Although the fraudulent acts of an insurance company can be subject to penalty and are a direct violation of a state’s insurance code, insurers persist in taking part in these malpractices to retain financial stability.
The individuals who continue to be a target of these violations are its policy holders and have had to face unlawful circumstances, especially when they have found themselves filing a claim for a situation that requires financial attention.
But who exactly is educating insurers on unethical tactics and entertaining the wrongdoing of policyholders?
Were you a victim of bad faith insurance practices? Let the team at Millin and Millin represent your bad faith case and bring you the compensation that is owed to you.
Give us a call for a free case evaluation at 956 631 5600.
A published article by Bloomberg asserts that insurance companies are hiring consultants who develop strategical concepts that aid in their profit goals.
Allstate for example is one of many insurance companies benefiting from corporations such as Mckinsey and Company for effective management strategies.
In fact, after hiring Mckinsey and Company in 1992, Allstate learned concepts that improved the efficiency and profitability of the company.
Through court documentation, it was shown that Mckinsey would advise insurance companies to make low offers in the event of a consumer claim.
It was also noted that Mckinsey encouraged insurance companies to delay a settlement so that they had in their possession, more income for investments.
Although felonious and very anti-consumer, the services offered by McKinsey were unbelievably effective and did not go in vain.
After directly assisting Allstate in their mission for profit making, Allstate began to implement these practices and creating the desired change.
These transformations were directly seen in Allstate’s loss ratio; the ratio of claims paid.
In the 1990’s, the ratio was dropped from seventy-nine percent to fifty-eight percent in 2006.
This massive drop was undoubtedly per the recommendations offered by Mckinsey, and the direct reason for its profit increase and stock value.
Bloomberg also asserted that Mckinsey’s advice generated drastic profit increases and Allstate was not the only company gaining financial benefit.
Farmers Insurance for example also engaged in these malpractices and gained an increase of 4.8 billion dollars.
The source detailed that Mckinsey suggested insurers to train their representatives to make very low claim offers in return for merchandise and financial bonuses.
Insurance representatives were counseled to lie to policyholders and have them believe that they were fully covered, but offered only thirty to sixty percent, when claimants filed for a damaged property.
With so much corruption between insurers and organizations who can care less about the people who are negatively being affected, it’s hard not to wonder if consulting firms are also responsible for the close relationships between insurers and insurance commissioners.
Throughout the years, numerous cases involving unethical insurance practices have proven that the insurance industry has become a profit leader by purposely harming its policyholders.
Lamentably, the insurance companies involved in these illegal acts are the same ones that spend billions of dollars persuading consumers to purchase their policies while guaranteeing the best coverage and compensation during an unfortunate event. The unfortunate truth is that not all insurance companies intend to provide their policyholders with the help that the individuals sign up for.
Although insurance bad faith acts are illegal and insurance companies face the risk of being penalized, it still occurs with the sole purpose of increasing revenue.
Have you been victimized by the unethical acts of an insurance company? Are you struggling to receive a fair compensation? The tough team of attorneys at Millin & Millin have helped and fought for the rights of a multitude of individuals. Call us today for a free case evaluation at (956) 631-5600.
Denying a claim is probably the most common malpractice utilized by an insurance company to continue increasing profit. In fact, there have been numerous cases in which individuals have been involved in severe accidents caused by other drivers, and which has left them in a coma, with collapsed lungs, and multiple injuries.
However, insurance companies identify these claims as acts of road rage, which therefore do not fall in the category of an accident.
But there is more than just denying your claim for unethical reasons; the most appalling insurance malpractice is delaying a claim until the death of an insured.
This act mostly happens to long-term policyholders such as senior citizens, with a history of medical conditions. Insurance companies know the health conditions of their policyholders and often take advantage of age and unhealthy condition.
As per the words of a regulator, “The bottom line is, insurance companies make money when they don’t pay claims, and will do anything to avoid paying because if they wait long enough, policyholders will die.”
Policyholders who have been victims of any kind of unfortunate situation, whether a traffic accident or a catastrophic event, often feel a sense of ease when they realize that their insurance provider will make up for any loss.
Unfortunately, policyholders face deeper challenges that often lead to major economical burdens. One of these burdens is being lied to about the type of damages that are covered by their policy.
In 2005, a policyholder in Mississippi suffered over $130,000 worth of damages when Hurricane Katrina struck his home.
The damages included flooding of the lower level of his home. Although the individual was supposedly covered by hurricane insurance, his insurance company pointed to the anti-concurrent clause of his policy, which concluded that his losses would not be covered.
The man testified that his insurance agent had told him that he did not need flood insurance and explained that the insurance company responded to his claim by saying he should’ve read his policy papers – papers that he had only received after he purchased the insurance.
Even more so, insurance companies do not always use plain English language in their forms and policies. Policyholders are often confused with the terminology used in their policies, which is another fraudulent tactic that keeps these disreputable companies increasing profit.
Auto insurance companies for example, also increase their profit by utilizing credit scores to develop their policies different for each individual. If you are the kind of person who finds it convenient to pay your purchases in cash, you may face a premium increase of over 100% for having no credit on file.
Furthermore, policyholders can have an impeccable driving record, no claims on file, and be eligible for many driver discounts, but will not qualify for a lower rate if they have no credit score.
The way insurance companies justify the credit scoring is by assuming that if you are careless about credit then you must be a careless driver or irresponsible property owner. This mostly affects less fortunate individuals who have no credit on file.
The element that makes this type of situation even more alarming is that insurance companies also investigate a policyholder’s lifestyle. One’s hobbies and grocery lists can be used to determine a policyholder’s premium, and work in favor of the company, thus helping them to stack up on profit.
‘Tis the season to be jolly, but if you’re unfortunate, the holiday season can also mean personal injury. Every year, thousands of people end up in the hospital because of holiday-related injuries. Whether you’re putting up lights, hanging wreaths, preparing a festive meal, traveling, or just working in wintry weather, you’ll want to be a little bit more cautious and patient, as one bad step can send you to the emergency room.
The attorneys at Millin & Millin, PLLC understand that sometimes accidents happen, but the best way to avoid them is to recognize what steps you can take to keep them from happening. So take into account the following holiday safety tips to ensure you and your family enjoy a safe and cheerful holiday season.
One of the most commonly reported decorating injuries involves slipping and falling.
With thousands climbing up on roofs and ladders to decorate houses and Christmas trees, it’s no wonder that we sees hundreds of slip and fall injuries during the holiday season. Consider the following safety tips to avoid a horrible accident:
Don’t let holiday travel dampen your holiday cheer.
Traveling means lifting and carrying baggage, but you’ll want to be extra mindful of your body to avoid common neck, back, and shoulder injuries. In fact, these injuries are so common that the Consumer Product Safety Commission reported 75,543 luggage-related injuries in 2013. So as you travel to visit loved ones consider the following tips:
Be careful when carving.
Turkey, ham, roast, and pies are all delicious holiday traditions, but they also require knife safety. The American Society for Surgery of Hands reports that hand lacerations are one of the leading causes of holiday injuries, so be wary and take care of those free fingers to avoid a carving injury. Here are some simple tips to remember:
An electrical shock is not the holiday surprise you need.
Electrical accidents are common during the holiday season because of the use of Christmas lights. Overloaded outlets and frayed wires can have horrific consequences on an unsuspecting victim, so remember to use the following tips to avoid an electrical shock:
This time of year can be especially hectic with huge to-do-lists that cause safety measures to be overlooked, and even then, sometimes the safest families have accidents.
If you are having to file an insurance claim, it’s likely due to the fact that you just 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.
Every insurance company owes it to their policyholders to act in good faith. When an insured individual has been involved in a circumstance that directly affects his or her way of life, the policyholder usually files an insurance claim immediately so that compensation can be granted and to diminish unexpected financial burdens.
Lamentably, policyholders face deeper issues when their insurer deceives them.
Although acting in bad faith, or implementing unfair practices in a valid claim, is out of compliance with the Texas Insurance Code, insurance companies sometimes prefer to not fulfill contractual obligations for their own advantage.
Are you currently dealing with a bad faith insurance situation?
Let the attorneys at Millin and Millin represent your case.
Although insurance companies are responsible for bad faith practices, insurance adjusters also play a role in this wrongful behavior. Adjusters have the responsibility of processing and properly investigating a claim, developing reasons why a claim should be denied, and figuring out whether the policyholder was at fault in a given incident.
In most cases, adjusters will spend hours investigating and trying to find details and evidence that can aid in denying a claim. These acts help adjusters implement claim evaluation techniques that can have a negative effect on a policyholder’s claim.
Courts around the nation have concluded that an insurance company must have systems that their adjusters can depend on when evaluating a claim. Although a bad faith act should never be a company standard, nobody truly knows exactly how insurance companies operate, so it’s difficult to get a full disclosure of what happens behind closed doors. There are, however, recognized tactics that are utilized by insurance companies.
Below is a list of examples that can aid in identifying a bad faith act:
There are certain steps that can be taken if you believe that your insurance company is acting in bad faith. Those include contacting the adjuster’s supervisor or taking legal action in an attempt to recover what is owed to you.
Most people begin by gathering all the facts and vital proof that can be used to back up their assertion. It is also advisable that claimants keep their cool when attempting to contact a supervisor about the matter; cooler heads prevail and will help you to receive the attention of a higher authority rather than being disregarded as a vexed claimant.
After your conversation, stay in contact, and following up as needed. Make sure that you send a certified letter to both the supervisor and a copy to the adjuster. Summarize all the elements that were discussed by phone and add an additional paragraph that details why you believe your adjuster acted in bad faith.
Conclude by saying that you are hopeful that both the insurance company and adjuster will begin a fair negotiation of your claim and that you will seek legal representation if the situation does not change.
If you find that your claim was rejected even after attempting to come to an honest agreement, then do not hesitate to contact the attorneys at Millin & Millin. Our litigators 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.
The holiday season is one of the most joyous times of the year. There’s a wonderful abundance of family, friends, festivities, and cheer. But there’s also an increased risk for a holiday mishap. Especially fires.
Naturally, the first instinct is to turn to your homeowners insurance company after a disaster. Once a claim is filed, your insurer will send over an adjuster to evaluate the damage. Sadly though, the adjusters are representing the company’s interest first and foremost, which means the homeowner gets the short-end of the stick.
In a catastrophic house fire, for example, the insurer will often recommend a professional cleaning service to clean the carpets, furniture, etc., rather than pay replacement costs.
Rather than have to deal with the consequences of a bad faith insurance claim, consider taking the necessary steps needed to reduce these risks.
The National Fire Protection Association (NFPA) issued a report in 2015 that showed that between the years of 2009-2013, Christmas trees were responsible for an estimated 210 house fires per year; this lead to an annual average of 7 deaths, 19 injuries, and $17.5 million in direct property damage.
Although Christmas tree fires are not very common, when they do occur, they are more likely to cause serious damage. Consider the following recommendations to avoid a fire hazard:
The same study completed by the NFPA found that U.S. fire departments responded to an average of 860 home fires during the same time frame (excluding Christmas trees). Annually, these fires account for an average of 1 death, 41 injuries, and $13.4 million in direct property damage.
Additionally, candles accounted for 38% of home decoration fires, with half of those occurring during the month of December. Remember the following candle safety tips to avoid a holiday tragedy.
Fireplaces are uncommon in the McAllen metro area, but electric space heaters are still widely used during those occasional winter cold fronts. While necessary for many families, the NFPA urges caution and ask the public to practice safe heating tips. Though electric space heaters only account for 32% of home heating fire involved space heaters, they cause 79% of home heating fire deaths.
The leading factors for space heater fires includes the equipment being too close to combustible items such as furniture, clothing, and mattresses, as well leaving the space heater unattended.
Millin & Millin bad faith insurance lawyers offer the following tips.
Even the most vigilant, safest family has accidents. 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 Millin & Millin legal team 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.
What on the outside appear to be simple meetings with State Department of Insurance employees and insurance companies, has individuals worried that these engagements are actually being used to persuade regulators to approve increased premiums.
Perhaps most tellingly, insurance companies are spending hundreds of thousands of dollars developing meetings at prime vacation spots where regulators have access to free meals and other privileges.
It appears that close relationships between state insurance commissioners and insurers are the leading reason why consumers are at greater risk of unfair treatment.
Have you been treated unfairly by your insurance provider? Let Millin & Millin Attorneys advocate on your behalf and help you take advantage of your legal rights.
Throughout the nation, insurers have played an influential role in the decisions of insurance commissioners, and while state commissioners are supposed to regulate the insurance industry fairly and protect policyholders, it appears that insurance companies have corrupted the system.
For example, an Arkansas case in 2008 involved an insurance commissioner who failed to comply to state standards, and showed little understanding of a hospital’s billing complaint.
After countless interactions with UnitedHealthcare lawyers and lobbyists, the Arkansas insurance commissioner decided to grant the case in favor of the insurance giant. The ultimate decision, and dishonest behavior of the state commissioner, saved UnitedHealthcare millions of dollars.
But the nation, as well as policyholders, faces a deeper concern as matters worsen. According to the Center For Public integrity, 6 percent of the annual revenues collected by insurance departments were spent on regulation.
This puts both a policyholder and the nation in general in economic distress. For example, a consumer is placed in a position of vulnerability, as insurance companies will potentially try to utilize social media to gain personal data about a customer.
This means that an insurer can adjust a policyholder’s premium to reflect a customer’s lifestyle.
Furthermore, insurance companies are economic development engines in many states, so a lack of political fortitude by regulators could place them in financial hardship.
The countless gatherings and powerful relationships that are developed between insurers and insurance commissioners usually are not in vain. In fact, these relationships build solid foundations and pathways for employment opportunities for former regulators who sometimes resign from their position before their term has been completed.
According to the Center For Public integrity, half of the 109 insurance regulators that resigned from their term obtained an employment opportunity with the industry they used to regulate.
There is no doubt that insurance commissioners were thinking about their future and no one else’s.
At Millin & Millin Attorneys, we understand how horrible it is to be victimized by a corrupt and unjust industry. If you have been the victim of bad faith insurance practices, then let us take the required measures that will help you gain the compensation you deserve. Our attorneys service the McAllen metro area and surrounding Rio Grande Valley cities.
Contact us today for a free case evaluation at (956) 631-5600.
If there isn’t any damage there can’t be any injury right? Wrong!
After a low speed impact collision, your insurance company may associate a lack of damage as an absence of injury. But this isn’t always the case. It is entirely possible for passengers in a auto accident to be injured, especially in soft tissue areas such as the neck and spine.
If these injuries occur and an insurer is involved, the adjuster assigned to the claim will attempt to minimize the compensation received. Unfortunately, this means offering the injured party the lowest amount possible without having to litigate.
A tactic that the adjuster will use might be pointing out the lack of visible damage to the vehicle. This sort of misused logic is a myth, as numerous studies have found that even though there isn’t much damage to a vehicle, it doesn’t mean that injuries haven’t occurred. In a low speed collision, the speed of the vehicles at the time of impact is only one factor that should be analyzed to determine the value of a claim.
One of the reasons that car wreck victims can sustain connective tissue injuries is because bumpers are not designed to crush in low-speed collisions, but are instead intended to minimize proper damages, as regulated by the National Highway Traffic Safety Administration (NHTSA). In fact, the NHTSA specifically mentions that bumpers are “not a safety feature intended to prevent or mitigate injury severity to occupants in the passenger cars.”
Furthermore, when a car is involved in an accident, seat belts will lock in place and cause the occupants’ bodies to thrust forward. While seat belts are great at decreasing injuries, they do inhibit body movement, but not head movement, which means your head can forcefully snap forward and then backwards in what is known as whiplash. Essentially, injured victims cannot brace themselves effectively on impact and their bodies are forced into unusual positions that may cause “soft tissue” trauma.
Car wreck cases exist in a specialized realm of knowledge known as wreck dynamics, which includes physics, biomechanics, biology, and other such fields. Many of the questions surrounding a car wreck and the sustained injuries are affected by scientific principles and only a qualified expert should give an opinion on issues that include:
The specialized knowledge needed to answer these questions is usually outside the realm of common understanding and can easily lead to the jury having to speculate or guess about the answers to these questions. The insurance company may argue that these questions are easily answers, but peer-reviewed scientific studies have debunked this argument.
A set of guidelines developed in the mid-1990’s, and presently used, are known as the MIST protocol and instruct claims adjustors that crashes with minimal damage are unlikely to cause significant damage or personal injury. This training system suggest vehicle damage is tied into injury presence, and that claims of $1000 or less are false
These guidelines recommend that regardless of medical evidence of an injury, these “fraudulent claims” should be remedied without lawful payment to the insured. Many insurers have adopted similar handling processes that focus strictly on the relationship between vehicle property damage and the potential for injury.
Regardless of medical evidence of injury, insurers may attempt to approach a claim through “common sense” assumptions rather than a scientific proof.
Insurance companies may try to use the myth of no damage equals no injury in hopes of getting you too frustrated to fight with them and thus accepting their low offer. That’s why it’s important to remember the truth that there is no scientific evidence or study that support the industry’s hypothesis based on this myth.
Instead, if you are injured, even in a small fender-bender, make sure you get medical treatment immediately. Medical records that prove you sought treatment and the doctor’s diagnosis of your injuries will prove to be vital in rebuffing insurance adjusters. You’ll also need to follow your doctor’s treatment plan, keep appointments, and maintain an organized file of medical records to show you followed the treatment.
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 PLLC 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.
In life, one thing that is guaranteed and cannot be avoided is change, and it sometimes comes as a surprise whether one likes it or not. But there are two types of change: those that we embrace and the ones that negatively affect our well being. So, what do you do when life throws you a curveball?
Perhaps you were in an accident that caused severe injuries, or you were a victim of catastrophic loss, in which your property and belongings were destroyed. The most reasonable response would be turning to your insurance company to obtain the necessary compensation.
After all, you are only seeking the financial help that rightfully belongs to you as a policyholder. While for the most part, there are plenty of devoted and loyal insurance companies who care about seeing you back on your feet after a life changing event, not all insurance companies have your best interest in mind.
Acts of bad faith happen all the time, but you do not have to be a victim. If you or a loved one are struggling to obtain fair compensation after an accident or unexpected event, contact Millin & Millin PLLC today. Our reputation and impeccable knowledge in civil litigation has helped many individuals take advantage of their legal rights.
How do you know if your insurance company is acting in bad faith?
Below are a few examples of insurance bad acts:
An insurance bad faith results in deeper loss for the company when the insurer fails to provide the claimant what he or she deserves by law. In one bad faith case, there was a man who was struck by a truck as he raked the leaves of his front yard.
Apparently, the driver had jumped the curb and hit the man. The injured individual was rushed to the hospital where he was diagnosed with a broken neck, brain hemorrhages, and a herniated disk.
Weeks after the incident, the man received minimal compensation from the driver’s insurance company and so decided to file a claim right after.
The insurance company was required to pay him $100,000 in underinsured motorist coverage. After his claim was ignored and unfairly denied, the man sued the insurance company and received $8.2 million in damages.
Those who do not have to worry about whether they must pay taxes on bad faith litigation recoveries are those who are granted compensatory damages for physical injuries or physical sickness.
Individuals who are not adequately compensated or whose health has worsened because of an insurance company’s failure to provide appropriate compensation are usually exempt from paying taxes.
However, one key element to take into consideration is to understand who paid the premiums on the insurance policy. If your employer paid the premium than you are subject to taxation.
The team at Millin & Millin PLLC is ready to advocate for your legal rights. We have helped a multitude of individuals from all around the Rio Grande Valley deal with bad faith insurance claims. Contact us today for a free case evaluation at (956) 631-5600.
Life insurance policies can help a family financially prepare for the unfortunate loss of a loved one.
Life insurance policies traditionally require that the insured policy owner pay premiums to the insurance company under the agreement that the insurer will pay a certain amount of money to the beneficiary after death.
Unfortunately, insurance companies do not always act fairly. Insurers may unjustly deny or delay claims for a number of reasons. That’s why it is exceedingly important that as the policyholder (or beneficiary), you know what a purchased life insurance policy includes.
But even when you are aware of the specifics of your policy, the insurer may act against your interest. That’s why at any delay or denial, you should have an experienced bad faith insurance firm like Millin & Millin PLLC assess your situation.
It is the responsibility of the beneficiary (if of age) to file the life insurance claim. Generally, a life insurance claim examiner will be assigned to your specific case and request the necessary forms needed to start the process including: an autopsy report, coroner’s report, medical examiner’s report, or other relevant documents.
If additional documents are needed you should be notified promptly to avoid delays. Once all the necessary authorizations have been signed, submitted, and filed, the insurance company must make a final decision on the claim within 30 days.
If the claim is to be paid, the insurer will provide the beneficiary the option of either being paid in a lump sum or having the funds deposited into a special account set up by the life insurance company. As a beneficiary, you have the right to request interest on a total payout if the claim was not paid within a reasonable time.
Unfortunately, a vast number of cases are unjustly denied by excuses designed to convince a beneficiary that the claim was invalid for a number of legal reasons.
Denial letters are often purposely drafted with difficult legal terms and ambiguous reasons to make the argument more convincing. It’s important to remember, however, that such letters should never be accepted as final verdict until an experienced attorney is able to analyze the situation.
Life insurance claims can get denied for a number of reasons including, but not limited to:
An insurer has the right to contest a policy if the insured died within the first two years the policy became effective. Contesting the policy usually consists of analysis of the various policy forms and application, which provide vital information about health, age, hobbies, etc.
If an insurance company is able to garner information that was not directly stated in the application, then the claim may be denied.
While only material misrepresentations (those that affect risk) can result in policy cancellation, insurers will attempt to contest under these conditions, even when the claim is valid.
Be aware of contestability and possible outcomes.
Generally, a policy is only active as long as premiums are up-to-date and paid. If there is a failure to make a payment, then the policy may lapse or terminate.
Very often, insurance companies are able to deny claims using nonpayment of premiums as justification. As a beneficiary, be aware of premium due notices and whether you were properly warned about an impending lapse.
A claim may be denied if there is no designated beneficiary. As there are provisions in a policy that state who should get the insurance money if there is no beneficiary, these claims may result in lengthy delays, or an outright denial.
Policy exclusions are used frequently to deny claims as they are ambiguous and allow for a number of possible of scenarios to be rationalized as non-payable.
Every state has their own set of statutes that govern the rulings behind insurance claims. However, they generally apply to state law claims and do not have legal standing in cases controlled by federal laws.
The claims adjuster working on your case may not have a full understanding of your specific state laws and may misinterpret them for the insurers benefit.
Insurance companies may attempt to deny your claim for a number of reasons, but that does not mean you are out of options.
A life insurance claim that has been fully and properly submitted, but not paid within 30 days can be considered delayed.
Delayed claims can often lead to denied claims, as adjusters will attempt to utilize this extra time to gather evidence to support a rejection. If you allow a delay to run indefinitely without an adequate explanation from the insurer, you increase this risk of denial.
If there is a delay in the claiming process, the insurance company must provide a reason for doing so. If there was no explanation provided, you will need to speak with experienced legal experts like Millin & Millin PLLC to get to the bottom of the issue.
Some of the most common reasons for delays include, but are not limited to:
A life insurance claim may be denied on the basis that the beneficiary is a minor and cannot receive the proceeds without a guardian.
A lawyer can help you to expedite payment of your claim once proper guardianship documents have been filed.
Including the funding of a life insurance policy in a will can result in claim delays. As a life insurance policy is a contract with another party, it cannot be legally controlled by the will.
After a major life event, such as a divorce, marriage, childbirth, etc., many people will want to change the beneficiaries on their life insurance policies.
Failing to do so may mean an excess of beneficiaries and the claim may be delayed as the insurance company proceeds to file an interpleader.
A failure to name a specific person, and instead use a group of people such as “children” or “relatives”, will likely result in a life insurance claim being delayed.
Also, when no beneficiary is named, the policy will be paid out according to the law of the state where the policy was taken out or according to policy terms. This issue will cause a delay as well.
There may be a delay in paying a claim when the primary beneficiary is not available (predeceased the insured or is not capable under law) and there is no secondary beneficiary.
If there is no contingent (secondary) beneficiary the claim will likely be delayed.
When submitting a claim, it can be in your best interest to obtain an experienced attorney who can help the beneficiary file the correct medical and financial information.
In order to avoid unnecessary delays or denials in a claim settlement make sure to:
You have the responsibility of providing the insurer with correct information on the life insurance application. You should provide the requested information in good faith as failing to do so can lead to a legally denied claim.
If you do not disclose certain medical conditions that can affect your health, the policy will be cancelled due to material misrepresentations.
If you do not designate a beneficiary, your family may have to deal with litigation disputes about who should receive the insurance monies. If there is no beneficiary, funding is paid according to the provisions of the policy.
This is exceedingly important; paying your premiums on time will help to avoid policy lapse or cancellation. Also, make sure to update your contact details or address changes to maintain receiving premium-due notices.
An insurance company cannot and will not settle a claim until all required documents are officially submitted. Documents can include forms related to the policy and documents proving the death of the insured. You will also be required to provide proof of your identity.
It is a good idea to send all documents in together, as a delay in submitting one document can mean a delay in claim decision. Also, if you are unable to obtain original documents, then you should produce certified copies of the required documents.
After the loss of a loved one, the last thing you need is to deal with the misleading practices of an insurance company. While insurers may try to play tough, here at Millin & Millin PLLC, we know how to play tougher to get you and your family your just due.
If you are experiencing difficulties with a dishonest insurance agency, then find some relief in knowing that Millin & Millin PLLC is here to help. We have a track record of going up against the big bad wolf insurance companies and getting the compensation you deserve.
Schedule an appointment with us today to find out how we can help you with your claim.
“Know what to look for to avoid claim denials.”
Dealing with a major illness is enough stress as it is. There’s no reason any one should add to your burdens, but sometimes insurance companies can make it downright difficult in helping you get the resolution you need by denying your claim and leaving you with a large medical bill on your hands.
However, it’s still very important that you understand the reason for the denial so that you can take the necessary steps to appeal the decision. While there is always the slim chance that the denial was simply an insurance company error, the likelihood is far greater that you were denied coverage for a number of reasons - especially if this was your first submission.
The attorneys at Millin & Millin PLLC want you to know that you do have the legal right to appeal the insurer’s decision, as well as request the support of an experienced and dedicated legal team that knows how to deal with bad faith insurance practices.
What is important to know about the appeals process is that action must be taken immediately as there is usually a time limit set in place by the insurer - usually about 30 to 40 days after a denial. Make sure that you ask for a written denial from the company (via certified mail) that explains to you the denial details so that you can make an informed decision on what action to take next.
It’s also vital to go into this situation well versed, so we offer you 5 reasons why your insurance company might have denied your claim.
One of the typical reasons for having your claim denied is for receiving services outside of your plan’s provider network. If you received elective or nonemergency care from a provider that was outside of your health maintenance organization (HMO) or exclusive provider organization (EPO), then this means you obtained care from a party that was not in agreement with your insurance company’s terms of payment. In this situation, your health plan may deny the entire claim and make the payment your sole responsibility, or it may require of you to pay a bigger portion of the costs. Contact your insurer to find out more about your HMO’s network of healthcare providers.
Another highly possible reason for the claim denial was that the procedure you received simply was not covered by your insurance policy. It’s going to be your responsibility as the policyholder to know exactly what is and what is not covered in your plan. While it can be easy to make assumptions about certain routine procedures, always double check with the terms of your policy to ensure that the specific treatment you are seeking will be covered by your insurance. If you know that you’ll need a certain form of health care that is currently omitted from your plan, then make the decision to shop for a new policy that will provide you what you need.
Mistakes happen, and hopefully, it was simply an accident in the billing department of your local clinic that caused the mishap. While it can be frustrating to have to deal with these minor inconveniences that turn into seemingly big problems, billing issues can be quickly handled. Something as simple as your provider having outdated insurance information on file can lead to a denial. Issues can also arise from having two policies, such as having coverage through own employer and your spouse’s. If you can’t figure out exactly what the issue is, then have a talk with your doctor’s billing department and try to find out if they accidently coded your claim improperly or excluded some vital information.
Your doctor’s billing department can make mistakes and so can your insurance company. Transcription errors on reports developed by the insurance company can mean denial. A misspelled name. An incorrect birthday. Incorrect procedure codes that are age appropriate can make the claim invalid. Minor data entry errors can definitely snowball into something bigger, but all you have to do is call the patient customer service representative to help get the data problem fixed.
Certain procedures will require preauthorization, which is initiated by a doctor’s request on your behalf. Depending on the given situation, the procedure may be denied by the specialist provider if there is no preauthorization, or you may have the procedure done but the claim is denied afterwards. If the latter should take place, then ask your doctor to contact your insurance company and explain to them that a referral/preauthorization did occur. This is essential because if the insurance carrier does not have the valid referral number, the claim with be denied until the referral is provided.
After making timely payments on your premium, it can be a shocking discovery to find out that your health insurance claim has been denied. Sadly, insurance companies aren’t always looking out for your best interest, and that’s why you’ll want a legal team that will.
The Millin & Millin PLLC attorneys are fully aware of the dubious nature of insurance companies and so we strive to provide clients with the most reliable legal consultation to help ensure that you get the rightful benefits you are owed.
While it’s important to anticipate some of the common causes of rejected health insurance, if your insurer continues to practice bad faith, then give the Millin & Millin team a call at (956) 631-5600 and we’ll make sure you don’t have to deal with their tactics again.
