How Insurance Companies Look for Ways to Deny Claims Rather Than Pay Them
When you purchase health insurance, you trust that your insurer will be there when you need them the most—during times of illness or injury. Unfortunately, it often seems like insurance companies prioritize corporate profits over policyholder needs, even to the extent of employing tactics to deny legitimate claims. We take a look at some of these strategies below. If you believe you’re your health or life insurance claim was unreasonably denied, contact Gianelli & Morris to review your situation with an experienced and successful California insurance bad faith lawyer.
Common Tactics Insurers Use to Deny Claims
- Misinterpreting Policy Terms
Health insurance policies are filled with complex language and fine print. Insurance companies may exploit this complexity to misinterpret policy terms in their favor, denying coverage for treatments that should be covered. For example, they might classify a necessary procedure as “experimental” or “investigational” or argue that a pre-existing condition excludes coverage. - Delaying the Claims Process
Delaying claims is another way insurers discourage policyholders. Prolonged delays can cause financial strain, forcing some individuals to give up pursuing their claims. These delays may include repeated requests for unnecessary documentation or failure to respond promptly. - Downplaying the Severity of Illness or Injury
Insurance companies often employ medical professionals to review claims. These reviewers might downplay the severity of your condition or assert that a treatment is not medically necessary, even when your doctor insists otherwise. - Issuing a Blanket Denial
Insurance companies like Anthem and others have been repeatedly caught by California insurance regulators relying on policy language to deny requested procedures as medically unnecessary without assessing the claims individually. Companies use computer algorithms and even AI to deny claims for certain procedures en masse, which is a dereliction of their duty to evaluate an individual’s need for a requested procedure. - Blaming Pre-Existing Conditions
Even when a pre-existing condition has no connection to the treatment being claimed, insurers might argue it as grounds for denial. This tactic shifts the burden onto the policyholder to prove that the claim is unrelated to the condition. - Misclassifying Treatments or Providers
Insurers may misclassify treatments as “out of network” or incorrectly categorize procedures to minimize reimbursement. This often leaves policyholders with hefty out-of-pocket expenses.
How to Protect Yourself
If you suspect your insurance company is acting in bad faith, consider these steps:
- Document Everything: Keep detailed records of all communications with your insurer, including emails, letters, and notes from phone calls.
- Review Your Policy: Familiarize yourself with your insurance policy’s terms and conditions. This can help you identify when an insurer is misinterpreting coverage.
- Seek Legal Help: If you believe your claim is unfairly denied, consulting with an experienced insurance law attorney can make all the difference. Attorneys with particular experience and expertise in insurance bad faith law can help you challenge the denial and hold the insurer accountable.
Fighting Back Against Bad Faith Denials in California
At Gianelli & Morris, we are dedicated to holding insurance companies accountable when they value profits over people. If your health insurance claim has been denied in bad faith, you don’t have to face the fight alone. Our experienced attorneys are here to help you recover the benefits you deserve.
Contact Gianelli & Morris today at 213-489-1600 for a free consultation to discuss your case. Let us help you stand up to the insurance company and secure the coverage you’re entitled to under your policy.
