It’s a story we’ve heard told over and over again, but still, it remains a seemingly consistent worry in the minds of the insured.
All across the nation, upstanding and responsible individuals are paying their insurance premiums on time. They are working hard and making sure that they handle their financial obligations. Suddenly, tragedy strikes. An injury at work. An accident on the road. A natural disaster that destroys their home.
It’s moments like this when they face some of their biggest challenges in life that they need support and protection the most. They turn to their insurer, expecting their company to be there. You should expect your insurer to honor their responsibility when you keep yours.
But that isn’t always the case, and a recent investigation into insurance giant Aetna proves just that.
Your bad faith insurance attorneys at Millin & Millin have represented hundreds of individuals and businesses confronted with their insurers acting in bad faith. When profit comes before a client, your team at Millin & Millin is there to make sure you obtain the benefits and compensation that are rightfully yours.
In February 2018, a shocking discovery first reported by CNN revealed a 2016 videotaped deposition of Dr. Jay Ken Iinuma, former Medical Director for Aetna in Southern California from 2012 to 2015, admitting under oath that he never looked at patients’ medical records when deciding whether to deny or approve their coverage. Instead, Iimuma claimed that he was simply following Aetna’s protocols and was making his decisions based on what nurses recommended to him.
As the third-largest insurance company in the United States with over 23 million clients, this horrific admission has made quite a wave in the news and with lawmakers.
Iinuma made these statements in a courtroom appearance for a lawsuit filed by Gillen Washington in 2016. Washington sued the company because he was initially denied treatment for a rare immune disorder known as common variable immunodeficiency (CVID). Individuals who suffer from CVID are highly susceptible to infection and often deal with recurring health issues in the lungs, sinuses, and ears.
Washington, 23, sued for breach of contract and bad faith when he was denied coverage for the treatments needed when he was 19 years old. The company claimed that his bloodwork was outdated, and that his treatment wasn’t medically necessary. Without that treatment, Washington eventually suffered pneumonia and a collapsed lung while appealing Aetna’s decision.
Iinuma’s denial of coverage to clients like Washington without properly reviewing medical records is underscored by his admission to not knowing what plagued Washington as well as never having treated a patient dealing with the condition.
A growing number of state and federal agencies have begun to investigate and request additional information to determine whether any laws were broken.
In the state of California, where the suit took place, two different agencies have begun to look into Aetna’s operations including the California Insurance Commissioner Dave Jones, who noted that the story was of “significant concern” to him. Considering that state law requires medical directors who are unqualified to review a patient’s case to seek consultation from another more qualified expert, the news of Iinuma’s action may prove to have been illegal. The California Medical Association and American Medical Association have shown similar concerns to Commissioner Jones.
Three other states have also begun their own investigation including Colorado, Washington, and Connecticut. Interestingly enough, Aetna is headquartered in Connecticut.
Now included in those state investigations, two Democratic senators have written a joint letter to current Aetna Chairman and CEO, Mark Bertolini. Ron Wyden of Oregon, ranking member of the Senate Finance Committee, and Patty Murray of Washington, ranking Member of Senate Health Committee, have requested for the company to release information related to their review process including “specific responsibilities of medical directors, nurses and chief medical officers, as well as any other company employees who are involved in such decisions.”
The senators also noted that, “In 2009, Aetna Health, Inc. and Aetna Life Insurance paid a $256,000 fine to Arizona insurance regulators for, among other things, denying health care provider payments without requesting additional information that could prove the claim valid.”
Sadly, this haunting truth isn’t the first time the insurance industry has been exposed for its seemingly rampant use of bad faith techniques and strategies to deny or underpay their clients. Thus far the company’s response has been that the testimony was “taken out of context”.
If you have any additional questions or simply need assistance with insurance claims and issues contact Millin & Millin at (956) 631-5600 to schedule a free case evaluation. Our compassion, dedication, and personal attention will get you the RESULTS you deserve.
Millin & Millin PLLC is pleased to announce that Gina Karam Millin has joined the Board of Directors of the Texas Civil Rights Project. TCRP believes that legal advocacy and litigation are critical tools to protect and advance the civil rights of everyone in Texas, particularly our state’s most vulnerable populations, and to effect positive and lasting change to law and policy. TCRP believes that by serving the rising social justice movement in Texas with excellent legal representation and bold strategies, they can respond to the needs of the communities served. TCRP has offices in Houston, Dallas, El Paso, McAllen and is based in Austin. To learn more about this outstanding non-profit organization, please visit https://www.texascivilrightsproject.org.
Hurricane season just started (June 1st) and residents all across the McAllen metro area and Greater Rio Grande Valley should begin preparing for these potential storms. While the 2017 Atlantic hurricane season forecast has predicted a lower number of storms than historical averages, it is still always in the best interest of homeowners to take the necessary precautions and steps to ensure that they are protected.According to NOAA’s Hurricane Research Division statistics, the U.S. averages one to two hurricane landfalls each year. While these odds may seem to work in your favor, a hurricane, or even tropical storm for that matter, can prove to be a devastating event both emotionally and financially.
At the bad faith insurance law offices of Millin & Millin in McAllen, Texas we believe that the best way to avoid a bad faith insurance claim is to recognize what your rights are and what your insurance does and does not cover. In order to be fully prepared for a disaster, there are a number of elements to consider.
The most important step you can take to ensure that your home is effectively covered is to carefully read through and understand what your policy covers. While this is a simple action, it is often the most neglected.
Understandably, insurance policies are full of technical jargon that can be difficult to understand for those unfamiliar with the language. But, unfortunately, your insurer will not accept this as an excuse. Contact a legal expert with experience in insurance law to help you better understand your coverage. You don’t want a disaster to strike only to find out you weren’t covered.
One of the most damaging effects of a hurricane or tropical storm is flood damage. Flood water can damage your property, uproot trees, and destroy your house’s interior.
Flood insurance is generally a separate policy that needs to be purchased alongside your traditional coverage. It should be noted, however, that there is a generally a waiting period (30 days) before the policy kicks in.
Waiting until the last moment before a hurricane reaches landfall to purchase this additional insurance rider can mean you will still be responsible for damages caused by flooding.
A best practice, you should take a thorough inventory of everything you own and consider whether you have the appropriate coverage in case of the loss of those items. This can help you to identify the value of the items and any potential gaps in your policy.
You should also take pictures of your valuables, and if feasible, record with video. In fact, “touring” your home and video recording it in its current condition - even if the potential for natural disaster is minimal - is a great strategy to stop bad faith insurance.
An unreasonable deductible can leave you high and dry.
Insurers in coastal areas generally offer separate deductibles for hurricanes and windstorms. Depending on the circumstances of the storm and the various scenarios that can get played out, a high deductible can leave you paying thousands of dollars before the insurance even kicks in.
Have you begun saving for this amount? Or does it make more sense to increase your premium and coverage to lower your deductible?
Aside from insurance considerations, you should also take some real world actions in order to limit the amount of damage that can occur to your property and home. Some of the most important steps you can take to protecting your house include:
Hurricane damage can be varied and affect your home and property in a number of ways. Recognizing where there is a high probability of damage can help you to take the proper steps to securing and protecting your house. The following types of damage are frequently caused by hurricanes:
If you, unfortunately, have to deal with the results of a hurricane, there are a number of steps that you can take after a hurricane to ensure that your insurance claim is properly handled.
While you should NOT commence fixing the damage yourself, you SHOULD take the reasonable steps necessary to stop further damage to your property. This can include covering up areas where water is leaking in or removing debris from broken windows. Insurers will use anything they can against you to deny a claim and might argue that you caused some of the damage if you do not properly take care of the limiting the situation.
After a major hurricane, insurance companies are bombarded with calls and claims, and often set deadlines on claimants. Don’t wait to make a claim. This also ensures damage is adequately taken care of in a reasonable amount of time rather than allowing it to continue growing.
Staying informed and documenting all interactions with your insurance company can help to protect you in the case of bad faith tactics or a claims denial.
Also, just as you should take images of your property and valuables before an event, you should also capture images of the damage after the catastrophe has taken place. These detailed shots (and video when possible) are the perfect evidence to show your insurer.
If you are having to file an insurance claim, it’s likely due to the fact that you have just suffered through a terrible event. Having to deal with the unscrupulous tactics of an insurance company is the last thing you need on your plate during this time.
Depend on the responsiveness of the bad faith insurance legal team of Millin & Millin to get you the justice you deserve when seeking your rightful compensation after a natural disaster like a hurricane.
Contact ustoday at (956) 631-5600 to get the legal representation you need. Millin & Millin serves the greater McAllen metro area and the whole Rio Grande Valley.
Summer offers perfect weather for poolside entertainment. This is especially true here in the Greater McAllen metro area where temperatures can soar into the 100s.
There’s nothing quite like spending a blazing afternoon cooling off in your very own pool or with friends at the local water park. But it is absolutely vital for parents and adults to recognize the risks and hazards associated with pools.
PoolSafely.gov recorded that between 2011-2013 there were over 4,900 pool and spa-related injuries and drownings among children 1-14 years old. Also, more than 50% of drowning victims treated in emergency departments required hospitalization or transfer for further care.
Diving injuries also pose a significant risk to children and adults alike. In more than half of all diving accidents, alcohol use was involved. Additionally, 57.2% of all swimming pool diving accidents occur in water four feet deep or shallower according to “Review of Spinal Cord Injury Statistics Related to Diving and Diving Board Use” from the American Institutes for Research.
The attorneys at Millin & Millin understand that sometimes accidents happen, but the best way to avoid them is to recognize when and how they can occur. Being informed about the most frequent pool accidents that cause serious injury can help you to prevent them before it is too late.
Some of the most common pool accidents include:
Sadly, the Center for Disease Control and Prevention has reported that one in five people who die from drowning are children 14 and younger, with drowning the number one cause of unintentional death in this age group. Even in non-fatal drownings, injuries can cause severe brain damage that can lead to long-term mental health issues. When around pools, parents should never leave a child unsupervised and should provide them adequate safety equipment. Awareness is the first step in safety.
Pool and spa areas pose a high risk of slip and fall incidents, understandably, because the water creates slippery conditions. When coupled with rock-solid cement, slip and fall accidents can lead to some truly serious personal injuries. But a few simple safety precautions can help to lessen the likelihood of a slip and fall accident at a private or public pool including:
Among males, diving ranks fourth in leading causes of spinal cord injuries and fifth for females.
Every year thousands of adolescents are taken to the emergency room because of diving-related injuries, with the majority being caused by headfirst dives. This is especially alarming as roughly 80% of these incidents occur in pools that were 4-feet or shallower - clearly preventable accidents.
While many of these incidents occur in pools, it’s also important to consider that diving injuries can also take place in lakes, rivers, or any other body of water that is used for recreational swimming.
Supervision is the key element to ensuring that a diving injury does not occur to your child or loved one. It is also recommended diving is first attempted with the swimmer’s feet facing downward so that their proximity to the bottom of the pool can be gauged.
Beyond horse playing and dangerous diving attempts, other potential sources of personal injury include product injuries and circulation entrapment.
Entrapment can occur when a swimmer is trapped by the suction of a drain in a pool or spa. If a swimmer’s clothing or jewelry is accidentally caught into the drainage system of the pool, the suction can cause accidental drowning or other serious injuries.
Some ill-designed products can also increase the risk of drowning and cause cases of entrapment as well. Pool cleaning equipment and other products may wrap themselves around the appendages of a swimmer and keep them submerged causing injury.
In these situations, the best preventative measures include:
But accidents happen.
If you are having to file a personal injury insurance claim, it’s likely due to the fact that you or a loved one suffered a terrible accident. Having to deal with the bad faith tactics of an insurance company is the last thing you need on your plate during this time.
Depend on the responsiveness of the Millin & Millin legal team to get your rightful compensation from deceitful insurers.
Contact us at (956) 631-5600 to get help from the premier bad faith insurance lawyers of the McAllen metro and Rio Grande Valley.
One thing the common citizen lives with, without noticing, is the constant construction going on around them. From the new house going up right down the street to the new retail malls popping up everywhere. Something is always being built.All of this construction involves a number of different parties including owners, contractors, builders, suppliers, vendors, and more, who are all involved in some manner in the undertaking of commercial and industrial projects.
The Millin & Millin Attorneys understand that even with the best intentions and efforts to work together, disputes can (and do) arise amongst the many groups involved.
Our experienced attorneys are here to help find a resolution to some of the common construction disputes that arise during a project including:
In 2014, this was the number one reason for contract disputes that arose during construction projects. This trend is still being seen today; it is still the biggest cause of disagreements.
The good news is that this can be easily avoided if a contract is thoroughly reviewed by a qualified attorney before everyone agrees on it.
This can save all parties plenty of trouble as the project moves forward.
This is has become a growing problem in recent years and is something that has to be monitored carefully. Whether intentionally or not, there can be instances where someone involved with construction fails to meet the terms they agreed to.
In these cases, the other groups who are part of the project will typically take some kind of action to rectify the situation. These kinds of disagreements will slow down and distract from other important matters, even after construction has been completed.
When someone places a construction bid, there are assumed working conditions that are part of that agreement. These factors are subject to unexpected changes and surprises, however.
One of the issues that can arise is the condition beneath the surface of a job site.
Regardless of the severity of unplanned differences, the plans that have been laid out will be affected and this leads to disputes.
This is a common occurrence in construction projects because there are so many variables and moving parts to account for, regardless of the size and scale of the job at hand.
If all groups working together laid out a detailed contract, there will usually be clarity regarding who is responsible for handling these excesses. Still, having to foot the bill, with or without a clear plan, has the potential to pit one party against another.
It might seem like common sense to pay somebody when they have finished the work they contractually agreed upon to perform. Sadly, this is not always the case, for a number of reasons.
In the event that they are not paid, a contractor or subcontractor does have legal actions they can take. Usually, place mechanic’s or materialman’s lien will be placed on completed project until there is some kind of resolution.
This is another tough situation that a contractor or subcontractor can find themselves concerning a construction project. When the quality of their work is called into question, it can create a good deal of confusion and discord.
If it is justified, it can still be a lengthy process to decided how to handle the results. There are also cases when these accusations are made to avoid paying someone for the work they have done.
This can lead to the situation as described in dispute number 5.
Construction projects are complex systems of work that require many people to work together toward a common goal. Even the best of teams, in any arena, united with a single vision experience their share of disagreement.
We believe in building a team of construction experts who will analyze and reinforce your claim until satisfactory results are reached. Our experience in construction litigation extends to:
Contact us today at (956) 631-5600 for a free consultation.
The Texas Supreme Court’s opinion was issued on a case between homeowner’s insurance company, USAA Texas Lloyds Co. and Gail Menchaca. The high court reversed the decisions of both the court of appeals and the trial court judgement.
In 2008, following the destruction caused by Hurricane Ike, Gail Menchaca made a homeowner’s property claim to USAA.
An adjuster was sent to investigate the claim, who found minimal covered damage, which did not exceed the policy’s deductible. Because of this USAA declined to pay out any benefits.
Nearly five months later, Ms. Menchaca requested a re-inspection of the damages. USAA sent a different adjustor that essentially confirmed the initial findings. Again, USAA refused to pay out on any benefits.
The insured party sued USAA for breach of contract and for unfair settlement practices that violated the Texas Insurance code. Ms. Menchaca sought insurance benefits under the policy, court costs, and attorney’s fees.
The case was tried to a jury in Conroe, Texas.
The jury first determined that USAA had not breached the contract and thus no policy benefits were owed. While the jury also validated that the carrier had not infringed on five provisions of the Texas Insurance Code, they found that the insurer was in violation of not reasonably investigating the claim.
Because the jury found that USAA had been engaged in unfair trade practices, they awarded Ms. Menchaca $11,350 for actual damages and $130,000 in attorney fees. Nothing was awarded for contract benefits as there was no breach of contract.
Both parties motioned for judgement in their favor. USAA argued that the Ms. Menchaca was not entitled to statutory damages as they had effectively complied with policy standards. The trial court denied this motion and ruled in favor of Menchaca.
The recent ruling by the Supreme Court of Texas reversed these decisions and remanded that a new trial take place using the five new rules they developed.
The Supreme Court outlined five new rules in order to help answer the question of “whether the insured can recover policy benefits based on jury findings that the insurer violated the Texas Insurance Code and that the violation resulted in the insured’s loss of benefits the insurer ‘should have paid’ under the policy, even though the jury also failed to find that the insurer failed to comply with its obligations under the policy.”
The five newly established statutes are as follows:
The manner in which the Menchaca decisions plays out in future cases is still to be seen, but rest assured that your bad faith insurance lawyers at Millin & Millin are diligently following the changes in law that may affect your own situation.
Our bad faith insurance lawyers are strong advocates for McAllen metro residents who have had to deal with bad faith insurance tactics. Our attorneys possess superior experience and the necessary knowledge to bring forth an exceptional case.
Contact us at (956) 631-5600 for a free consultation.
Insurance companies have a number of tactics they use when they are attempting to act in bad faith. One of the most objectionable actions that an insurer can take is to cancel a policy after having received premium payments for years.The attorneys at Millin & Millin recognize such bad faith insurance tactics for what they are and fully believe that no policyholder should ever be subjected to such deceitful behavior.
While insurance companies do have certain rights when canceling a policy, they also have duties owed to the consumer and must follow the terms of the agreement in order to act in good faith. If your insurer has canceled your policy without providing you a written communication explaining their reasoning, then you should immediately contact a bad faith insurance law firm to ensure that you have the proper representation to get what is properly owed to you.
In order to effectively understand when an insurer is acting in bad faith, it is important to first recognize when they DO have the right to cancel a policy.
First and foremost, it is vital that you as the policyholder always read the contract you are signing, or obtain assistance from an experienced lawyer to help you understand the provisions of the policy. It is your responsibility as the consumer to be as informed as possible.
Depending on the provisions of the contract, most insurance companies are usually allowed to cancel a policy within the first 60 days. During this period, the insurer has more leeway when it comes to reneging on the policy.
Some of the legitimate reasons an insurance agency can cancel your policy include:
If your insurer is legitimately able to uncover faults and conditions that make you ineligible for coverage, then they must send you a written notice explaining their reasons for canceling.
This initial cancellation can be repealed and should be done so if you believe that their arguments are invalid.
Your insurer is not allowed to simply cancel your policy for no reason nor without explaining why.
The Texas Insurance Code sets the legal standard for how insurance companies must go about canceling a policy and sets the requirements for the written statement that must be provided to you, including:
Bad faith cancellation can occur through a number of methods including:
If your insurer has acted in such a manner under no reasonable proof, then you may be the victim of bad faith insurance policy cancellation.
Unfortunately, post-claim underwriting is often seen following an insurance claim. This is a transparent attempt to avoid paying out what is rightfully owed to the insured and will often lead to the victim carrying the financial burden of the loss.
Sadly, some insurance companies are going to attempt to act in bad faith in order to keep as much money as possible. If you have made an insurance claim after a disastrous event and your insurer is attempting to claim your policy was canceled, don’t just accept it, fight back with Millin & Millin.
Our bad faith insurance lawyers have advocated for McAllen metro residents who have had to deal with bad faith insurance tactics. Our attorneys possess superior experience and the necessary knowledge to bring forth an exceptional case.
Contact us at (956) 631-5600 for a free consultation.
From thunderstorms to hailstorms and more, Texas has seen record breaking losses and insurance claims increase over the last few years. In 2016, March and April recorded storms that caused more than $4 billion in damages to thousands of homes.
Having to file an insurance claim after a disastrous storm can be a difficult process, especially when insurance adjusters attempt to find reasons not to compensate you correctly. That’s why it’s essential that you do some preparation before a storm even hits to help you reduce potential storm damages.
By preparing your home early from weather damage, you give the insurance less reason to deny your claim, and you are able to utilize the home improvements as proof of you taking preventative measures should your insurer attempt to use bad faith insurance claims against you.
If you are having to file an insurance claim, it’s likely due to the fact that you have just suffered through a terrible event. Having to deal with the unscrupulous tactics of an insurance company is the last thing you need on your plate during this time.
Depend on the responsiveness of the bad faith insurance legal team of Millin & Millin to get the justice you need when seeking your rightful compensation from deceitful insurers.
Contact us at (956) 631-5600 to get the legal representation you need. Millin & Millin serves the greater McAllen metro area and the whole Rio Grande Valley.
A devastating property loss can be an overwhelming experience, leaving you confused, and unsure of what steps to take next. Unfortunately, there are numerous occasions in which large-loss claims are denied, either at home or at a business, and oftentimes these are done in “bad faith.”
Your bad faith insurance attorneys at Millin & Millin understand that after a major property loss, you may not have the fortitude to fight against unfair treatment from your insurer. However, it’s important to remember that you have rights and that you deserve to be treated fairly after making claim.
It’s also beneficial to recognize your responsibility as the insured and to understand what legitimate reasons are given for a large-loss claim denial.
You must take your responsibility as a policyholder serious to prevent a claims denial and to inhibit the insurer from merely taking advantage of you.
Many of these tips fall in line with reasons why you may be denied, so take the necessary steps forward to properly file your claim.
If after several attempts to rectify the issue and negotiate a claim effectively, the insurance company continues to act in a malicious manner, contact Millin & Millin immediately at (956) 631-5600.
Bad faith lawsuits can be complicated, but our experienced lawyers have the know-how to deal with any insurance company—big or small. The Millin & Millin bad faith insurance lawyers of the McAllen metro and Greater Rio Grande Valley even offer free case evaluations.
Let us fight for your rights!
The death of loved one can have a profound affect on our lives. Losing a close relation is difficult enough, but sometimes insurers can make the recovery process much more challenging by not paying out on a life insurance policy.
In Texas, and throughout the United States, life insurance companies generally have 2-year window known as the contestability period. The clock starts the day after the life insurance policy has come into effect.
The contestability period was developed as a means by which to prevent cases of insurance fraud. During this time frame, the insurer has the ability to investigate a life insurance claim by reviewing the life insurance application, the insured's medical history, as well as determine whether there was material misrepresentation.
Unfortunately, families are often unsure what steps to follow after a claims denial, but it is important to remember that you can obtain legal support from bad faith insurance lawyers like Millin & Millin to help you find out exactly why your claim is being delayed or denied.
It is also in your best interest to understand some of the key components of the contestability period so you can avoid any issues should you have to undergo investigation.
There are a number of possible outcomes should your insurer happen to find mistakes in the application or if they determine that misrepresentation occurred:
If your loved one filled out the insurance policy truthfully and correctly, there is no reason that their family should have to deal with the stress of an investigation.
Insurance companies will often utilize this contestability window to avoid having to pay a claim or to reduce the amount paid. If you received a denial from your insurer, then it is in your best interest to contact the bad faith insurance law offices of Millin & Millin in McAllen, TX.
Our experienced and trustworthy team will make sure that the insurers are acting legally and not in bad faith. We know how to deal with insurance companies - no matter how big they are.
Contact us today at (956) 631-5600 for a free case evaluation that can help beneficiaries take action against bad faith insurance company tactics.