An insurance company’s goal is to maximize its profits, which means that it does not always have its policyholder’s best interest in mind. It is not uncommon for an insurance company to deny, delay, or underpay an individual’s claim even though it is a valid claim. With this happens, the insurance company has acted in bad faith and has committed an injustice. The role of a Los Angeles bad faith insurance lawyer is to fight for the policyholder’s rights and ensure that they are able to get the medical treatment that they need. A dedicated bad faith insurance attorney will keep your best interests in mind and help you recover.
Attorneys Could Help Someone Understand Their Rights
When a health insurance company denies or delays the medical treatment a patient needs, the individual should quickly consult with a knowledgeable lawyer about health insurance and insurance bad faith. The role of a Los Angeles bad faith insurance lawyer is to ensure that the injured person understands their rights. Most patients do not understand their rights and are subject to unfair or unlawful and fraudulent denials that could damage their health. For example, if someone is waiting on back surgery and their health is declining, they may suffer permanent spinal injuries because of the health insurance company’s bad faith denial of their back surgery.
Also, health insurance companies often use their appeals process to further delay treatment and deny care to boost their profits. In California, individuals enrolled in non-ERISA health insurance plans, do not need to go through the appeals process before filing a lawsuit. While many people think the appeals process may help them obtain the medical treatment they need, often the process is a delay mechanism that might cause the patient’s injuries to worsen and could help the health insurance company’s ability to deny the claim.
Assisting with the Medical Review Process
Health insurers may direct their policyholders to pursue an independent medical review process in California through the California Department of Managed Healthcare or the California Department of Insurance to further challenge bad faith health insurance denials. It may be a mistake for individuals to pursue an independent medical review for various reasons. Depending on the type of medical treatment, independent medical reviews are not successful and result in a determination that upholds the health insurance company’s denial. If this happens, it is incredibly difficult to prevail in a lawsuit even where the treatment is medically necessary and covered.
When the independent medical review results in a reversal of the insurance company’s denial of treatment, the insurance company must provide the treatment. In California, patients can only seek an independent medical review of medical services that were denied claiming the treatment is not being medically necessary, experimental, or investigational or under narrow circumstances involving terminal diseases and clinical trials. One of the roles of a Los Angeles bad faith insurance attorney is to help the policyholder determine the best strategy to get the medical care that was denied in bad faith. During the medical review, the lawyer could see which bad faith insurance liability issues exist if there are any.
Pursuing a Lawsuit
The role of a Los Angeles bad faith insurance lawyer is to advocate for the injured person by filing a lawsuit to stop the insurance company’s bad faith conduct of unreasonable and improper cause for denying needed medical treatment.
Health insurance companies are more likely to authorize medical treatment they previously denied once a lawsuit is filed. This is because they realize their conduct is under scrutiny from a legal perspective. In litigation, a bad faith insurance attorney investigates and may discover why the insurance company denied the medical treatment. Through depositions, requesting the health insurance company’s documents, and exploring the health insurance company’s policies and procedures, a lawyer could discover conduct that the policy holder’s denial is reflective of systemic bad faith conduct that jeopardizes the health of thousands of people. A denial of medical treatment for one patient is a reflection of bad faith conduct, affecting thousands of members.
If you want to learn more about the role of a Los Angeles bad faith insurance lawyer and how a legal professional can help you, contact an experienced attorney today.
