Getting injured can often lead to additional, ongoing problems. Not only will an individual have to deal with the process of recovery and any associated doctor's visits and hospital stays, after their recovery they may have high medical costs to pay back to their hospital. While most adults have health insurance to cover the cost of their injuries, at times, their coverage may be in dispute. At times, a person may be denied coverage from their insurance company, placing the full brunt of the costs on the individual. Medical costs can quickly skyrocket for serious injuries, oftentimes making health insurance a necessity to prevent nearly perpetual debt. When a person's claim is denied, they may be able to pursue a case to make a claim with their insurance.
Health Insurance Disputes in Georgia
When a health insurance dispute arises, there are a number of ways to proceed. The first step should be getting in contact with an attorney. Health insurance companies are large corporations that can bury your claim under a mountain of paperwork in an effort to run out the time period to file a legal complaint. This time period if known as the "statute of limitations" and varies depending on the initial injuries, and the insurance policy itself. There may be other time periods as well, such as time periods for giving notice of a dispute about a claim.
Common Causes of a Health Insurance Dispute
A health insurance dispute may arise from a number of contributing factors, however, most of the time it boils down to an insurance company trying to avoid paying a claim by arguing that a person's injuries are not covered under the policy. Some common factors that may contribute to a health insurance dispute include:
- Gap in Coverage: At times, a gap in coverage can cause an insurance company to claim that a person is not entitled to a claim on their insurance. Depending on the situation, an attorney could examine the facts to see if there were any errors that caused the gap and if a person was entitled to coverage.
- Cancellation: At times, an insurance company may abruptly cancel a person's coverage in an effort to avoid paying out a claim. Depending on the situation, this cancellation may not be allowed under Georgia law.
- Incident Outside of Policy: Sometimes, an insurance company may attempt to claim that a person's claim for coverage rests outside of the policy's bounds. The policy is often left up to the interpretation of the insurance company, however, this can be argued in court to protect a policy holder's right to a claim.
- Bad Faith Insurance: According to law, insurers are required to act in good faith, meaning that they must pay legitimate claims. If they refuse to pay a claim that is covered, they may be acting in bad faith, which can be met with a legal action against the insurance company.
Can an Attorney Resolve an Insurance Dispute?
If a health insurance company refuses to pay a claim in bad faith, an attorney may be hired to sue for damages. Cases against an insurance provider often rest on the plaintiff obtaining what the insurance company should have paid out, based upon the plaintiff's coverage. This can be a complex matter, as there are several ways an insurance company may attempt to deny coverage. An attorney can negotiate with an insurance company in order to fulfill the plaintiff's claim, or the case can be brought to court, where the company may be made to answer.
Damages Seen in Claims Against a Health Insurance Company
When a person wishes to make a claim against their health insurance company, depending on the case, they may claim several types of damages. Damages is a legal term that refers to monetary compensation for a plaintiff's loss in a situation. Some damages that a person may claim in a case against their health insurer can include:
- Cost of the Claim: The purpose for claims against an insurer is to collect the cost of the claim that necessitated the lawsuit in the first place. For health insurance claims, a person may be entitled to damages for the full cost of the claim the insurance company should have paid out.
- Losses for Denial/Delays: When an insurer delays a person's claim or denies it, the full cost falls on that person to pay. Medical problems often have several hidden costs beyond the simple initial payment. This often means medical debt, repeat doctor visits, or any associated medical equipment costs. If an insurance company causes delays or denials, when a case is made against them, a plaintiff may demand repayment of these amounts if they should have been covered.
- Punitive or Bad Faith Damages: If the insurance company was particularly wrongful in their actions when denying coverage, it may be appropriate to pursue punitive damages or bad-faith damages against them. These types of damages are less associated with repaying the plaintiff for their loss, and instead focused on delivering a form of financial punishment to the insurance company.
Speaking to a Georgia Insurance Dispute Attorney
Insurance dispute cases are complex matters in Georgia. These cases should be taken on quickly, as an insurance company may consider attempting to delay a person's case until the statute of limitations or other time limits have run out. In addition, speaking to an insurance company may cause them to attempt to settle the case before it can become a legal matter. If your insurance company is trying to get you to settle for a claim well below what your policy entitles you to, or if you are being denied coverage you are owed, it may be wise to get in touch with an attorney before continuing discussing the matter with your insurance company.
If you or your loved one is involved in an insurance dispute, contact the Gautreaux Law Firm today for a free consultation on your case.