When you have suffered an injury or an illness, you expect your insurance carrier to cover your medical treatment. Unfortunately, there are many occasions when the insurance company may refuse to provide coverage for your care. If this has happened to you, it is important that you know the steps following a Los Angeles insurance denial. A compassionate lawyer can walk you through the process and may be able to help you get the coverage that you need.
Filing a Lawsuit
There are many benefits an attorney can offer to health insurance members who were denied medical care. One of the steps following a Los Angeles insurance denial that an attorney can take, is counseling and advocating for the person, while also filing a lawsuit against the health insurance company. Filing a lawsuit can help the person obtain the medically necessary treatment and compensation for the injuries caused by the insurance company’s denial. Many times, patients who were denied medical care can recover money for their damages and change the practices of the insurance company that wrongfully denied treatment.
In their efforts to boost short-term profits, it is common for large health insurance companies to create systemic ways to deny expensive medical treatment. Many companies develop policies, procedures, and guidelines that lead their employees to deny treatment based on reasons that are not medically justified and are not justified under their contracts with their members. Lawyers can evaluate a denied person’s contract and then fight for the patients to make the insurance company stop their wrongful practices.
Initial Steps a Lawyer Takes to Help
One of the most important steps following a Los Angeles insurance denial a person should take is contacting a lawyer. An attorney can first gather all relevant documentation regarding the patient. The lawyer can then consult with experts about the insurance at issue, review all the insurance contract language, and then advise the policyholder about their rights. If the policyholder wishes to proceed with a lawsuit, the attorney files a complaint in the appropriate court to help attain the insurance coverage.
In litigation, the lawyer obtains the written documents through the discovery process and other information. They take depositions of the insurance company employees involved in the claim and evaluate the best trial strategy for proving the case. The attorney conducts formal discovery and informal discovery such as internet research and other ways of obtaining information from the insurance company from publicly-available databases and websites.
Bad Faith Cases
In bad faith cases, lawyers can seek on behalf of the policyholder to recover the benefits of the insurance contract for the treatment that was denied. The attorney can attempt to receive additional damages including lawyer’s fees incurred to obtain the benefits under the contract, emotional distress damages, and potentially, punitive damages. Punitive damages are meant to protect the public by punishing wrongful conduct to deter it in the future. Punitive damages law is based on the public policy of protecting the public and making insurance companies act appropriately in the future.
Consulting a Los Angeles Health Insurance Denial Attorney
When someone has been denied insurance coverage, they should seek the services of a lawyer as soon as possible. It is crucial to present the best evidence to the health insurance company as to why treatment is medically necessary to maximize the chances the company will cover the medical treatment. A health insurance lawyer can advise a patient about whether to file appeals with insurance companies.
In some circumstances, it might be detrimental to file an appeal when an appeal is not necessary. Also, patients should consult lawyers to determine whether to file an appeal with a state regulatory agency such as the California Department of Managed Healthcare or the California Department of Insurance. The outcome of such an appeal can have a substantial impact on whether a lawsuit can proceed. In some circumstances, it is much more advantageous to file a lawsuit than go through a regulatory appeal process which may be unsuccessful and may destroy the patient’s ability to obtain coverage through a lawsuit. Patients should also contact counsel when treatment for mental health conditions are denied. For more information about the steps following a Los Angeles insurance denial, call a dedicated lawyer.