Broken Bones and Broken Promises: Bad Faith Tactics in Serious Injury Insurance Claims
As a policyholder, the insurance company owes you certain obligations under California law. If they have violated these obligations, a Rancho Cucamonga insurance bad faith attorney at Quincey Law can hold them legally accountable.
If you have suffered a serious injury, you will likely require extensive medical care and numerous procedures. The insurance company may not be there for you when you need them. Depending on the circumstances of your case, you may not only seek to force them to cover your claim, but you may even be able to seek damages in a bad faith lawsuit.
The Rancho Cucamonga insurance bad faith attorneys at Quincey Law make it their mission to get justice for clients when insurance companies have broken the law. Contact us today at (866) 945-9175 to discuss your case and learn how we can help you.
Health Insurance Companies Do Not Always Provide the Care They Have Promised
When you have suffered a serious injury, you are relying on your health insurance company to uphold the legal obligations that they assume as part of your coverage. They may need to approve many claims over time, and some of these can be for expensive medical care and procedures. The insurance company may not want to pay for your care because it can cost them a considerable amount of money. If the coverage is required by the terms of your policy, they do not have this option. Not only may you have the ability to force the insurance company to cover the care, but you may even be able to take direct legal action against them.
Why Insurance Companies May Deny Your Coverage
An insurance company can make your life difficult in many ways when you are relying on them, and denying your claim is just one of them. The law in California is that a health insurance provider is generally required to cover medically necessary care as defined by law and their policy contracts. In other words, they must cover care that is deemed to be clinically appropriate. However, the insurance company may use one of a number of reasons to deny you the care that you need, including:
- Lack of medical necessity is the most common reason for the health insurance company to deny a claim
- The specific medical care is not covered under the terms of your policy
- The claim itself may have been missing key information
- The specific treatment is considered experimental, investigational, or not yet widely accepted by the medical community
Know that the insurance company must perform a reasonable investigation of your claim before it issues a denial. The reason for the denial must be rooted in the terms of your policy. If the insurance company reflexively refuses to cover care that should be covered, or they have done so without investigation, you may have grounds for a bad faith lawsuit, in addition to fighting the denial.
How Insurance Companies Break the Law When You Have Suffered a Serious Injury
It is not just unreasonably denying a health insurance claim that could constitute bad faith for an insurance company. How they handle your claim matters every bit as much. As a seriously injured policyholder, you are relying on prompt responses and communication because your health depends on it. The insurance company may have other motivations at play. Whether it is due to inadequate staffing, or the desire to drag out your claim, they may take an unreasonably long time to respond to your claim with a decision. That alone can constitute bad faith under California law.
Other bad faith tactics that the insurance company may use to delay or deny your coverage may include:
- Unreasonably delaying their investigation of your claim
- Not responding to your claim within a reasonable amount of time
- Unreasonably delaying their payment of your claim
- Misrepresenting the terms of your policy when denying coverage
- Employing biased or incompetent medical reviewers to justify denials
- Requesting documentation that is not necessary to the consideration of your claim (and doing so repeatedly)
If the insurance company engages in any of these practices, you may be able to take direct legal action against them. California law prohibits insurance companies from using bad faith tactics, and you can hold them legally accountable when they do so. In these instances, you may be able to recover damages from the insurance company.
Contact a Rancho Cucamonga Insurance Bad Faith Law Firm
If your insurance company is giving you the runaround, or they have wrongfully denied your claim, schedule a free initial consultation with a Rancho Cucamonga Insurance bad faith attorney at Quincey Law. You can speak with an Insurance bad faith lawyer by filling out an online contact form 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.