If you’re involved in a dispute with your health insurance company, filing a lawsuit will not usually be your first step in the dispute. Instead, you must first go through several formal procedures to address the insurance dispute out-of-court. If all else fails, and no resolution is achieved, it may be necessary to seek justice in the courtroom.
Prior to filing a lawsuit, you should go through the following process to appeal a health insurance decision:
- A first internal review with insurance company
- A second internal review with insurance company
- An Independent, or the so-called "external review"
If the external review results in an unsatisfactory decision, you can bring a formal lawsuit. Whether you’ll be able to do so depends on your insurance plan and your state’s laws. Seeking advice from a qualified attorney is necessary at this time.
Before consulting with an attorney, you should have in your possession:
- Your healthy insurance policy
- A written log of your communications with your insurance company
- The documents of the insurance company’s denials of your claim
- A comprehensive set of documents received during the internal and external review processes
There are several key points that you should keep in mind in order to have a strong chance of winning a lawsuit or obtaining a satisfactory settlement:
- Your insurance may send you back your premiums with other documents that may ask for a release. However, DO NOT sign anything. After a lawsuit is filed, all communications from your insurance must be reviewed by your attorney.
- Make sure you understand the bad faith insurance laws of your state and hire a qualified lawyer who specializes in these laws.
- Typically, bad faith insurance lawsuits involve contingency fee payments, so that you only pay a lawyer when you win or settle the case.
A claim filed in court is likely to be that of a "bad faith insurance" claim. Such a clam against your insurance company may result from your insurance company’s:
- Failure to respond to your claim in a timely manner
- Declining a claim or refusing to settle
- Failure to investigate
In a bad faith insurance claim, your insurance company must prove that it acted appropriately. In another words, the insurance company has the burden of proving its innocence.
If you have a dispute with your insurance company, an experienced personal injury attorney can help you during the review process and can help you understand if you should file a lawsuit. A lawyer will present the best evidence for your claim and will represent you in court.