California Insurance Claim Denial Lawyer
You, like most Americans, buy insurance for peace of mind, hoping you will never need it. You pay your insurance premiums like clockwork to protect you, your family, or your business. In return, you trust the insurance company will be there for you in your time of need. Unfortunately, insurance companies are rarely as helpful and friendly as they portray themselves on television ads.
In fact, insurance companies are primarily interested in their financial bottom lines. Their goal is to make money, making them experts at finding loopholes and delaying claims. Rather than helping you at a time you need it most, insurance companies are masters at the deny, delay, underpay tactics. Attorney Scott Glovsky has made it his job to ensure his clients are not taken advantage of. Scott will take on any act of bad faith on the part of an insurance company, forcing the company to fulfill its promises to you and other policyholders.
Scott wrote the book on Fighting Health Insurance Denials.
Lawyers are taught in law school not to get personally involved with their clients, which is why many people feel little connection with their attorney and do not believe he or she really understands what they are going through. Scott’s first experiences as a lawyer were working for large, impersonal, corporate law firms where empathy and personal feelings did not apply.
Scott soon learned this was not a rewarding way to live his life, so he walked away from corporate law, starting his own law practice to help the victims of corporate abuse who desperately needed his help. Scott wants you to know you are not alone, and while you should prepare for a battle with your insurance company, he will be by your side every step of the way.
What is Insurance Bad Faith?
When your insurance company denies your legitimate claim, the company could end up being liable to the insured for more than the amount of the initial claim, once bad faith is proven. When your insurance company denies a claim for anything that is not reasonable, bad faith may have occurred. It is important to note that if your denial was due to an error in assessment, there was no bad faith involved.
Your attorney will show that your insurance company failed to engage in a thorough investigation prior to denying your claim. It might also need to be shown that your insurance company ignored obvious information and facts that would have made a difference in its decision. If your attorney can show your insurance company has a pattern of denials that violate state insurance regulations, bad faith would certainly be demonstrated.
The Law Offices of Scott Glovsky serve bad faith insurance individuals and business insurance policyholders throughout Los Angeles, the San Gabriel Valley, and all of California who have legal needs resulting from disputes with their insurance providers. Scott Glovsky is recognized as one of California’s most experienced, compassionate, and trusted insurance law attorneys.
What Types of Insurance Denial Does Scott Glovsky Handle?
Insurance Bad Faith Denials
Being denied a service you pay for every time you pay an insurance premium can be difficult to accept. You may feel as though you are insignificant and powerless when dealing with a larger, impersonal corporation. When you have a strong advocate in your corner, you realize you can take on a large corporation when they are in the wrong. Insurance companies that deny your claim, delay paying your claim or underpays your insurance claim for the wrong reasons, result in injustice. Having a strong, experienced lawyer by your side can help convince the courts that such an injustice is more than just a breach of contract. Scott Glovsky will work hard to get your insurance company to pay what they should rightfully pay. In some instances, a badly-behaved insurance company can be financially punished for failure to pay or provide services to policyholders.
Health Insurance Denials
In 1999, Scott Glovsky started representing policyholders after years of representing large insurance companies. The Law Offices of Scott Glovsky has litigated many health insurance claim denials for people like you—people who have faithfully paid their health premiums only to have their insurance company deny them a service or treatment. Scott has taken on some of the biggest names in the insurance industry, including Anthem Blue Cross, Blue Shield of California, Health Net, UnitedHealthcare, Kaiser Permanente, and other large health insurance companies. Scott will stop your insurance company from their deny, delay, underpay tactics. For insights on fighting health insurance denials, download our eBook.
Medical Necessity Denials
A medical necessity denial is often used by insurance companies to minimize costs, even though it comes at the expense of the health and interests of their members. The Law Offices of Scott Glovsky are leading the charge in California against Anthem, Blue Shield, Aetna, Health Net, Kaiser, and others who deny coverage to members claiming the services are not medically necessary.
Experimental or Investigational Denials
Perhaps your health insurance provider has denied your claim on the grounds it is experimental or investigational. If this is the case, Scott Glovsky has helped many people who received such a disheartening denial obtain the treatment they needed. Scott will seek out your doctor’s support in providing additional documentation or evidentiary support that explains the treatment, why you need it, and shows it is regarded as safe and accepted for patients with your condition. In some cases, research may reveal that a specific procedure is far from experimental, and, in fact, has widespread support from the medical community. Scott will help you gather the evidentiary support you need when appealing a denial on these grounds.
There are times when you may need to go out-of-network for certain types of care, particularly if you or a family member has a rare illness, and no provider in your network has the training or experience to treat it correctly. If you have received a denial for out of network provider, Attorney Scott Glovsky can help by requesting that your insurance company review their decision and reconsider your benefits denial. In certain cases, you may have to go to an external appeal, appealing to an independent outside group.
Disability Insurance Denials
California’s definition of a disability includes any illness or injury that keeps you from working your normal job. The state of California can deny a disability claim for a variety of reasons, particularly if they suspect fraud. The state may also deduce that a person working part-time could be the result of that person’s choice, rather than a disability. If your disability application is denied, Scott Glovsky is the Los Angeles disability insurance claims denial attorney who can help you understand why your claim was denied, while pursuing an appropriate remedy.
Life Insurance Denials
Life insurance is a simple concept; you take out a policy on your own or another person’s life, then upon death, the beneficiary collects the value of the policy. While not common, life insurance companies may attempt to deny a claim, or rescind a valid life insurance policy. Scott Glovsky can help you collect the life insurance paid for and owed by the life insurance company.
Property Insurance Denials
Perhaps you have suffered structural damage, personal property loss, lost profits, physical injuries, or losses caused by other damages. The Law Offices of Scott Glovsky provides assistance and answers to those who have suffered damages, helping them seek compensation for their losses.
Insurance Policy Rescission
When you suffer a loss and turn to your insurance company for payment, it can be a shock to learn that the insurance company is denying the claim using the excuse that the policy has been rescinded. This denial of coverage can be catastrophic if you are in poor health or have recently suffered property damage. The Law Offices of Scott Glovsky works to hold insurance companies responsible for their actions and to recover the compensation that you deserve.
How Attorney Scott Glovsky Deals with Insurance Bad Faith
When an insurance company denies, delays, or underpays your insurance claim for improper reasons, it commits an injustice. But it takes a lawyer to convince the courts that this injustice should be more than a breach of contract. Your insurance is evidenced by an agreement or contract between you and your insurance provider. Historically, the courts only looked at this contract to determine damages and remedies. Under such circumstances, the worst an insurance company might have had to pay was what they agreed to pay in the first place.
But several years ago, law firms interested in punishing badly-behaved insurance companies for failure to pay or provide services to their policyholders suggested that insurance companies had a duty beyond their contracts—a duty of good faith and fair dealing to the persons or businesses they insured. The courts agreed, and today, this duty is referred to as the “implied covenant of good faith and fair dealing:” a duty that exists by operation of law in every insurance contract. If an insurance company breaches this covenant, the policyholder may sue the company on a tort claim (for bad faith) in addition to a standard breach of contract claim. Under tort law, the plaintiff may recover punitive damages – damages for behaving badly.
The specific duties of insurance companies vary by type of claim (“first-party” or “third-party”) and by type of policy (health, property, life, business, etc.). Generally, insurance companies must have policies and procedures in place to review and pay claims. They must investigate claims, determine coverage, and pay proper values, and they must follow applicable laws and regulations.
When they violate one or more of these, they may be acting in bad faith. Los Angeles bad faith insurance attorney Scott Glovsky used to work for large insurance companies and defend them against bad faith claims. But he strongly disliked this work. He felt more empathetic toward the policyholders who had their insurance claims denied, often under questionable circumstances.
Mr. Glovsky switched sides to work for policyholders – the people and companies that trusted their insurance companies. Today, Mr. Glovsky runs his own firm, The Law Offices of Scott Glovsky, and the firm works all over California ensuring that insurers pay for claims and provide the treatments and services that their policyholders need and deserve.
First-Party vs. Third-Party Insurance Claims
In a third-party insurance claim, there are three parties—the insured, the insurance company, and another entity. So, if you were hit and injured by a negligent driver, he or she would be the insured, his insurance company would be the second party, and you, as the injured party seeking damages from the negligent driver’s insurance would be considered the third-party.
The most common type of third-party insurance claim is a liability claim like the example above. Since no contract exists between you and another person’s insurance company, if that person causes you injury, you can make claims for such things as medical expenses, loss of wages, and compensation for pain and suffering.
A first-party insurance claim is between you, the policyholder, and the insurance company. You are the first party, and your insurance company is the second party. Your insurance company has a duty to abide by contractual claims, based on the language of your insurance policy. As an example, a first-party insurance claim could occur if you have homeowner’s insurance and a fire causes damage to your home, Here, you will file a claim with your insurance company for the damages to your home.
Your insurance company will then compensate you according to the language of your insurance policy, covering damages and repairs. While the things that are covered under a first-party insurance policy are specified in the contract, sometimes insurance companies fail to pay what you rightfully deserve, and what is required under the law. When this occurs, it is referred to as bad faith insurance practices.
What Are Some Types of Insurance Bad Faith?
While there are many types of insurance bad faith, the most common types include:
- Insurance companies that harass and intimidate you while investigating a claim
- Insurance companies that delay or deny compensation for your claim without justification
- Insurance companies that make the claim process as burdensome as possible as a means of discouraging you from making a claim
- Insurance companies that ignore your claim, or fail to reply to your claim in a timely manner
- Insurance companies that provide no explanation to you for a denied claim or a claim that is significantly underpaid
- Insurance companies that do not thoroughly investigate your claim
- Insurance companies that deliberately do not tell you about the appeals process
- Insurance companies that fail to properly investigate your claim
- Insurance companies that deliberately misrepresent the policy limits of your insurance policy
- Insurance companies that refuse to initiate settlement discussions with your attorney
- Insurance companies that fail to protect you from excess liability
- Insurance companies that misrepresent coverage to avoid paying a valid claim
- Insurance companies that use deceptive business practices
- Insurance companies that wrongfully cancel or fail to renew your insurance policy
- Insurance companies that unfairly charge a higher premium after you file a claim
What Damages are Available if Bad Faith is Proven?
There are damages available to you if insurance bad faith is proven. You could be able to recover the following damages:
- The amount of money the insurance company should have paid you for your original claim
- Statutory penalties (fines required by law)
- Coverage of economic losses and attorney’s fees
- The amount of money you incurred as a consequence of the bad faith insurance claim
- Money to pay you for emotional distress as a result of your claim denial
- If you can show the insurance company acted in an intentional or reckless manner that harmed you, you may be able to ask for punitive damages. Punitive damages are damages awarded to punish the insurance company, so it doesn’t act in the same manner in the future.
If the insurance company can show you made an intentional misrepresentation during the filing of your claim, then the insurance company did not commit an act of bad faith. To avoid charges of bad faith, the insurance company must be able to show it thoroughly investigated your claim, and that the decision it came to was a reasonable one.
With so much at stake, it is essential that you have an experienced insurance bad faith attorney by your side, fighting aggressively for the compensation you are entitled to receive. Scott Glovsky can help you through this difficult time. With over two decades of experience helping those in the same situation, Scott always has your best interests and your future in mind during the entire course of the bad faith claim.
Summaries of Cases That We Have Filed
- We filed a case against Blue Shield of California for denying medically necessary emergency treatments. When our client got seriously ill with a strep infection while on a trip out of the country, Blue Shield initially lost and then denied his claim for coverage of his emergency treatment. This treatment included hospitalization, an ICU stay, and surgery to remove parts of his lungs. Blue Shield claimed that his treatment wasn’t an emergency, leaving our client with tens of thousands of dollars in medical bills. Our lawsuit alleges that Blue Shield has a system in place that is designed to save money by denying emergency care coverage to its members. It also alleges that Blue Shield doesn’t properly investigate claims before denying coverage and even incentivizes its medical reviewers to deny care. The lawsuit alleges that this conduct violates California law and is unfair, unlawful, and fraudulent. We are suing Blue Shield for breach of implied covenant of good faith and fair dealing, breach of contract, and violations of Business & Professions Code Section 17200.
- We filed a case against New York Life Insurance Company for unreasonably denying our client’s claim for long-term disability benefits. Our client’s life was forever changed when he experienced a very traumatic event. This traumatic experience caused our client, a successful professional, to suffer from serious mental health issues, including post-traumatic stress disorder, depression, anxiety, and suicidal ideation. He has been unable to work due to his severe mental health struggles, but New York Life has unreasonably denied his claim for long term disability benefits, despite being contractually obligated to provide them. In addition, New York Life forced our client to undergo a biased Independent Medical Examination, which worsened his mental health issues and inflicted emotional distress on him. We are suing New York Life Insurance Company for, among other things, breach of the implied covenant of good faith and fair dealing, and breach of contract.
Common FAQs for Insurance Bad Faith
Below are some frequently asked questions regarding insurance bad faith:
What is the “duty to defend”?
Your insurance policy includes a provision that states it has a duty to defend you against certain types of lawsuits. If a lawsuit is filed against you that is within the scope of your coverage, the insurance company has an obligation to provide legal representation on your behalf. In other words, part of what you pay each month on your insurance premiums is for your insurance company to defend you should the need arise. That being said, there are certain situations that negate the insurance company’s duty to defend. One of those is if you drive under the influence of drugs or alcohol, then have an accident as a result.
What do I do if my insurance company is acting in bad faith?
Prior to filing a claim for bad faith, you must show you’ve done everything possible to work with your insurance company. It is important that you keep good records of every conversation, email, or other correspondence to enable you to show you made a good faith effort to reach a mutually acceptable agreement. Make sure you review your insurance policy, so you know exactly what is covered and what is not.
How do I file an insurance bad faith lawsuit?
If you suspect your insurance company is acting in bad faith, the situation may not be as straightforward as you might think. Because of this, it is important that you hire a lawyer who specializes in lawsuits against insurance companies like Scott Glovsky at the Law Offices of Scott Glovsky. Scott will advise you on whether your case should be filed in state or federal court, and while you may be filing a claim for bad faith, the other elements involved that may include negligence, breach of contract, or even fraud.
Getting the Help You Need from the Law Offices of Scott Glovsky
How bad can an insurance claim denial get? One of Scott Glovsky’s clients complained to her doctors about painful headaches that would not go away. Her insurance provider denied her request to have an MRI (an expensive brain imaging test that reveals more details about the brain than other tests like such as an X-Ray). Mr. Glovsky’s client passed out while traveling overseas and was hospitalized. An overseas hospital ordered an MRI and found a brain tumor that could have killed her. Mr. Glovsky’s clients have been denied stem cell treatments, liver transplants, surgeries, sand other treatments capable of extending their lives or preventing their deaths.
As a young lawyer, Mr. Glovsky spent the first phase of his career defending insurance companies in bad faith lawsuits. He did not enjoy defending these lawsuits. He felt for the people suing their insurance company, not the insurance company defending their questionable reasons for denying, delaying, and underpaying claims.
Los Angeles bad faith insurance lawyer Scott Glovsky learned that large insurance companies put in place procedures and policies designed to process large amounts of paperwork and reap the insurance companies huge profits. They don’t focus on people. This focus on paper, not people, gets people hurt.
The Law Offices of Scott Glovsky focuses on people and fights to protect your rights. We fight liability insurers, life insurers, disability insurers, property insurers, and several other types of insurers. We also help individuals fight their health insurance companies and health plans to obtain appropriate treatment for medical conditions and reimbursement for denied medical treatment. If your insurance company has delayed or denied your claim or is not treating you fairly, we want to help. Call us at (626) 243-5598 or click the button below to fill out our online contact form.