McKennon Law Group, Author at McKennon Law Group

Many disability insurance policies provide benefit payout periods that are much longer for disabilities caused by physical conditions as opposed to mental conditions. Typically, while allowing benefits for disabilities caused by mental or nervous conditions are paid only for a limited time period, often two years. Additionally, insurance companies operate for the purpose of generating profit and therefore have a substantial financial motivation to avoid paying benefits whenever possible. If an insurance company is unable to justify denying a disability claim outright, the next best action they can take to save money is to limit the benefits it pays out to as short a period as possible. Thus, given the choice between paying benefits related to a physical condition versus a mental or nervous condition, any insurance company will logically prefer to only approve a claim for a mental or nervous condition, and not for a physical condition. To complicate matters, there are many times when a claimant suffers from both a physical condition and a mental/nervous condition, which may or may not be separately disabling. On top of this, some disabling conditions, such as chronic fatigue syndrome, are subjective in nature, lacking objective testing. When a claimant is disabled due to such a condition, it will be difficult, if not impossible, to provide objective evidence to the insurance company to prove such a disability.

A recent District Court decision, Veronica L. v. Metropolitan Life Insurance Company, 647 F.Supp.3d 1028 (D. Oregon 2022), sheds light on how insurance companies handle claims based on subjective conditions and how claimants can recover their much-needed benefits. The plaintiff, Veronica, made a claim for long-term disability (LTD) benefits with MetLife. She had been diagnosed with PTSD, major depressive disorder, and generalized anxiety disorder, all mental/nervous conditions. She had also been diagnosed with chronic fatigue syndrome (CFS).

MetLife approved Veronica’s claim for LTD benefits based on her PTSD, anxiety, and depression. During its review of her claim, MetLife conducted a “paper review” of her medical records, done by a physician who reviewed Veronica’s medical records without examining or speaking directly with her. The paper review physician concluded that Veronica had no restrictions or limitations caused by CFS, supporting the conclusion with vague language: “based on the medical documentation, it is understood that the claimant’s low energy [is] likely related to psychological condition.” A second paper review physician also “found insufficient support for a diagnoses of CFS” based only on Veronica’s medical records, which included no interaction with Veronica and no discussion with her treating physicians.

Veronica began treating with a new physician who noted that she had fatigue that had progressively worsened over the previous three years. The new physician provided records to MetLife, but by the time MetLife received the records, it had already determined that Veronica was entitled to LTD benefits subject to the mental/nervous limitation of three years. Veronica appealed MetLife’s decision, highlighting records and notes from her physician supporting her position that she was disabled due to CFS, a physical condition, independent of her mental/nervous conditions.

In reviewing Veronica’s appeal, MetLife hired a third paper review physician, who’s opinion was, predictably, that Veronica had no restrictions or limitations based on CFS, “given the lack of objective evidence.” In response to this, Veronica’s treating physician asserted that CFS is difficult to assess through objective evidence but rather is determined by personal interaction with the patient. Simply put, CFS is inherently subjective in nature and objective evidence, such as imaging or lab work, does not exist. This did not change the opinion of the paper review physician, who again pointed to a lack of objective evidence to support his conclusion that Veronica was not disabled due to CFS.

The court decided the matter on de novo review, meaning that it would determine in the first instance if Veronica had adequately established that she was disabled under MetLife’s plan. After reviewing the evidence, the court found that MetLife had based its decision on incomplete information and had erred by failing to conduct an independent medical exam (IME). Citing Salomaa v. Honda Long Term Disability Plan, 642 F.3d 666 (9th Cir. 2011), the court noted that there are no objective laboratory tests for CFS, its etiology is unknown, and a diagnosis of CFS is based on a patient’s subjective reports of symptoms, reviewing her medical history, and ruling out other disorders. Because there was no means of objectively proving that she had CFS, evaluating Veronica’s disability was essentially a credibility determination.

The court found that Veronica’s treating physicians provided credible evidence that she in fact suffered from CFS; the evidence included a substantial history of subjective complaints by Veronica regarding her lack of energy, her inability to perform more than one major task per day, the fact that she no longer was able to do activities she had previously enjoyed, and requiring abnormally long periods of sleep. Additionally, Veronica had sought treatment for her CFS for several years but had not been able to find any treatment that alleviated her symptoms.

Because Veronica had presented evidence that she was disabled due to CFS, including her uncontested diagnosis of the condition, her own statement about her subjective symptoms, and corroborating statements made by her treating physicians, the court explained that because CFS cannot be objectively measured, MetLife would need to make a determination that Veronica’s claim was not credible in order to justify denying her LTD benefits beyond the mental/nervous limitation period.

The court explained that MetLife had a duty to conduct an adequate investigation of Veronica’s claim, citing Petrusich v. Unum Life Ins. Co. Of Am., 984 F. Supp. 2d 1112 (D. Or. 2013). While ERISA did not require MetLife to conduct an IME, failure to do so may raise questions about the thoroughness of its review and determination. The court noted that failure to conduct an IME may be particularly dubious when a claimant’s condition is based on subjective symptoms, citing Robertson v. Stand. Ins. Co., 139 F. Supp. 3d 1190 (D. Or. 2015). In this case, MetLife could have conducted an IME, which could have provided the evidence it needed to determine whether Veronica was disabled from CFS but declined to do so. Especially considering that MetLife expressed doubt as to Veronica’s credibility and the severity of her subjective symptoms, for MetLife not to conduct an IME meant that its decision was based on inadequate evidence. None of Veronica’s treating physicians ever questioned her credibility, nor did they opine that she exaggerated symptoms yet MetLife still discredited her subjective symptoms anyway, without providing any rationale for doing so. However, MetLife was obligated to consider Veronica’s self-reported symptoms because no objective tests exist for CFS; MetLife could not condition her LTD benefits on objective proof of CFS because it is a recognized condition but is not objectively provable.

ERISA does not have a rule requiring treating physicians’ opinions to get more deference than other physicians but treating physicians have more opportunity to know and observe a patient than those who have not examined the patient. See Black and Decker Disability Plan v. Nord, 538 U.S. 822 (2003). Especially with a condition like CFS, which requires examination of a patient’s symptoms and medical history, that patient’s treating physician is likely in a better position to diagnose such a condition than a paper review physician. In this case, MetLife’s paper review physicians did not provide any explanation for discounting the opinions provided by Veronica’s treating physicians, who had expertise with CFS. Thus, MetLife’s decision was improper.

It is vital to understand your insurance company’s obligations in reviewing your disability claim. Especially if your condition is something like CFS, for which objective evidence is impossible to provide, accepting the insurance company’s denial of your claim may be tantamount to foregoing disability benefits to which you may be entitled. To avoid such circumstances, you should consult with an expert disability insurance claims attorney with expertise and knowledge of ERISA and insurance companies’ obligations. The team of attorneys at McKennon Law Group PC have exactly such expertise and knowledge and can help you navigate your disability claim and appeal of the insurance company’s denial of your claim. If you have made a claim for disability benefits or intend to do so, contact McKennon Law Group PC immediately for a free consultation.

Introduction

Long-Term Care (LTC) insurance is designed to cover services and expenses that are not covered by regular health insurance when the insured suffers from a chronic medical condition, disability or disorder, like dementia. These policies typically pay a set daily benefit for reimbursement for needs such as nursing home care, assisted living facilities, home healthcare, home modifications, adult day care services, and care coordination. In California, LTC Insurance is defined in Insurance Code Section 10231.2.Under the statute, LTC insurance includes:

A. Any insurance policy, certificate, or rider advertised, marketed, offered, solicited, or designed to provide coverage for diagnostic, preventive, therapeutic, rehabilitative, maintenance, or personal care services that are provided in a setting other than an acute care unit of a hospital.
B. All products containing coverage for care in a nursing home, convalescent facility, extended care facility, custodial care facility, skilled nursing facility, or personal care home; home care coverage including home health care, personal care, homemaker services, hospice, or respite care; or community-based coverage including adult day care, hospice, or respite care.

Typical LTC policy terms provide for payment of a daily benefit amount and will pay an insured the amount incurred each day they are in a qualified care facility, up to this daily amount. There is often also a total maximum amount payable from which the benefits paid are deducted. A typical LTC policy will pay benefits if the insured is unable to perform a given number of Activities of Daily Living for a given period of time due to a loss of functional capacity, or if they demonstrate severe cognitive impairment.Many early LTC policies provide unlimited lifetime benefits. Most issued today contain a stated limit in lifetime benefits.

The Underpricing Dilemma

In the late 1990s and early 2000s, there was a trend in the insurance industry to issue LTC policies at attractive rates. Many who purchased these policies were middle-aged at the time and are now reaching the age at which they now need to receive the benefits they expect to be paid under the LTC policies. Insurers now realize that they may have issued policies with rich benefits at premiums that are too low to profitably underwrite them. In other words, insurers made erroneous pricing decisions and are now reaping the costs associated with these poor decisions.

The Denial of Legitimate Claims

As a result, insurance companies are denying legitimate claims, including using many of the same tactics that have led to substantial insurance bad faith and punitive damages awards in lawsuits over disability claim denials and LTC claim denials.

For example, LTC insurers deny claims based on illegal policy provisions. In California, insurance companies may not include policy definitions that conflict with statutory provisions as required pursuant to state law. A policy may require the insured to demonstrate “severe cognitive impairment” for a claim to be approved, and the insurer will insert its own definition of what constitutes “severe” impairment. But if “severe cognitive impairment” is defined by law, the insurer’s definition may not comply with the law. Under California law, “Severe cognitive impairment” means a loss or deterioration in intellectual capacity that is (1) comparable to (and includes) Alzheimer’s disease and similar forms of irreversible dementia; and (2) measured by clinical evidence and standardized tests that reliably measure impairment in the individual’s short-term or long-term memory; orientation as to people, places, or time; and deductive or abstract reasoning. See Ins. Code, § 10232.8(e); IRS Notice 97-31.

Insurers might also use deceptive language in their claim forms to wrongly deny claims. The covenant of good faith and fair dealing requires insurers to thoroughly inquire into all possible bases to pay a claim before denying it. See Egan v. Mutual of Omaha Ins. Co., 24 Cal.3d 809 (1979). Also, the insurer has the burden of seeking out information relevant to a claim, so it must communicate with the insured and his physicians in a manner calculated to elicit an informed response. See Hughes v. Blue Cross of Northern California, 215 Cal.App.3d 832 (1989). However, insurers still will strategically word forms to allow for ambiguities to justify denials, such as using varying degrees of cognitive impairment – “mild,” “moderate,” “severe” – then denying any claims not marked “severe.” But the form will use a different definition for “severe” than the statutory definition. Such a denial may not comply with the law.

Insurers also use abusive tactics designed to take advantage of vulnerable insureds, such as insisting on multiple forms to be regularly submitted by each insured, her physicians, and her guardian, then denying the claim for any error found in any of the forms, however minor. Or the insurer will require specific information from the insured in a confusing manner that prompts the insured to call to inquire about what information to provide, then the insurer will pass the insured around from one person to another without ever providing an answer. When the insured does not provide the information on time, the insurer may deny the claim.

Clearly, LTC insurers issuing these policies did not expect to receive so many claims under their LTC policies. And the insurers have now determined that they can expect the number of LTC claims to increase substantially in the future. Because insurers are currently using these tactics to deny legitimate claims, it is likely that insurers will become even more aggressive in denying LTC claims as more claims are filed in the future.

Protecting Your Interests

If you have made a claim under an LTC policy, or plan to make a claim soon, you can expect that your claim will likely be denied. If your LTC claim is denied, you should contact a knowledgeable and experienced insurance claims LTC attorney. The attorneys at McKennon Law Group PC have the knowledge and expertise needed to determine whether a claim denial is proper and we can ensure you are placed in the best position possible to receive the LTC benefits you are entitled to under to the LTC coverage you purchased.

What is Professional Liability Insurance?

Businesses and other organizations are typically required to carry insurance, and many types of commercial insurance exist. Discussed here is one type of commercial insurance, professional liability insurance.

Like any type of insurance, professional liability insurance involves premiums paid to secure insurance coverage. When there is an event related to the policy, the insurance company or its representative is supposed to investigate the claim. If the event results in losses that are covered under the policy, the insurance company is supposed to pay out.

Professional liability insurance, which is also sometimes called professional indemnity insurance, is specifically designed to cover losses associated with errors and omissions made by certain professionals or negligence of those professionals.

Additionally, insurance bad faith claims are possible in professional liability cases, which occur when the insurer ignores its obligations under its own policies and fails to pay out claims as it should.

One of the first steps in seeking compensation from any insurance company is knowing what type of coverage your policy provides.

Who Needs Professional Liability Insurance?

Typically, businesses only need this type of insurance if they offer specific types of guidance, advice, and services. Some types of businesses that need professional liability insurance include:

Accountants
Engineers
IT and business consultants
Lawyers
Life coaches or trainers
Construction professionals

If the advice or services you provide could in any way seriously impact the business, lifestyle, or livelihood of your clients, you may need professional liability insurance. It is important to talk to an experienced professional liability insurance agent to understand what policy and insurers may be right for your company.

When Will Professional Liability Insurance Pay Out?

Professional liability cases can include a wide variety of scenarios. Some examples are:

An accountant makes a mistake on a tax return, resulting in a loss for a business. An error on the part of a professional in his or her line of expertise that causes damages for the client can result in a claim.
A construction company does not complete permit paperwork in a timely manner, resulting in long delays and more expenses for a project. This might be considered negligence because the construction company failed to act in the best interests of its client, which could result in a professional liability claim.
A business consultant misrepresents their knowledge in a specific niche area, resulting in a client relying on poor advice. If this advice leads to losses, the client might have a claim for damage.

Note that professional liability insurance does not cover criminal acts, nor does it cover breach-of-contract, negligence, or personal injury claims. Professional liability coverage may be denied where the claim arises out of activities not associated with the professional duties being insured Many businesses that are required to carry professional liability insurance also must carry public or general liability insurance to ensure they are covered in such scenarios. These policies are almost always known as claims made policies where claims must be made within a certain period of time after a known claim exists. It is critical that one a policyholder is aware of a potential claim, that a claim is made under the policy.

What Happens When You Have a Claim and the Insurance Company Will Not Pay?

Professional liability policies are almost always known as claims made policies. Claims must be made within a certain period of time after a known claim exists. It is critical that once a policyholder is aware of a potential claim, that a claim is made under the policy. The claim may be a lawsuit against your business or a letter accusing your company of professional negligence. It is critical that you immediately submit a claim to your insurance company.

If you have a claim against your business and believe that your professional liability insurance should cover the claim, you first need to submit a claim as soon as possible. In cases where the insurance company does not review the claim and agree to a settlement you feel is fair, you may need to seek further legal recourse, including filing a lawsuit for breach of contract and insurance bad faith.

Unfortunately, insurance companies often deny valid insurance claims. Most insurers have shareholders and others to whom they must answer financially, and the friction between profits and compensating business for their losses and defense costs can easily lead to bad faith practices. Insurance policies are typically long and complex, which allows insurance companies to take advantage of this to improperly deny claims and exclude coverage based on ambiguous policy language.

To reduce the chance that you deal with such insurance bad faith practices, consult an experiences insurance bad faith lawyer before you submit your claim or, if you have already submitted a claim and the insurance company has denied it, contact McKennon Law Group PC and schedule a free consultation to find out how we can help with your case.

You have experienced an accident or medical condition that has caused you to be unable to continue working. Thankfully, because you had disability coverage, you were able to submit a claim for disability benefits and were approved, and you have been collecting disability benefits. Although the benefits are not as much as your salary was, receiving the benefits alleviates much of the stress that accompanied your unfortunate situation. While things could be better, you still breathe a sigh of relief that you carried disability insurance. However, one day you receive a letter from your disability insurer saying that it has determined that you no longer meet the policy definition of total or partial disability, and you will therefore not receive any further disability benefits. You panic because you know that you will not be able to survive without the disability benefits. This type of scenario can be incredibly stressful. And it is common.

If you receive, or plan on receiving, disability benefits, it is crucial to be prepared for your disability insurance company to terminate your disability benefits after you begin receiving them. Because paying your disability benefits are a significant cost to your insurer, it has a vested interest in finding a way to discontinue paying them to you. Thus, it is reasonable to believe that your insurer is always looking for a justification for terminating your benefits, even if the reason is improper. They do this by conducting ongoing surveillance of you, reviewing your medical records to look for inconsistencies and or lack of support for your disability, conducting so called “independent” medical examinations with biased medical personnel or by waiting for a change in definition of disability under your policy to assert you no longer qualify for disability benefits.

If you have been notified that your benefits have been terminated or are going to be terminated, it is vital for you to take certain steps to protect your benefits.

What to Do if Your Disability Benefits Have Been or Are Going to Be Terminated

First, you should do carefully read the insurance company’s reason for terminating your benefits so you can understand exactly what that reason is. If you do not understand why your benefits have been or are being terminated, you will have an extremely difficult time presenting an effective appeal to your insurance company. If you have read the insurance company’s rationale and do not understand it, you should immediately consult with an experienced disability insurance attorney. The knowledgeable and experienced disability insurance attorneys at McKennon Law Group PC will provide a free consultation regarding the termination of your benefits.

Second, review the policy language to see whether it supports the insurance company’s basis for termination. It may be that your benefit period under the policy has expired and you are no longer entitled to benefits. On the other hand, it may be that the insurance company has concocted an illegitimate reason that is not supported by the policy. Without reviewing your policy, you may not understand whether the insurance company’s determination was proper.

Third, you should review the medical and other evidence supporting your disability claim. If you submitted sufficient evidence and the insurance company approved your claim, then it reversed itself without presenting new evidence or pointing out what in the existing evidence changed to prompt its determination, it is likely that the insurance company’s decision was improper. Once you have been determined to be disabled under either an “own occupation” standard (under which you are considered disabled if you are unable to perform the duties of your own occupation) or an “any occupation” standard (under which you are considered disabled if you are unable to perform any occupation for which you are suited by education, training or experience), the insurance company may not then determine that you are no longer disabled under that same standard without presenting evidence that your condition has improved. Therefore, it is important to understand the evidence supporting your claim and how the insurance company interprets that evidence.

It may be a matter of your insurer expecting to see ongoing evidence of your disability, in which case it will request additional information from you. This is entirely normal and expected unless you have an undisputed permanent disability condition. If you fail to provide that information or provide insufficient information, the insurance company may be able to properly terminate your benefits under the policy. However, if you have provided sufficient information and your insurer still terminates your benefits, there is a good chance that the insurance company acted improperly. In such a case, you should seek experienced disability insurance lawyers to assist you. The award-winning team of attorneys at McKennon Law Group PC can help you avoid having your benefits terminated, or help you recover your benefits if they have been terminated. Reach out to McKennon Law Group immediately for a free consultation.

If the insurance company has enlisted a physician to certify that you are not disabled, you may need to get your treating physician or physicians to provide additional certification supporting your position that you are disabled. Not only that, but it will also likely be necessary to present evidence that calls into question the opinions of the insurance company’s physicians or nurses.

If you are receiving ongoing disability benefits, it is important to understand the very real possibility that your insurance company will terminate them at some point. When this happens, the best thing you can do is immediately contact the expert disability insurance lawyers at McKennon Law Group PC who specialize in all types of disability insurance issues.

Has Your Disability Insurance Claim Been Denied?

If your claim for long-term disability benefits has been denied – or is denied in the future – you will need the advice and services of a California life and disability insurance claims lawyer. You should contact that lawyer as swiftly as possible after your claim is denied.

Long-term disability policies typically contain two different standards of disability: “own-occupation” and “any-occupation.” Some policies have a hybrid combination of the two.

It is important to understand the differences between the “own-occupation” and the “any-occupation” standards, as these distinctions can be confusing. Failing to understand the difference between the two standards can lead to a claim denial.

Know Your Disability Policy

It is critically important to know exactly what your long-term disability insurance policy provides. The most important provision of the policy is its definition of disability, which establishes the requirements you must meet to receive long-term disability benefits. The definition of disability varies by the policy, but it always focuses on your ability to work.

You should know that individual and group disability policies also substantially differ in their definitions of disability. Most individual disability policies do not contain “any-occupation” definitions of disability while group disability policies almost always do.

The “Own-Occupation” and “Any-Occupation” Standards.

Under an “own-occupation” standard, you are generally considered disabled if you are unable to perform the job that you were doing before becoming disabled. Most group disability policies provide that one’s “own-occupation” is based on how one’s occupation is generally performed in the “national economy” rather than how it was performed specifically for a specific employer. On the other hand, under an “any-occupation” standard, one is generally considered disabled if he or she is unable to perform any job that is realistically suited for a disability clamant based on age, education, and experience. If a disability claimant is able to work, potentially even at a lower-paying job, he or she may not be eligible for benefits under an “any-occupation” standard.

Regardless of the disability standard in your employer-provided group long-term disability insurance policy, it is important to note that you always have the option of independently purchasing supplemental coverage for added protection via individual disability insurance.

When are You Considered Disabled Under an “Own-Occupation Standard?

Under the “own-occupation” disability standard, you may be considered disabled if you are not able to perform the substantial and material tasks of the job you were working at the time you became disabled.

To prevail with a disability claim under an “own-occupation” standard, the physical requirements of your job, like walking, standing, or lifting, must be considered, and you must compile and present evidence that demonstrates why you can no longer meet those requirements.

The exact evidence you will need to prevail with a disability insurance claim will depend on the details of your job and disability, but that evidence will almost certainly include your medical records and the opinions of medical professionals who have examined or treated you. As explained above, most group disability policies have a definition of total disability that is based on how the job is performed in the national economy, not how it is performed for a specific employer.

When are You Considered Disabled Under an “Any-Occupation” Standard?

The “any-occupation” standard is more stringent than the “own-occupation” standard. Under the “any-occupation” standard, a disability claimant is considered disabled if he or she cannot perform the substantial and material tasks of any job for which he or she is reasonably qualified.

This can be a very complicated determination and insurers/employers must complete a vocational analysis that includes a transferability of skills analysis to determine what jobs may be available given the restrictions and limitations at issue.

Has Your Claim for Disability Benefits Been Denied?

If your long-term disability benefits claim is denied, or is denied in the future, [the skilled and knowledgeable attorneys at McKennon Law Group PC] a California life and disability insurance claims attorney can help you appeal the denial and help you obtain the benefits you have paid for and are entitled to.

How Will an Attorney Help You?

If you purchased disability insurance privately or through your employer, and if you believe that your claim has been wrongly denied, a California life and disability insurance claims attorney can submit an appeal to the insurance company on your behalf.

If it becomes necessary, your attorney can take your case to the federal or state courts. McKennon Law Group PC has a detailed Guide on its website available for download regarding filing long-term and short-term disability claims and getting them paid.

McKennon Law Group is Here for You

The award-winning team of disability insurance attorneys at McKennon Law Group PC is ready to help. With offices in San Francisco, Los Angeles, San Diego, and Newport Beach, California and more than seventy-five years of legal experience, we advise and represent disability and life insurance policyholders and beneficiaries throughout California and the United States. McKennon Law Group PC is committed to the highest standards of client service, professional ethics, and legal excellence. If your claim for disability benefits is denied, call McKennon Law Group PC today at (949) 504-5381 for a free consultation with one of our disability attorneys,

McKennon Law Group represents clients at every stage of the disability insurance claim process, and you pay no fee to McKennon Law Group PC until we recover your disability benefits.

Needless to say, our society is currently built upon a foundation where health insurance does not benefit everyone in all situations. In fact, health insurance companies are for profit at the end of the day, so they may prioritize their pocketbook and not fair coverage that a person needs. It is devastating to realize that in our culture health insurance is not just a given and fair for everyone. As someone who pays into health insurance, it can make the matter even more distressing if a health insurance claim denial also results in an exacerbation of a personal injury. Simply the stress of realizing that your insurance claim did not get covered can be enough to result in mental anguish and overwhelm about what happens next. Health insurance claim denials are incredibly frustrating, but there are steps that you can take to appeal or avoid them from happening.

Reasons For Denials

It may seem like there are limitless reasons why an insurer may deny payment for a certain healthcare service. Some reasons are simple and understandable, and others may be confusing and more difficult to believe. The most common reasons for denials include paperwork errors or mix-ups, questions about medical necessity, cost control, provider network issues, missing details, not following health plan rules, or the service just wasn’t covered by the plan. Unfortunately, this leaves a lot of room for potential bias or making a mistake when it comes to denying a fair claim. People are at the mercy of whoever decides whether coverage should be provided, or not. Because of all the ways that a person may have their claim wrongfully denied, it is not uncommon for people to speak with an injury lawyer for assistance. Having a lawyer’s representation to handle an insurance claim denial can make all the difference in the outcome of an appeal or litigation. An experience health insurance lawyer can walk you through the steps of appealing a denial and ensure your paperwork is strong for approval of your claim.

Byproducts of a Denial

Realizing that an expensive medical service will not be covered can affect a person’s mental health. A person may then have to wonder where they will get the money to afford this new bill. Will you have to work more hours? Will you have to find another job? What will be the consequences if you are unable to pay? These are all normal concerns that anyone facing a health service denial would probably feel. A claim denial does more than inconvenience someone, as they can become vulnerable to further injury simply because of the stress. Anyone who has ever been so distracted from a stressor can attest to how everything else may fall to the wayside. To make matters worse, someone may shortly thereafter be involved in an injury event, like a car crash or workplace accident (from overworking to afford the bill). As our friends at Cohen & Cohen can attest, dealing with more injury on top of an already difficult situation can become a byproduct of a health insurance claim denial.

If you have a denied health insurance claim and need an experienced California health insurance attorney to review your claim denial, please contact us for a free consultation.