Health Insurance

There are several types of health insurance that are governed by different laws.  Individual health policies are governed by state laws, which typically provide a broader array of damages for policyholders.  Most of the health policies issued through employers are governed by the Employee Retirement Income Security Act (“ERISA”) (see the “FAQs” section of our website for more information on health insurance policies and ERISA).  California law implies in every insurance contract the covenant of good faith and fair dealing, also more commonly known as insurance “bad faith.”  If an insurer denies an insurance claim and does so by engaging in bad faith conduct (see the “FAQs” section of our website for more information on what actions constitute bad faith), a policyholder may sue for policy benefits due under the policy, “consequential damages” that are caused by the bad faith conduct, emotional distress, punitive damages, attorneys’ fees and interest on past-due benefits (typically at the legal rate of 10%).

As to the policies governed by ERISA, a policyholder can sue for policy benefits, attorneys’ fees and interest due on the benefits not paid.  Health insurance policy denials and rescissions are on the rise and there has been much publicity about them.  The reasons for not paying these claims are many, including that coverage is not provided in the policy, that the policyholder made misrepresentations in the insurance application and the insurer is entitled to rescission of the policy, that the services were “not medically necessary” or were not “authorized,” or that the treatments were “experimental.”

We have had extensive experience litigating ERISA and insurance bad faith cases involving life, health and disability claims.  We are nationally recognized experts in insurance bad faith law and litigation.  No attorneys in California are better suited than we are to litigate your insurance claims.  We can and will aggressively litigate your case to achieve maximum success.

Call or email us for a free consultation.