Help! My Employer-Provided Health Insurer Denied My Claim.

BIKLaw Medical Malpractice Lawyer > Breach of Contract > Help! My Employer-Provided Health Insurer Denied My Claim.
As many Californians are fully aware, insurance companies are good at taking money—but not so good at paying money to clients for valid claims. In fact, most, if not all, insurance companies actively look for ways to not pay valid claims. Under California law, when an insurance company wrongfully denies a valid insurance claim, the insurance company is acting in “bad faith.” If your valid claim is denied in bad faith, you can sue the insurance company for breach of the insurance policy contract and for bad faith with the help of an experienced insurance bath faith lawyer in Los Angeles.
Sometimes, your case will settle before it goes to trial. However, if your bad faith insurance case goes to trial and the jury determines that the insurer did breach its insurance policy contract, and was acting in bad faith, you may be able to recover significant damages, including punitive damages. Punitive damages are often awarded as a way to punish the insurance company for wrongfully denying a your valid insurance claim and encouraging them and others to not do it again.


Unfortunately, this is not the case with employer-provided health insurance, which falls under the protection of federal law (i.e. ERISA). If you have health insurance provided by your employer, you give up significant rights due to ERISA. Therefore, if the insurance company wrongfully denies your health insurance claim you can only sue them for the actual cost of your medical bills—not for bad faith.

This means that there is no incentive for an employer provided health insurance company to pay for a life saving treatment that is covered under your employer provided health plan. The insurance company’s view of it is it can pay the costs now, or it can wait to see what happens, deny your claim, and know that two to three years down the road the most it will be required to pay to you (or your family if you die) is the costs of the surgery it denied you.

If you had purchased your own health insurance (most likely more expensive than your employer provided plan) coverage, you are no longer precluded by federal law (ERISA) from suing your health insurance company for wrongful denial of a valid medical claim. Instead, with the help of your insurance bad faith lawyer, you can recover “bad faith”, or punitive damages, against your personal health plan for bad faith denial of a valid claim.

For more information on insurance bad faith and how to file a lawsuit against your insurance company for denying a valid claim, reach out to the aggressive insurance lawyers at BIKLAW today.


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