California Anthem Blue Cross Claims Denial Lawyer

Attorney Nick Quincey California law allows you to file a bad faith lawsuit against an insurance company when they have committed any of a number of illegal practices. Not only can you be compensated for your actual losses if you win your lawsuit, but you may also receive emotional distress damages and punitive damages.

Attorney Nicholas Quincey at Quincey Law has fought for clients against companies like Anthem Blue Cross when they have wrongfully denied your claim. He has even filed bad faith lawsuits on behalf of clients when health insurance companies have crossed the line.

Quincey Law has office locations in Orange County & San Bernardino County and handles Anthem Blue Cross claim denials throughout the entire state of California. Contact Quincey Law at (866) 945-9175 or fill out a contact form to learn how we can vigorously protect your legal rights to have your Anthem Blue Cross health insurance claim covered.

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Why You May Be Able to Sue Anthem Blue Cross

Anthem Blue Cross may use a number of wrongful practices when processing or responding to your claim. These can include:

Denying your claims without a reasonable basis or with an improper motive
Excessively delaying payment of your claims
Misrepresenting the language of your policy
Taking too long to respond to claims

These practices are illegal under California law, and you may even be able to file a lawsuit directly against Anthem Blue Cross when they occur.

Lawsuits Against Anthem Blue Cross

Anthem Blue Cross has been sued for denying coverage in cases, especially when it comes to cancer treatments. Here are a few examples of cases in which courts have found Anthem Blue Cross liable for denial of coverage:

In Dardinger v. Anthem Blue Cross & Blue Shield, the Ohio Supreme Court upheld a finding of liability when the insurer denied a claim for intra-arterial chemotherapy (IAC) to treat metastatic brain tumors. The executor received $10 million, and Anthem was ordered to pay an additional $10 million to establish a cancer research fund.
A celebrated trial lawyer filed a lawsuit against Anthem Blue Cross Blue Shield when they refused to cover his treatment for throat cancer. They claimed that the proton therapy necessary to treat his cancer was not “medically necessary.”
A class action lawsuit in California accused Anthem Blue Cross of bad faith for its failure to pay for medically necessary prosthetics. The lawsuit alleged that there was a “widespread corporate practice of conducting a limited paper review of medical-necessity claims.”

If you have been denied the coverage that you expect under the terms of your policy, you may be able to take legal action.

Regulator Actions Against Anthem Blue Cross

The California Department of Managed Health Care often takes aggressive actions against health insurance companies when they unreasonably deny claims in violation of state law. They often issue large fines to punish health insurance companies. However, these fines do not do much to get justice for your individual case. For that, you would need to file a lawsuit directly against the health insurance company.

Anthem Blue Cross has often been fined by California regulators. These violations have ranged from failure to make timely reimbursement payments to policyholders to “systemic violations” in its grievance policies. According to one estimate, fines against Anthem Blue Cross constituted 44% of the total fines assessed by the California Department of Managed Health Care over a five-year period.

Bad Faith Lawsuits

Bad faith claims could be the root of your lawsuit against the insurance company. California state insurance law lays out a number of prohibited acts that would be considered unfair and deceptive business practices on the part of insurance companies.

In addition, health insurance coverage is a contract between you and the insurance company. Any party to a contract has an implied duty to act in good faith. If they do not uphold this duty, they can be subject to a lawsuit that could lead to extensive damages.

Challenges in a Bad Faith Lawsuit

Not every health insurance claim denial is automatic grounds for a bad faith lawsuit. People are generally presumed to act in good faith, unless you have specific proof to the contrary. There is a relatively high bar for winning a bad faith lawsuit, although it is certainly possible when the insurance company has acted extremely poorly.

Generally, you would need to show that there was unreasonableness associated with Anthem Blue Cross’ actions. When they have denied benefits that were clearly allowed under the terms of your policy, you may be able to make the showing of bad faith.

Damages in a Bad Faith Lawsuit Against Anthem Blue Cross

If you are able to prove your bad faith claim, you may be entitled to a substantial amount of money. Insurance companies have been held accountable by juries that awarded significant damages due to extremely poor conduct.

Your bad faith lawsuit damages can include the following:

The actual payment that the insurer was supposed to make under the terms of your policy
Emotional distress damages that you suffered as a result of their conduct
Economic losses that you sustained from the wrongful conduct
Attorney’s fees

What may really increase the size of your award is the fact that juries can assess punitive damages against an insurance company. Never underestimate the justice that can be awarded when a group of people see a large company acting in poor ways that cause harm to an average human being. Punitive damages can reach millions of dollars.

What to Do if You Have Been a Victim of Anthem Blue Cross’ Bad Faith

If you believe that Anthem Blue Cross has crossed a line in denying or delaying their response to your claim, you may do the following:

Retain all documentation of your correspondence with the insurance company and the damages that you have suffered
Fully go through the insurance company’s internal appeals process
Reach out to an experienced insurance bad faith lawyer to consider the possibility of a lawsuit directly against the insurance company
File a complaint with the California Department of Managed Health Care, so they can investigate the insurance company’s actions

Call a California Bad Faith Insurance Lawyer Today

Quincey Law handles health insurance claims denials cases against companies such as Anthem Blue Cross throughout the state of California. Call (866) 945-9175 or fill out our confidential contact form to speak to someone at our office. Together, we can seek justice.