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.

Pre-Litigation Forms of Resolution

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"

Bringing a Lawsuit against Your Health Insurance Company

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:

  1. Your healthy insurance policy
  2. A written log of your communications with your insurance company
  3. The documents of the insurance company’s denials of your claim
  4. 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.

Insights and Precautions for Suing Your Insurance Company

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.

Seeking Help from an Attorney

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.