Fighting Insurance Claim Denials for Water and Sewer Department Technicians and Street Maintenance Workers

Your health insurance coverage is a crucial part of your job benefits. When the health insurance company does not give you what you deserve under the terms of your policy, the Inland Empire public employees insurance claims denial attorneys at Quincey Law can help.

Your health insurance policy is a contract between you and the carrier. Like any contractual relationship, one party does not get the final say over whether and how services are provided. Not only do you have an external review of a claim denial available to you as an option, but you may also sue the insurance company for bad faith if they have broken the law.

You do not have to be afraid of the insurance company. Schedule a free initial consultation with the Inland Empire public employees insurance claims denial lawyers at Quincey Law to learn how you can hold the insurance company accountable. Call us today at (866) 945-9175 to speak with an insurance claims denial lawyer.

You’ve Worked for Your Benefits; They Should Work for You Too

As a sewer department technician or street maintenance worker, you likely have your health insurance provided to you as part of your job benefits. Your union has worked hard to negotiate a contract that not only provides you with fair pay but also adequate benefits. The problem is that the road to the benefits that you need always runs through the health insurance company, and they have their own motivations at work. You may find yourself or a family member locked out of the coverage that you need to pay for medical care.

When the health insurance company has denied your care, you must recognize that it can just be the starting point of the legal process. The insurance company must give you a reason for the denial, and then you can decide how you will deal with it. If the care is something that should be covered by the terms of your policy, you can take on the insurance company. You may also decide to go through the insurance company’s internal appeal process, even though there is not much of a chance that you can persuade them to reverse their denial.

Should I Seek External Review of the Denial or Sue the Insurance Company?

Assuming that the insurance company denies your internal appeal, you must determine what course of action to take next. If the dispute is over medical necessity, you may seek an external review of the decision from the California Department of Insurance. They administer an independent medical review program that allows an objective third party to make a decision about whether your care should be covered.

There are cases in which there may be a legitimate dispute about whether care is medically necessary. In other cases, the insurance company’s denial simply comes from the fact that they have broken the law. If the insurance company has engaged in bad faith, you do not have to go first to seek an external review. Because you are receiving your health benefits through your job as a public employee, any restriction on suing the insurance company that is found in ERISA does not apply to you. In that sense, you have far more leeway to hold the insurance company accountable for its conduct.

Examples of Bad Faith That May Allow You to Sue the Insurance Company

You can take the insurance company straight to court in a bad faith lawsuit when they have done the following:

• Denying your claim without an adequate record of medical review
• Misrepresenting the terms of your policy in justifying their denial
• Unreasonable delay in authorization or payment
• Ignoring the recommendation of your treating physician or a specialist

While your main goal may be to force the insurance company to cover the care that you or a loved one needs, you may also be able to hold them liable for damages that their illegal behavior has caused. A bad faith lawsuit can accomplish both of these goals. If you can prove your bad faith lawsuit, you may be entitled to the following forms of damages:

• Additional medical expenses to treat your condition or harm that resulted from the denial
• Emotional distress
• Lost wages, if the denial kept you from being able to work
• Potential punitive damages in the event of egregious conduct
• Attorney’s fees

Contact an Inland Empire Public Employees Insurance Claims Denial Law Firm

When you are having difficulty getting vital medical care covered, an Inland Empire health insurance claims denial attorney at Quincey Law can take up the fight for you. We are driven by the prospect of helping individuals stand up to large businesses. Schedule a free initial consultation by messaging us online or by calling us today at (866) 945-9175.