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Insurance Law

Insurance Law

Increasingly, health insurance companies are denying claims. The reasons given are many, including that coverage is not provided in the policy, that the services were “not medically necessary” or were not “authorized,” or perhaps the insurer will characterize the treatments as “experimental.”

We have seen all of these reasons advanced to deny coverage, as well as dozens of other reasons. Sometimes the insurance companies are correct in their decisions, but quite often, they are not, and the result is that deserving people are denied their insurance benefits.

This might not be a huge problem when the treatments are simply for the routine maintenance of good health, but when treatments or medications are critical to treat dangerous or even life threatening conditions, challenging the insurance company decision becomes an absolute necessity.

Health Insurance Denial

A denial of health insurance benefits can lead to devastating consequences for you and your family. If you have a chronic illness that requires a lot of medical attention, testing, and care, you can easily rack up hundreds of thousands of dollars in related bills. When your health insurance company issues a denial for these claims, you can be left out in the cold with mounting bills and no way to pay them.

Health insurance companies attempt to justify their denial practices, citing material misrepresentation and the use of non-network providers as reasons not to pay claims. However, there are ways around these issues. You just have to hire a lawyer to help you fight for what you are owed.

OUR HEALTH INSURANCE LAWYERS EXPERTLY HANDLE CASES IN Los Angeles County, Riverside County, Orange County and San Diego Country. 

Our team of health insurance lawyers is second to none. We have a phenomenal reputation among other lawyers, as well as insurers. The insurance companies know that we are a tough group of legal experts who will not back down from a fight. They also know that we will fight for our clients’ rights with passion and ingenuity.

We are dedicated to our jobs and our clients like no other firm in Southern California. If we can’t achieve a satisfactory settlement for you, then you pay us nothing.

Call us today at +1 (800) 237-3027 to find out how we can be of service in your health insurance case.

Sub-Categories

Bad Faith Issues 

What is insurance bad faith? At its core, bad faith exists whenever an insurance company unreasonably fails to uphold its end of a bargain. Insurance companies are legally required to act in good faith and to use only fair claims practices. California law defines certain acts and conduct that can qualify as bad faith. They include the following:
  • Unreasonable denial of policy benefits
  • Misrepresenting facts or policy provisions to claimants
  • Failing to respond or act promptly with respect to a claim
  • Not having reasonable standards for the prompt investigation and processing of claims
  • Failing to either approve or deny claims within a reasonable time period after the insured has submitted adequate proof of loss
  • Refusing to make a good faith effort to fairly settle claims when liability is reasonably clear or failing to settle one part of a claim in order to influence other parts of the claim
  • Compelling the insured to litigate the claim because the insurance company has refused to make an adequate settlement offer
  • Attempting to settle for an amount that appears unreasonable when compared to statements made in written or printed advertising material that accompanied the application for insurance
  • Attempting to settle claims using an application that was altered without the knowledge and consent of the insured or his or her agent
  • Threatening to appeal an arbitration award in an attempt to compel the insured to accept a settlement less than what was awarded in arbitration
  • Failing to provide prompt justification for the denial of a claim
  • Advising a claimant not to hire an attorney
  • Misleading a claimant as to the legal deadline for filing a claim or initiating a lawsuit

Disaster-Related Claims

Disaster related claims are made by policyholders when a hurricane, flood, fire, earthquake, or other natural disaster ruins or damages a person’s property. It is expected that most of the recovery to the damaged property will come from an insurance policy, where the insurance company offers an appropriate settlement. Policyholders are usually prepared for having disaster related claims by having insurance before the natural disaster strikes and expect recovery after it’s over.

What are Disaster Related Claims?

Homeowners or business owners that have insurance may need to file a disaster-related claim if their property undergoes a fire, flood, hurricane, earthquake, or other natural-disaster. In any of these cases, their insurance company is obligated to cover the majority of damages that may have occurred. A policyholder can submit a disaster related claim if a natural disaster strikes, and they will expect to receive a settlement that can cover their property damages.

Insurance companies have a fiduciary responsibility to settle disaster-related claims made by their clients. It is in their client insurance contracts that they must act in good faith and respond to all claims. Unfortunately, however, some insurance companies try to escape having to give out settlements, even if they are for valid disaster-related claims. They may make insurance claim procedures difficult, stall responding to claims, break promises, change the terms of their contract, cheat the client out of the full settlement amount, or even deny the claim entirely.

Homeowners Insurance 

Homeowners Insurance Law

Lenders often require homeowners to purchase homeowners insurance, or hazard insurance, before completing their mortgage loan. Homeowners insurance covers damages caused by fire, smoke, hail, wind, vandalism, or other events. Homeowners insurance covers the house and its furnishings, personal items, structures on the property such as garages and pool houses. Homeowners insurance may also cover personal liability such as if someone gets injured on your property.

What is Homeowners Insurance?

Homeowner’s insurance is a form of hazard insurance that covers one’s home and property. It pays out benefits for losses caused by fires, theft, hail, wind, vandalism or other similar damaging events. A homeowner’s insurance policy will typically cover the house, personal property, furnishings, and other structures such as garages, sheds, or pool houses. If a homeowner has a mortgage, they are often required by their lender to purchase homeowner’s insurance. The policy can also cover personal liability and legal responsibility for injuries that happen to other people while on the property. This includes damage or injuries caused by the homeowner, his or her family members, and even their pets.

Unfortunately, even if a homeowner has a valid homeowner’s insurance policy, their claim could be denied in certain instances, leaving them to suffer a major loss. Insurance companies may create impossible conditions and terms in their contracts, delay or stall a claim to force the policyholder to accept a smaller settlement, make false promises that they do not follow through with, trick policyholders with false adjustments or by changing the terms of their contract, etc.

Homeowner’s Insurance Lawyers

Being denied benefits from your homeowner’s insurance policy can be devastating to you and your family if you have suffered damages to your property. If an insurance company denies your claim, challenges your claim, or pays you a smaller settlement that you are owed, a homeowner’s insurance lawyer can help. An experienced homeowner’s insurance attorney will act as a mediator between you and your insurance company if they try to escape paying for the damages to your home or does not pay you enough to replace the property you may have lost. An attorney can help prove that your insurance company acted in bad faith by denying you the coverage you are rightfully owed. They will do their best to settle any disputes quickly, so that you can get the compensation you need to rebuild your life.

Consequences of Homeowners Insurance:

There are instances where a homeowners insurance claim made by a policyholder is valid but an insurance company denies the claim. Insurance companies could:

  • Use delay and stalling tactics to make policyholders accept a small settlement
  • Creating impossible conditions such as asking for unreasonable documentation or verification 
  • Wasting a policyholder’s time by requiring them to resubmit existing information
  • Charging multiple quotes
  • Making promises without following through with them
  • Tricking policyholders by changing the terms of the policy and giving false adjustments

What an Active Law Group Lawyer can do for you:

Homeowners insurance companies might try to escape paying for the costly damages that occurred to your property. This is when an experienced homeowners insurance lawyer can help. An Active Law Group attorney can settle disputes between policyholders and insurance companies who act in bad faith. Homeowners are often hurt when they are denied insurance coverage. An (A.L.G.) homeowners insurance lawyer will be a mediator between you and your insurance company when your insurance company does not pay enough to replace your belongings or your house.

Accident Insurance 

California Vehicle Code §16056 requires all drivers to maintain a minimum of 15/30/5 coverage on all registered vehicles, which includes: $15,000 for injury or death to one person. $30,000 for injury or death to more than one person, and. $5,000 for property damage.

Accident Insurance Law:

An accident insurance policy is a legally binding contract in which an insurance company agrees to pay the insured or policyholder in the case of an accident, if the losses are covered in the policy. An accident insurance settlement is the compensation that a victim will receive when the insurance company receives the claim.

Accident Insurance Claim Legal Issues:

In many cases, insurance companies have refused or denied to pay a policyholders accident insurance claim. An insurance company can decide to deny a claim because the loss is not covered by the terms of the policy or because the policyholder voided their coverage due to misconduct. Sometimes, insurance companies unjustly deny accident insurance claims.

What an Active Law Group Insurance Lawyer can do for you?

Most accident insurance policies are complex and the resolution of coverage disputes should be carefully analyzed. Hiring the assistance of an accident insurance attorney to handle insurance coverage matters could be useful. An attorney can ensure that a victim’s rights are protected throughout the settlement. Accident insurance lawyers help victims get the appropriate compensation for accident damages. An Active Law Group attorney can help with medical expenses and property damage and make sure you get fair compensation for your accident.

Health Insurance

Under California law AB1672, small employers are guaranteed group coverage should they choose to purchase it, regardless of the employees’ health status. A “small employer” is defined as a business with 2 to 50 full-time employees. In 2016, a small employer will be defined as a business with 2 to 50 full-time employees. Owners are generally counted as employees, so sole proprietorships with one employee fall into this category, as do partnerships without any employees (by definition partnerships have two or more partners).

California state law AB1672 says that small employers cannot be denied coverage as long as they:

  • Pay their premiums.
  • Have been in business longer than two months.
  • Offer medical insurance coverage to all eligible full- and part-time employees.
  • Comply with insurer requirements regarding employer contribution and employee participation.
  • Have not committed fraud against the insurer.

Disability Insurance:

Disability Insurance (DI) provides short-term benefits to eligible workers who have a full or partial loss of wages due to a non-work-related illness, injury, or pregnancy.

Disability Insurance

Disability Insurance is an insurance policy that covers a portion of your work income when you are disabled due to an injury or illness. There are short and long term disability insurance policies. Short term disability insurance is often a part of an employee’s benefits package and covers the early part of a disability. Long term disability insurance replaces income for an extended period of time.

Disability Insurance Claims Legal Issues:

Many disability insurance policyholders have their claims denied. Insurance companies make excuses such as not receiving documentation on time, failure to receive medical reports, that the illness or injury is not covered under the policy or that the pain is not severe enough to hinder the employee’s work. Disability insurance providers deny claims in order to save money and deny legitimate claims, hoping the policyholder does not appeal the claim.

What an Active Law GroupInsurance Lawyer can do for you?

An (A.L.G.) Disability insurance lawyer can assist you with any issues that come up regarding your claim. A disability insurance lawyer knows the law and the trial strategies involved in identifying and seeking damages. Our attorney can help you understand the complicated terms in the policy. If you are considering filing for Disability Insurance Claims benefits, an Active Law Group attorney can help you throughout the process and even help you get the disability compensation you need.

Life Insurance

Life Insurance Law

Life insurance is a contract between an insurance company and an “insured” or “policyholder“, or someone who buys the policy. Life insurance is also known as death insurance. If an insured, who has been paying a premium to the insurance company dies while the policy is still active; the insurance company pays a set amount to the beneficiary. The premium for life insurance increases with age and amount.

Life Insurance Legal Issues:

When making a life insurance claim, there may be certain problems that arise, in which the life insurance company may delay payments, such as:

  • Questions about whether or not the policy was in force at the date of death
  • If the policy is less than 2 years old
  • If the death was suspicious and might be set up by the beneficiary
  • If the death as a result of an accident and the life insurance policy covers death benefits
  • If the death certificate verifies that the insured is older than what is stated on the policy
  • If the person was a smoker and claimed he/she was not a smoker when applying for the policy

What is Life Insurance Law?

Life insurance, also known as death insurance, is an insurance policy that pays out a lump sum settlement to one’s beneficiaries after death. It is a legal contract between the policyholder and insurance company, promising to provide death benefits to the policyholder’s beneficiaries after death, in exchange for a monthly premium being paid to the insurer while the policyholder is alive. The premium paid for life insurance depends upon the settlement amount, and it typically increases with the policyholder’s age.

There may be issues that arise when making a life insurance policy claim, which leads to the insurance company either delaying payments or denying the claim. Some such problems may include:

  • The policy being under 2 years old at the time of the insured’s death
  • Suspicious circumstances surrounding the death
  • Questions about whether or not the policy was active at time of death
  • The insured lied about their health or age when purchasing the policy
  • The insured was a smoker and did not divulge such information to the insurance company

Insurance Fraud

Insurance Fraud Law

Insurance companies should always act in good faith to the insured and not make policy holders victims of insurance fraud. An insurance company is required to abide by the terms of the policy and pay when a customer makes a valid claim. Insurance fraud occurs when an insurance company lies or hides so that they may avoid payment for a legitimate claim. Some insurance fraud is also motivated by greed, such as when insurance companies cheat customers by charging unauthorized fees and premiums and discriminating against applicants.

Consequences of Insurance Fraud:

Insurance fraud occurs in all forms of insurance (automobile, workers’ compensation, disability, life, healthcare and homeowner’s insurance). A policy holder becomes a victim of the insurance company when the insurance company breaches their duty of good faith. Most state laws allow victims of insurance fraud to bring legal action against an insurance company and to seek monetary damages.

What an Active Law Group Lawyer can do for you?

An insurance company is required to abide by the laws and terms of the policy. If you feel you are a victim of insurance fraud because your insurance company has been delaying payment of a claim or refuses to pay a claim, an experienced Active Law Group insurance fraud lawyer can help. Insurance fraud lawyers investigate the insurance company by using your policy as their guide. Insurance fraud lawyers fight for a policyholder’s rights.

Disability Insurance

Disability Insurance (DI) provides short-term benefits to eligible workers who have a full or partial loss of wages due to a non-work-related illness, injury, or pregnancy.

Disability Insurance:

Disability Insurance is an insurance policy that covers a portion of your work income when you are disabled due to an injury or illness. There are short and long term disability insurance policies. Short term disability insurance is often a part of an employee’s benefits package and covers the early part of a disability. Long term disability insurance replaces income for an extended period of time.

Disability Insurance Claims Legal Issues:

Many disability insurance policyholders have their claims denied. Insurance companies make excuses such as not receiving documentation on time, failure to receive medical reports, that the illness or injury is not covered under the policy or that the pain is not severe enough to hinder the employee’s work. Disability insurance providers deny claims in order to save money and deny legitimate claims, hoping the policyholder does not appeal the claim.

What an Active Law Group Insurance Lawyer can do for you?

A Disability insurance lawyer can assist you with any issues that come up regarding your claim. A disability insurance lawyer knows the law and the trial strategies involved in identifying and seeking damages. An Active Law Group attorney can help you understand the complicated terms in the policy. If you are considering filing for Disability Insurance Claims benefits, an attorney can help you throughout the process and even help you get the disability compensation you need.