Fighting Insurance Claim Denials for Teachers

You have come to expect coverage from your health insurance when you need it. When it is not there for you, and it is supposed to be based on the terms of your policy, Quincey Law can help you take action.

As a teacher, you are allowed to challenge any denial of your claim in an attempt to force the insurance company to pay what you deserve. Depending on the circumstances, you may even be able to file a bad faith claim directly against the insurance company when they have engaged in an egregious violation of the law. You  can and should fight back when the insurance company has broken the law.

Schedule a free initial consultation with an Inland Empire insurance claims denial attorney by calling our insurance law firm in California at (866) 945-9175. We take on big business on behalf of our clients, fighting for just and fair results.

How Teachers Get Health Insurance in California

California teachers get their health insurance coverage through their jobs. They have insurance provided through private insurance carriers. Health insurance coverage is often negotiated in collective bargaining agreements at the district level. When you receive coverage, it is through a for-profit insurance company who receives part of their premium from you and the other part from your employer.

You are at the mercy of the insurance company and whether they choose to pay your claim. Just because you are a teacher and a public employee does not necessarily mean that the insurance company will be any more likely to follow the law with your claim.

How to Get Your Health Insurance Claim Covered if it Has Been Denied as a Teacher

Anytime that your health insurance claim is denied, you have an appeal mechanism to contest the insurance company’s decision. You can fight to force them to cover your claim, and you can even take your case to court. Your first priority is to get the care that you need that you are entitled to under the terms of your policy. Depending on whether the insurance company broke the law, you may be able to take additional action against them to make things right.

You Can Take Action Directly Against the Insurance Company

When you take action to recover the damages that you have suffered from a denial, it would be against the insurance company itself in a bad-faith claim. California law specifies exactly what an insurance company must do when you file a claim and the actions that they cannot take. For example, if the insurance company wrongfully denies your claim without investigation, or in the face of overwhelming medical evidence that it is necessary care, it could be a violation of the law. Then, the insurance company may owe you money directly for how you have suffered due to their actions. It may even be possible to recover punitive damages, depending on the level of egregiousness of the insurance company’s actions. You could be entitled to a substantial amount of Damages if you fight and win. Your damages in a bad faith lawsuit can include the following:

• Additional medical expenses necessary to treat your condition due to the initial denial of your claim
• Other economic losses that you have suffered, such as lost wages, because you should have been able to return to work if you had gotten the necessary treatment
• Emotional distress for the ordeal that you were forced to go through
• Possible punitive damages (as discussed above)
• Attorneys’ fees

You Can Sue for Bad Faith for Denied Health Insurance Claims

The good news is that you have a much more likely path to fighting the insurance carrier and potentially obtaining compensation if they have wrongfully denied your claim. In most cases, when you have received insurance coverage through your job, there is a federal law called ERISA that applies. When this is the case, you must go through the internal appeals process first, and courts may apply a deferential standard of review when you are fighting the denial. Then, you may not be able to sue the insurance company for bad faith. There is an exception to ERISA for public employees. Here, you can and should hold the insurance company accountable. You can do so with the help of an Inland Empire insurance bad faith lawyer who knows how to fight on your behalf.

Contact an Inland Empire Insurance Claims Denial Law Firm Today

If your claim has been wrongfully denied, you can go on the offense against the insurance company by speaking to an attorney at Quincey Law. Our Inland Empire insurance claims denial attorneys take an aggressive approach to fighting for you to get the coverage you deserve and potentially seeking damages from the insurance company. You can schedule a free initial consultation with an insurance claims denial lawyer by filling out an online contact form or by calling us today at (866) 945-9175.