Health Claim Denials in Public Sector Plans? Here’s Why You May Be Owed More
The insurance company that covers you as a public employee may be on the hook for far more than just the cost of paying your claim if they have wrongfully denied it. The experienced Orange County health insurance claims denial attorneys at Quincey Law can fight for you and your legal rights.
Because your employer-provided plan does not originate in the private sector, you may have more legal rights. Chief among these rights is the ability to sue the health insurance company directly in state court for bad faith damages if they have violated California law in denying your claim.
Schedule a free initial consultation with an Orange County health insurance claims denial lawyer at Quincey Law by calling us at (866) 945-9175. Just because your coverage comes from a public employer does not mean that you lack the legal ability to fight back when your rights have been violated.
There are various ways that public sector employees receive health insurance coverage in California. The most common form of health insurance benefits is through CalPERS, which has over 1.5 million enrollees. There are other means of coverage for those who work for certain universities in California.
Public Employees Who May Be Affected By Wrongful Claim Denial
Anyone who is employed by a public entity in California may be subject to a wrongful claim denial. The following types of professionals may receive their insurance through their job:
- State employees: Civil servants receive healthcare coverage through CalPERS.
- Special district employees – This class of employees includes transportation workers and those who are on the rolls of other special purpose government agencies
- Public safety officials (including firefighters and police officers)
- Teachers: School district employees, including teachers, administrators and maintenance personnel receive coverage from school district-sponsored plans, often through CalPERS or private carriers.
- University employees: Professors and other university employees are covered through CalPERS or the UC health benefits program.
ERISA Does Not Apply to Public Sector Employee Health Claims
Usually, if you are working for a private employer, your health insurance plan is governed by a federal law called ERISA. However, there are exceptions to ERISA that carve out health insurance plans for public employees. This carve out could actually mean that you could be entitled to more money if your health insurance claim was wrongfully denied.
Even though ERISA may not apply to your case, California has robust laws that protect public sector employees from a wrongful denial of their health insurance claims. If you are filing a claim for health insurance denial under ERISA, you would not be able to sue the insurance company for bad faith. ERISA does not apply to CalPERS provided plans, meaning that there is no bar to a bad faith lawsuit.
The entire legal process is more favorable when you are exempt from ERISA. If the federal law applies, the insurance company’s decision would get some level of deference throughout the process. You would need to first go through the insurance company’s appeal process, and you would not be able to build the record after you have submitted the initial appeal file. Things are much different when you can begin your case in state court, and the insurance company does not get the same level of deference.
You Can Sue the Health Insurance Company Directly
When you are suing an insurance company for a claim denial, not only could you force them to cover your medical care, but you may also be eligible to obtain other damages from them if you can prove that they violated California law. Then, you may be able to receive the following in a settlement or jury award:
- Emotional distress for the ordeal that the insurance company has subjected you to
- Financial losses that you may have suffered from the denial of your claim
- Attorney’s fees
- Potential punitive damages, if a jury concludes that the insurance company’s conduct was egregious (you could only receive punitive damages if you take your case to court and win, and these damages are relatively rare)
As a public sector employee, you have a much more unfettered right to go after the insurance company itself for wrongful conduct. Not only can you overturn a wrongful denial of your claim, but you may also be able to take the fight to the insurance company by seeking damages directly from them.
Contact an Orange County Insurance Claims Denial Law Firm Today
If you are a public sector employee, and you believe that your claim was wrongfully denied, reach out to an Orange County insurance claims denial attorney at Quincey Law. You can schedule a free initial consultation with a health insurance claims denial lawyer by contacting us through our website 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.