The attorneys at Millin & Millin understand that the process of filing for long-term disability insurance can be complicated. Insurers will expect a lot from claimants and will often deny a claim because of a small mistake in the filing process.
There are quite a few things that you should be aware of to ensure that you have a viable claim that won’t get rejected by your insurer.
Consider the following tips to help you through the process when filing a disability insurance claim:
Failing to answer each question truthfully and factually can lead to a denial of benefits. Insurers will purposely seek out omitted info or misinformation on your forms and call it fraud. Insurance companies can effectively claim that you misrepresented yourself by not fully disclosing medical or financial information.
Insurance claim forms can be complicated and difficult to get through. Questions may be misleading and you may feel uncertain as to what sort of information you should include. Contact our lawyers at Millin & Millin for a free consultation and to get information on what you should include in the forms.
You’ll want to keep detailed notes of every phone call and document every interaction with your insurance company. Mark down who you spoke with, the date, time, what the call was about, and anything you received from them or sent to them. You will want a paper trail in this scenario to prove your claim.
Insurance companies will usually attempt to contact and communicate with you over the phone. Unfortunately, verbal answers can easily be skewed and used against you in your claim. Instead, try your best to respond to all claim-related questions in writing. This will help to keep things clear and does not allow your insurer to purposely misinterpret your words.
Maintain your medical treatment and communicate regularly with your physician.
If you are filing a disability claim, it’s because you have been injured. Naturally, you should be receiving medical care for your needs, especially if they are debilitating. Failing to attend your regular treatment appointments can have a substantially negative effect on your claim. It is absolutely vital that you follow doctor’s orders and maintain complete medical records.
When meeting with your doctor, or any specialist that may be treating you, make sure to gather relevant information from them including:
If there is a gap in your treatment, document them and make sure to have a proper explanation. Be aware that any inconsistency in your treatment plan can be viewed in an unfavorable light. Ultimately, the more medical information and records that you can gather, the more you can support your claim.
There is nothing you say to your insurer (or their reps) that is considered “off the record.” You will want to carefully choose your words when communicating with the insurance company, as a misinterpreted phrase, or seemingly innocent remark can be utilized to delay or deny your claim. Do not offer unnecessary personal information to your insurer and make sure to give only factual, straightforward answers.
Failing to effectively respond to your insurers requests for more medical, vocational, or financial information can cause delays in the claims process. Because long-term disabilities claims often take a lengthy amount of time to resolve, meeting these requests quickly will help to shorten the process of an already long and winded process.
This also relates to deadlines. Most policies will have strict time frames for filing a claim. Failing to meet these deadlines usually results in a denial of benefits. It’s also important to be aware that insurance companies often utilize unreasonable time limits as a bad faith insurance tactic. Pay close attention to these deadlines and contact your team at Millin & Millin if you have reason to believe that your insurer is acting in bad faith.
Millin & Millin Are Your #1 Advocates
If after several attempts to negotiate a disability insurance claim effectively, your insurance company continues to act in a malicious manner, contact Millin & Millin immediately at (956) 631-5600. We service the entire McAllen-Edinburg-Mission metro area as well as the greater Rio Grande Valley metropolitan.
Insurance companies are in the business of denying claims, Millin & Millin doesn’t take no for an answer. Our experienced lawyers have the know-how to deal with any insurance company—big or small—and we will fight for your rights if they have acted in bad faith.
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.
During the holiday season, accidental fires tend to occur more frequently because of various reasons: Christmas trees catching ablaze, bad wiring on Christmas lights igniting, electric blankets malfunctioning, or electrical space heaters being placed too close to fire hazards.
When a family faces a catastrophic event like a house fire, the stress added on by insurance companies acting in bad faith can be downright deplorable. In the aftermath of such a misfortune, your family will expect to file an insurance claim and quickly receive compensation for the damage done to their home - this isn’t always the case.
The attorney’s of Millin & Millin are here to help you fight against insurers who are acting in bad faith and making it hard to receive payout for your legitimate home fire claim. It’s important to realize that it is not uncommon that insurers practice in bad faith, but also that you can oppose their illegitimate denials.
If you should find yourself filing a fire insurance claim, then pay attention to some of the common warning signs that your insurer is seeking to act in bad faith. By being familiar with these tactics used by insurance companies, you can know when it’s time to challenge them.
[bctt tweet="Fire insurance claim? Bad faith insurer? Millin & Millin will fight for you. #bad #faith #tactics #MillinMillin #mcallen #fire #claim" via="no"]
Tactic #1 - Your insurer will claim that you do not have an active policy.
One of the first bad faith tactics that insurers will resort to, this sort of behavior generally means they are looking to deny your claim. This type of practice is known as post-claim underwriting and includes insurers alleging that you missed a payment or did not renew your policy when it expired.
As a policyholder, you need to remember that:
In these sorts of scenarios, you’ll have to prove that you do indeed have an active policy. Bank statements showing timely monthly payments can be a crucial piece of evidence.
Tactic #2 - Your insurer says you policy doesn’t cover fire damage.
Insurers may claim that while you do have an active policy with them, it does not specifically cover damage associated with a fire claim. That’s why it is essential that at the time of purchase, you have a clear understanding that coverage does indeed extend to fire claims. You’ll also want to read through the insurance policy to make sure that fire damage protection is mentioned.
If your policy does cover the damage mentioned in the claim, then you’ll likely need the support of an experienced legal team to help you fight the insurer’s bad faith tactics. Millin & Millin can help you get the full compensation that you legally deserve.
[bctt tweet="Bad Faith Tactic #2 - Your insurer says you policy doesn’t cover fire damage. #fight" via="no"]
Tactic #3 - The insurance adjuster is dragging out the investigation.
After any insurance claim, an insurance company will utilize their own adjusters to investigate. In the case of a fire, adjusters will usually determine:
While these investigations can generally take some time to complete (especially when other parties are involved), the decision on your claim should occur within a reasonable timeframe. In the state of Texas, the acknowledgment must come within 15 days, and approval or denial of the claim within 15 days after receipt of all requested information. The insurance company has the option of extending the time for up to 45 days if it offers an explanation for the extension.
If you have not received any information, or a claim approval or denial in a timely manner, then this can be a red flag that the insurer is purposely prolonging the investigation to frustrate you into accepting a settlement that is far less than the claim is actually worth.
Tactic #4 - Placing blame on you.
During the investigation, the insurance adjuster should be able to find a reasonable cause for the fire. However, your insurance company may attempt to claim your negligence caused the accident or damage.
If your fire insurance claim is denied on this basis, it is vital that you hire a lawyer that can defend your rights and challenge the insurer. In the case of a fire, there are often a number of parties (including fire departments, police departments, and public adjusters) that can provide evidence on your behalf. An effective law team can ensure that you receive this assistance and will guide you through the process to help you obtain the full amount you are entitled to.
[bctt tweet="Bad Faith Tactic #4 - Placing blame on you. #not #your #fault" via="no"]
Tactic #5 - Your insurer claims damage mentioned in the claim predated the fire.
An insurer may use this bad faith practice to allege that some (or even all) of the damage existed prior to the fire. By using this tactic, your insurer is attempting to avoid paying your claim in its entirety.
In order to effectively oppose this, it is vital to keep insurance logs and home maintenance records. It’s always a good idea to take pictures of your home’s structure, so as to have evidence of how the house looked prior to sustaining any natural or accidental damages.
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 deserve. Contact us today at (956) 631-5600 to get the legal representation you need to fight for your rights.
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.
The holiday season is one of the most joyful times of the year; there’s family, friends, food, and a festive spirit that makes the whole time of the year seem like one giant celebration. However, a day of celebration can quickly turn into a moment of tragedy, especially if you or a loved one are involved in an auto accident.
Whether traveling to visit family, or simply enjoying the evening at a friend’s holiday celebration, it’s important to remain diligent on the road. Unfortunately, during the holiday season, 2 to 3 times more people die in alcohol-related crashes, with 40% of traffic fatalities involving a driver impaired by alcohol. There are, however, a few things that you can do in order to improve your safety and that of your family’s as well.
Tips for Traveling Out-of-Town
The safety of you and your family should be number one on your list this year as you travel to-and-fro to visit relatives. Stay safe with these tips:
Maintain Good Driving Techniques During the Holidays
While the holiday season is a time of joy and relaxation for many, it can also be quite chaotic and frenzied because of all the traveling and holiday shopping that takes place. While it’s easy to get flustered by all the aggressive drivers, make sure to maintain good driving techniques yourself. Follow these good driving techniques to ensure safe travel:
Safety Tips for that Holiday Party
Holiday parties usually include a bit of alcohol. Sadly, The National Institute of Alcohol Abuse and Addiction states that between Thanksgiving and New Year’s Day, 1200 people will be killed and 25000 will be injured in traffic accidents caused by alcohol. Consider the following safety tips to enjoy time with your friends and family and get home safely.
You don’t have to be drunk to be affected by alcohol. You may feel normal, but nobody drives well after a drink.
The winter holidays are some of the best days of the year because we get to enjoy time with our loved ones in a festive environment. That why our lawyers at Millin & Millin want you to share this information with friends and family to ensure you stay safe during these busy days.
However, if you are involved in an auto accident, and are dealing with bad faith practices from your insurer, then do not hesitate to contact us at (956) 631-5600.
‘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.
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.
