Unfortunately, accidents happen and things don’t always go as planned. An insurance claim that's denied only adds to the frustration of an already difficult situation. People end up in predicaments like this all the time, but why and how?
While some claims are denied in bad faith, there are many reasons why a health insurance claim may be denied with just cause. The bad faith insurance lawyers at Millin & Millin are here to present these key factors so that you’re prepared no matter what.
Though the specific details of each case differ, there are a few reasons frequently cited which can cause someone’s health insurance claim to wind up denied. Let’s explore some of these in greater detail:
Of course, you’re always able to appeal, and the company must cover your medical expenses if you succeed. If bad faith is involved, you may need the help of legal counsel.
Take it from the professional bad faith insurance lawyers at Millin and Millin, it’s vital to know what you’re covered for and why insurance claims are denied. If you’ve been denied in bad faith, reach out to our office to take the first steps to set things right!
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The owner of Cheers in Boston is suing its insurance carriers over what it claims was a wrongful denial of its business interruption insurance claims. Hampshire House, the owner of five restaurants and a distribution center, claims to have lost millions of dollars due to the pandemic.
As the novel coronavirus spread across the globe earlier this year, businesses closed and residents stayed inside in an effort to stem the tide of coronavirus cases. In the months since those closures, many businesses have faced a business coverage denial by their insurance carriers. In some instances, business owners are claiming that their carrier is wrongfully denying these insurance claims based on ambiguous policy language that legally should be interpreted in the policyholder’s favor.
The Hampshire House lawsuit is filed against Fireman’s Fund Insurance and Associated Indemnity Corporation, as well as their parent company Allianz Global Risks United States Insurance Company.
The suit against the company argues that it breached its contract with Hampshire House and failed to act in good faith.
“Hampshire (like others who purchase business interruption insurance) has faithfully paid its premiums. Yet, when Hampshire made a claim because of a catastrophic business interruption caused by state and local emergency orders, the defendants summarily and arbitrarily denied Hampshire’s claims,” the plaintiffs argue, according to the Boston article.
Hampshire House closed all of its facilities as a result of the pandemic and a state order issued earlier this year. The Cheers locations also relied heavily on tourism, according to the suit. Hampshire House continues to pay insurance premiums of up to six figures. It carries $10 million in business interruption insurance and estimates losses of several million dollars.
“Hampshire (like many businesses) has relied on its business interruption insurance to cover what it is supposed to cover – replacement of business income and payment of ongoing expenses in order to rebuild its businesses,” the filing states.
The suit argues that Allianz instituted a practice regarding COVID-19 insurance claims that led to “improper denial of countless business interruption claims”. Plaintiffs cite a post on the carrier’s website regarding coronavirus claims that read, “In general, any standard property and business interruption coverage must be triggered by physical loss or damage to property at an insured location and infectious disease is usually not a covered peril.”
Hampshire House argues that Allianz failed to make a “good faith investigation, determine coverage and adjust Hampshire’s claims because defendants reached a pre-determined conclusion to deny coverage”.
Attorneys for Hampshire House argue that insurance policies have long been interpreted in the policy holder’s favor by the court. This is allegedly largely due to the fact that these policies are created and sold by carriers in an effort to make money. Language that is ambiguous or “attempted catch all language” should be interpreted in the policyholder’s favor.
“While the insurance industry may cry afoul about their bottom line, too many small business owners, restaurant owners, gym owners, hotel owners, and medical providers are staring bankruptcy in the face,” attorneys for Hampshire House wrote in a statement. “This is a survival moment and all options must be on the table.”
For two decades, Millin & Millin, PLLC has represented hundreds of policyholders in their fight against insurance companies who wrongfully denied or underpaid their commercial property insurance claims. During this time, our firm has litigated claims for business interruption and property damage for hotels, retail centers, churches, office buildings, warehouses, and public schools all over the country.
Due to the government’s decision to issue shelter-in-place orders because of the COVID-19 virus, we know that many business owners are suffering tremendous losses in revenue. While many have coverage for business interruption and orders issued by a civil authority, we expect the industry to attempt to avoid paying trillions of dollars in legitimate claims. Insurance agents and adjusters will tell you that your building must sustain “direct physical loss or damage” before coverage is triggered, but we know this is not always the case.
Simply put, insurers will save themselves money by issuing a broad range of wrongful denials, and they will eventually settle the relatively small proportion of lawsuits filed by policyholders who are willing to fight for what is rightfully their money. Millin & Millin, PLLC is uniquely qualified to represent consumers like you in this battle. Call or email us today so that we can conduct a free review of your policy and provide you with advice you need to make the appropriate decision for your business during this tumultuous time.
At the beginning of the new year, many people often make resolutions to better themselves. From eating healthier to exercising more, saving money to completing a project, we all make goals for the year.
In 2020, resolve to better protect yourself and your loved ones by performing an annual insurance review. This simple act can save you from a ton of problems should you have to file an insurance claim down the road. By knowing exactly what coverage you have and - perhaps more importantly - what you are missing, you’ll be able to make the right decisions about your insurance needs.
Your insurance claim lawyers at Millin & Millin highly recommend you review your policy at the start of every year with your insurance agent. Here’s why.
If you have coverage for any of your property - including a home or other valuables - you may find that you are actually underinsured because of how property value increases. For instance, if the property value of your home is greater than the cost of when you first bought it, then you may not have enough coverage to rebuild in the event of a catastrophe.
For example, if you paid $150K for your home but over the years its value has increased to $250K, then a lack of coverage could leave you footing the bill on any damages suffered.
When reviewing your insurance policy, you may find the means by which to save yourself a bit on insurance costs, including taking advantage of discounts you weren’t aware of, adding extra coverage at no extra costs, or even taking coverage off of property you no longer have, such as a vehicle you recently sold.
Depending on your insurance provider, you may even be able to lower your premium if you have improved your credit score over the past year, decided to pay an annual premium versus monthly installments, or simply been with the company for a significant amount of time.
Businesses in the United States are expected to have certain policies in place in order to protect employees and clients. Failure to update your coverage can lead to substantial penalties, or even bigger issues, like being sued by another party.
It is much better to be proactive when it comes to your business and seek out adequate coverage so you can protect your business and yourself from financial hardship.
When performing an annual insurance review, there are several questions you will want to ask your insurance agent in order to ensure that you have the protection you need to keep yourself, your family, and your valuables safe.
Start the decade off on the right foot by reviewing your insurance policies. If it’s been some time since you last examined them, you’ll have the opportunity to make adjustments before disaster strikes. This can prove to be absolutely pivotal when making an insurance claim.
Unfortunately, even with the right coverage in place, insurance companies may still act in bad faith. If you are dealing with an insurer who does not want to pay out the coverage that is rightfully owed to you, then do not hesitate to contact the dependable and trustworthy insurance claim lawyers at Millin & Millin. We have the skill, knowledge, and compassion necessary to get you the results you need.
Winter is here in the Rio Grande Valley, and while we might not get as cold as the rest of the state, there is still the occasional cold front that sweeps through the area. These cold spells can bring with them chilly temperatures, rain, and heavy winds.
An accidental fire or roof damage caused by winter weather can mean having to file an insurance claim. But unfortunately, insurance companies may try to deny, delay, or underpay your winter damage claim by placing fault on you.
If you’re having issues with your insurer over a winter damage claim, then contact the law offices of Millin & Millin, your bad faith insurance lawyers. We have the experience and know-how to get you the resolution your situation deserves.
Also, consider the following winter damage claims that are frequently denied and how you can avoid them.
While the McAllen metro area doesn’t necessarily experience the same bitter winters as northern Texas, the few cold snaps that move through the area sends residents towards their space heaters and other heating equipment. According to a study conducted by the National Fire Protection Association:
Insurance companies will try to avoid paying your fire claim by investigating if the fire was an act of arson. If the fire department is unable to identify the source or reason of the fire, any inconsistencies in your story and personal property listing can cause some major issues.
One strategy to inhibit a heating equipment fire is to keep any combustible items, such as clothing or furniture, at least 3 feet away from the heating source. Also, be sure to check equipment prior to use, as any loose connections or wiring can easily lead to a fire. Lastly, make sure to have smoke alarms working properly throughout your home for an adequate early warning system.
The winter weather of the Rio Grande Valley won’t bring any snow, but it can bring rain and roof damage. A collapsed roof or damage caused by rain should be covered in your home insurance policy, but contract language can make it difficult for policyholders to protect themselves, and insurers will use this tactic to avoid paying out on a roof damage claim.
Prior to any damage happening, you might just want to conduct an outdoor inspection, so that you can repel any arguments by your insurer that you hadn’t take the right steps to prevent or minimize damage. Check for missing, cracked, or creased shingles and also check your home’s flashing. If your home has rain gutters, then inspect them also, as rusted gutters with leaking seams can allow water into your house.
Should you still fall victim to roof damage caused by winter rains, then take the following steps to ensure an effective insurance claim is made:
If your insurance company avoids paying you out, and it doesn’t seem fair, it probably isn’t.
While freezing temperatures in the McAllen area are rare, they do occur nonetheless, and if you aren’t prepared, a busted pipe can lead to some major water damage. While water damage caused by a leaking pipe is typically covered by your insurance company, they may try to place the blame on you by declaring that you failed to properly winterize your pipes, thus avoiding their responsibility to you.
Because water expands when it freezes, this expansion puts tremendous pressure on water pipes, and can cause them to break. Outdoor hose bibs, swimming pool supply lines, water sprinkler lines, pipes that run along the exterior walls, and water supply pipes in unheated interior areas are subject to freezing.
One of the most basic tips you can follow when the weather is very cold outside is to let cold-water drip from the faucets served by exposed pipes. Even a trickle of running water will help prevent pipes from freezing. Also, on freezing nights, keep kitchen and bathroom cabinet doors open to allow warm air to circulate around the plumbing.
Remember that if your policy is unclear about water damage, you have the ability to fight a denied or underpaid claim.
If you’ve done everything in your power to protect your home this season, but you’re still having to deal with the bad faith tactics of your insurance company, do not hesitate to contact Millin & Millin, PLLC.
Our comprehensive knowledge means we have the ability to represent clients in difficult cases that involve bad faith insurance. Individuals and businesses can rely on our professionalism and skills to guide them through the most complex legal matters.
Don’t let your insurance company scare you with their tactics. Fight their denial today by calling (956) 631-5600.
“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.
It’s no secret that insurance companies tend to react slowly, especially when it comes to claims. And in all likelihood, if you’re having to submit an insurance claim, then you’re probably going through a horrid situation. Having to fight for your what’s rightfully owed to you shouldn’t even be an issue, but if that’s the case, here are a few tips to help you during those dire days.
Use That Tech
The first step you want to take before submitting a claim is to utilize technological resources to your advantage. That means using insurers’ apps, Web tools, smart-phones, and various tools to help you prepare the evidence for your claim. By being proactive, you should hopefully be able to take a few measures towards securing your monies, or at the very least, helping yourself build a meaningful “offensive” strategy should the insurance company initially deny you.
Understand Your Policy
The devil is in the details and it’s no different with insurance policies. Your understanding of the fine print will be advantageous in providing you the best insight into what your claim requirements will be. It will be necessary for you to know exactly what your policy covers, the claim process, how quickly you can submit, and the manner by which damage estimation is calculated.
Knowing your rights is also essential when disputing a denial. This information should be explicitly detailed in a policy or during discussions with an agent or with an experienced insurance attorney like Gina Millin.
In fact, it’s highly recommended to have an attorney assist you through the disputing process so that all legalities and specifics are properly explained for you. Legal support can also mean depositions are less emotionally taxing, which is vital when providing details about an accident or values of possessions - especially when large sums are on the line.
Keep Track of Those Records
Often it seems like insurance firms are eager to receive that monthly premium, but not as willing to provide that same level of promptness during the claims processes. That’s why it is exceedingly vital that you maintain immaculate records to provide yourself with meaningful reinforcement for those evasive insurance agents.
Make sure you maintain records of who you spoke with, as well the dates and times of these interactions. You should also write down specifics of what was discussed.
Last, but not least, you should also consider doing a video-tour of your home to record all the valuables you have insured. When completed, you should safeguard this video in a deposit safebox.
Don’t Give Up
The reality is that most disputes are efficiently and ethically handled by insurance companies. But there are times that claims can go awry and situations can get a bit out of hand - it can be very frustrating. However, it’s your responsibility to keep contact and save records of the entire process.
If you’re dealing with health insurance policies the delay may simply be a matter of providing some additional paperwork to prove the validity of the claim.
If it’s house insurance issues, every state has an insurance department that provides free services to ensure you’re getting what you are legally entitled to under your policy.
When dealing with auto policies, there’s always the ability to make a case as to why your vehicle is worth more than the appraiser estimates.
Regardless of the particular situation you may be in, you can always fight for what is rightfully yours and Millin and Millin is here to help. We want to be sure that your rights aren’t being ignored. We’ve represented hundreds of individuals against the illegal tactics of major corporations and have helped secure the rightful benefits of individuals from a variety of situations.
So if you’re unsure of where to turn to next, contact Millin & Millin at 956.631.5600 for the guidance you need.
