Firefighters, Police, Government Workers: Know Your Rights if Your Health Claim Is Denied
As a public worker, you would receive your insurance through a public plan. If your coverage has been denied, an Orange County health insurance claims denial attorney at Quincey Law can help.
You may be surprised to learn that you have potentially better legal remedies than someone who receives their health insurance from a private company. Because of the governing law, you may even be able to take action directly against the health insurance company. Not only may you force them to pay your claim, but there is a chance that you could potentially receive other damages, such as emotional distress and punitive damages.
Speak to an Orange County health insurance claims denial lawyer at Quincey Law by calling us at (866) 945-9175 to learn whether you can successfully demand the coverage you deserve and possibly receive damages for the harm that you have suffered.
You Can Appeal the Denial of Your Claim
If you are a public sector worker in California, your health insurance coverage is a vital part of your benefits. You are relying on your health insurance to protect you and your family and to cover the medical care that you need. Unfortunately, health insurance companies do not always live up to their legal obligations. You have the ability to take legal action to not only force the health insurance company to cover your claim, but also to potentially seek damages from them.
Public sector health insurance companies do not get the final word when they deny your health insurance claim. You are entitled to due process. The first step towards contesting the denial of your claim is to go through the insurance provider’s internal appeals process. If you choose to do so, you should work to present your strongest possible case as to why your coverage was wrongfully denied. However, the truth is that it is relatively rare to persuade the insurance provider to overturn their own denial of your claim.
You Have the Ability to Sue the Insurance Company
If the insurance company simply will not cover your benefits, no matter the evidence that you have provided them, you have the right to file a lawsuit against them in state court. Since ERISA is not the governing law, you may not have to file your case in federal court. State courts can provide you with a favorable forum for your lawsuit.
The Insurance Company May Not Get Deference
Under ERISA, the insurance company would receive some deference if a court is reviewing the denial of your claim. The court would review your case for an abuse of discretion, which would make it harder to overturn a denial of your claim. When ERISA does not apply, the court does not give the insurance company the same level of deference. Here, the court or jury would conduct their own independent review, beginning your case nearly from scratch to determine whether your claim was wrongfully denied.
You May Be Able to Obtain Damages from the Insurance Company
Because ERISA does not apply, you are free to file a bad faith claim against your insurance company. If the law was broken, such as through an unreasonable denial of your claim without adequate investigation, you may be able to seek monetary damages for the harm that you have suffered. In certain egregious circumstances, it may even be possible to obtain punitive damages from your health insurance company if you take your case to trial and win. The prospect of a bad faith lawsuit should give you some leverage when you are fighting back against a wrongful denial of your health insurance claim.
You Need a Health Insurance Claims Denial Attorney
You would not stand much of a chance of successfully fighting health insurance providers in court if you do not have the help of an experienced Orange County health insurance claims denial lawyer. Your attorney could present your strongest possible arguments in court, including evidence that the health insurance provider may have acted in bad faith. The insurance provider may be more likely to take you seriously if they see that you have an experienced attorney advocating for you.
Contact an Orange County Health Insurance Claims Denial Law Firm
If the insurance company is denying you the care that you believe you are eligible to receive, reach out to an Orange County health insurance claims denial attorney at Quincey Law today. Our health insurance claims denial lawyers are standing by and ready to speak to you during a free initial consultation, which you can schedule 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.