Insurance companies can sometimes commit what’s called Insurance Bad Faith or insurance fraud. You might want to legally dispute your claim with the insurance company if it denies payment.
What are insurance claims?
If you pay for health, auto, or property insurance (for a few examples), you are paying a premium with the understanding that should you have to employ the services you are insured for, the insurance company will be able to cover the costs (as stipulated in your contract with the insurance company). You go to the doctor. You pay a copay, and the insurance company covers the rest of the visit’s costs. You accidentally rear-end a car on the road. Nobody’s hurt, but there is damage to your car and to the car that you hit. You are at fault. Your insurance company, according to your contract, is responsible for paying the cost of your vehicle’s and the other vehicle’s repairs.
That’s really what you’re paying insurance for: The payment of claims when they’re made.
Claims are filed with the insurance company through you, the insured, or on your behalf by brokers and agents, such as a doctor’s office. Incoming claims are given to clerks called “adjusters.” They investigate each claim and determine what to pay based on the contract. Sometimes, and of course, not in all cases, the company can commit insurance fraud, or arbitrarily decide not to honor its side of the bargain by paying up.
It’s at times like this that the insured party gets mad, and decides to fight the insurance company’s decision by disputing it.
What are insurance claim disputes?
When you disagree with an insurance company’s refusal to pay a claim, and the insurance company will not budge on its decision, you can decide to legally dispute that claim. That means you intend to take legal action against the insurance company in hopes of forcing it to pay your claim.
What can insurance company dispute lawyers do?
Insurance dispute lawyers have an intimate knowledge of insurance laws: how they are written, what they mean, how they work, and how they are executed. That also means insurance lawyers know how to argue against insurance companies to make them pay the claim you are disputing.
Insurance dispute lawyers review each case (sometimes free of charge), and then determine how best to proceed so as to successfully obtain a complete resolution. The resolution they seek depends on the case. Overall, insurance dispute lawyers want the court to rule in your favor, the plaintiff, so that the insurance company has to pay the claim, any other legal fees associated with the case, and any additional charges or punitive fees the court may decide on.
Here are a few examples of the charges you and your insurance dispute lawyer could bring against an insurance company.
Insurance Bad Faith: This is when the insurance company denies a legitimate insurance claim. For example, based on your contract, the insurance company could be responsible for paying mental health fees, and you are responsible for a $20 copay. The insurance company would commit Insurance Bad Faith if you had gone to a legitimate therapy session that was covered by contract, and yet the company refused to pay the cost of the visit (other than the copay). Perhaps the insurance company is making up false, arbitrary, and fictitious reasons to support its denial of the claim. These are lies. An insurance dispute lawyer is looking to get the denial reversed, to force the company to pay your claim.
Insurance fraud: This is when an insurance company completely fabricates a charge. The only reason a company would commit such an egregious wrong would be to obtain financial benefit at your expense. In this case there might not even be a claim, except for the fraudulent one the insurance company concocts to make money. An insurance dispute law service could include you as a plaintiff in a class action law suit brought against the insurance company.
Who should look into hiring an insurance dispute lawyer?
If your insurance company continues to refuse payment for a claim you think is legitimate, or if you think your insurance company is fabricating fraudulent insurance claims, you may want to contact an insurance dispute law practice.
