Denied MRI, CT, or Surgery After an Injury? It May Be More Than Just a Disagreement
After you or a loved one has suffered an injury, you are relying on your health insurance company to provide the coverage that you need. If they fail to do so, a Rancho Cucamonga health insurance claims denial attorney at Quincey Law can help you fight back.
The insurance company may deny your claim, hoping that you may not take the case any further. As a policyholder, you have the ability to take on the insurance company, both obtaining a review of their initial decision and potentially suing them directly. Denying you the care that you need after you have suffered an injury can be far more than just a difference of opinion. It can represent a manifest violation of the law, for which the insurance company can be held accountable.
Take the first step towards obtaining justice by calling a Rancho Cucamonga health insurance claims denial lawyer at Quincey Law. Our mission is to take on big business on behalf of our clients, to whom we give a voice.
Legal Issues When a Health Insurance Claim Has Been Denied
The term “coverage disagreement” actually gives more legitimacy to an insurance company’s actions than they may deserve when they have denied crucial medical care. What is really going on are two separate yet related questions, the answers to which can determine both whether the insurance company is required to cover the care and whether they may potentially owe you money and damages. Those two questions are as follows:
- Is the insurance company legally obligated to cover the specific care that you need through the terms of your policy?
- Has the insurance company’s denial of your care crossed the line into bad faith, where they would owe you compensation for their wrongful actions?
The Insurance Company May Be Legally Obligated to Pay for Your Care
Health insurance companies in California have been denying claims at an increasing rate in recent years. Oftentimes, the insurance company will claim that the care that you need is either not medically necessary or it is experimental in nature. When you have suffered an injury, it should go without saying that an insurance policy should cover things like a magnetic resonance imaging exam or a CT scan. However, insurance companies often balk at the cost of these exams, and they may find various reasons to deny claims.
The problem can be even more intractable when a surgical procedure is involved. Some post-accident surgical procedures can cost tens of thousands of dollars or more. The cost of the procedure should not be your problem. If it is covered by the terms of your policy, you would only be responsible for your share of the costs. Yet, insurance companies routinely deny claims for surgeries that policyholders or their family members critically need. They often couch these denials in terms of legitimate reasons why they may refuse to cover care. However, these denials often do not hold water, and the real reason is that the insurance company does not want to pay the money.
At this point, the denial becomes a matter of breach of contract. When you pay premiums for a health insurance policy, or one is provided to you through your job, the insurance company assumes a contractual obligation to provide the care that you need, even if it will cost them a considerable amount of money. A breach of contract is something that is actionable through the courts. If the insurance company is refusing to uphold the obligations it owes you under the terms of its contract, you have the ability to file a complaint or case on numerous levels to force them to provide this coverage.
A Claim Denial May Mean a Bad Faith Lawsuit
Moreover, bad faith laws may also come into play if the insurance company acted illegally in denying your claim. To be clear, not every coverage dispute would rise to the level of bad faith. The insurance company may break the law when they deny your claim without adequate investigation, or their denial has no basis in the terms of your policy. When that happens, you can certainly fight to force the insurance company to cover the care that you need, but you may also take direct legal action against them in court. Insurance companies fear bad faith lawsuits because there could be disastrous consequences. The insurance company may be ordered to pay you damages for their illegal conduct, which could include a punitive award.
Contact a Rancho Cucamonga Health Insurance Claims Denial Law Firm
If you believe that you have had medical coverage that you deserved kept from you by an insurance company, speak to a Rancho Cucamonga health insurance claims denial attorney at Quincey Law. Call us us today at 866-945-9175 or fill out an online contact form.
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.