After filing an insurance claim, most families will expect their insurer to act in good faith. As a policyholder, it’s natural to expect the process to work in your favor, especially when you have maintained a solid payment record. When an individual has been involved in a situation that affects their way of life, compensation may be needed immediately to diminish unexpected financial burdens.
Unfortunately, insurance companies do not always act in the best interests of their policyholders, and they use bad faith techniques to diminish the payout or completely reject the claim on illegal grounds.
The bad faith insurance lawyers of Millin & Millin want to ensure that you have the necessary knowledge to protect yourself from the unacceptable actions of your insurer. What follows are some of the most frequently asked questions about insurance bad faith.
The team of attorneys at Millin & Millin have the experience, knowledge, and ability to represent individuals, businesses, and property owners in the Rio Grande Valley against all the major insurance companies. Millin & Millin has secured tens of millions of dollars in unpaid benefits for clients. From health, life, home, and auto, our attorneys are effective and swift.
Contact us today at (956) 631-5600 for a free case evaluation and to find out how we can help you with your bad faith insurance claim.
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.
“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.
