your claim, it can constitute bad faith. You do not have to prove that the action was intentional. However, if you are able to demonstrate intentional conduct, it may mean that a jury could award you punitive damages if your case goes to trial.
If you win a bad faith lawsuit against the insurance company, you may qualify for the following damages:
- Medical expenses to treat your condition in the meantime
- Lost wages, if your condition renders you unable to work
- Pain and suffering, which can be considerable if you have a spinal or back condition
- Loss of enjoyment of life
- Emotional distress, which can also be a large part of your damages when you are in pain, and you cannot get an approval or denial of your claim
For example, you could be entitled to a significant amount of financial compensation if your medical condition worsened during the time that you were waiting for insurance company approval. You should speak with a Rancho Cucamonga insurance bad faith lawyer if a response to your claim has been delayed. You should also document all communications with the insurance company with the intent of establishing the date where they should have responded and showing that you were pursuing the coverage you deserve.
Contact an Inland Empire Insurance Bad Faith Law Firm Today!
Consult with an Inland Empire insurance bad faith lawyer at Quincey Law when you need to fight back against wrongful insurance company practices. You can contact us by visiting our website or by calling us today at (866) 945-9175.
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.