Health Insurance Claim Wrongfully Denied? Why You Need an Insurance Law Attorney and Not a Personal Injury Lawyer

If your health insurance claim has been denied in bad faith, you may be wondering what kind of legal help you need. Many people assume that a personal injury lawyer is the right choice, especially if they have been physically harmed by a claim denial or unreasonable delay. But bad faith insurance cases are fundamentally different from personal injury claims. To successfully challenge a wrongful health insurance denial, you need an experienced California insurance law attorney, not a personal injury lawyer. Here’s why.

Understanding the Difference: Insurance Denial vs. Personal Injury

Personal injury cases are based on proving negligence—establishing that someone acted carelessly and caused injury. These cases focus on evidence of fault, such as police reports, witness testimony, and medical records that demonstrate the extent of physical harm. Legal and factual issues such as breach of duty and causation take center stage.

Bad faith insurance denial cases, on the other hand, do not require proving negligence. Instead, they focus on areas of law like the California Insurance Code and legal issues related to breach of the implied covenant of good faith and fair dealing implied in the contract for insurance (the insurance policy). When an insurance company wrongfully denies a claim, the issue is whether they acted unreasonably and in bad faith in handling the policyholder’s claim, rather than whether they caused an injury through negligence.

Why a Personal Injury Lawyer is Not the Right Choice

Personal injury lawyers handle physical injuries arising from incidents like car accidents, slip-and-falls, and medical malpractice. While these cases require knowledge of liability laws and damages calculations, they do not require understanding and interpreting health insurance contracts, policy language, and state-specific insurance statutes. A lawyer who does not regularly handle bad faith insurance cases will be unfamiliar with key elements essential to winning your claim, such as:

• Interpreting Insurance Policies: Health insurance policies contain highly technical language, exclusions, limitations, and conditions that must be carefully analyzed to determine whether a denial was wrongful.

• Reviewing Medical Necessity Guidelines: Insurance companies deny claims based on internal medical policies, which must be scrutinized to assess their validity.

• Challenging Evidence of Coverage and Response Letters: Insurance denials often cite policy provisions that may not apply or have been misinterpreted.

• Understanding Insurance Regulations: State and federal laws govern how insurers must handle claims, and an experienced insurance law attorney knows how to leverage these laws to hold insurers accountable.

• Fighting Unfair Claim Handling Practices: Insurance companies are legally required to investigate claims properly, respond timely, and provide valid reasons for denials. Violations of these duties can form the basis of a bad faith claim. Your lawyer must know the applicable laws and understand when a violation has occurred.

Why You Need an Insurance Law Attorney

Insurance law attorneys, like those at Gianelli & Morris, have the particularized knowledge necessary to take on insurance companies and win. They understand the California Insurance Code, Department of Insurance regulations, and industry practices that personal injury lawyers are not familiar with. They know how to:

• Review denial letters and policy provisions to identify improper claim denials
• Challenge insurance companies’ medical policy guidelines that are used to justify wrongful denials
• Negotiate with insurers and escalate claims to litigation when necessary
• Hold insurers accountable for bad faith actions, potentially securing compensation beyond just the original claim amount

Get the Right Legal Representation for Your Case

If your health insurance claim has been denied unfairly, don’t seek out a personal injury lawyer who doesn’t have the expertise required to challenge an insurance company’s bad faith actions. The attorneys at Gianelli & Morris focus exclusively on insurance law and bad faith claims, giving you the best chance of recovering the benefits you are entitled to under your policy.

Contact Gianelli & Morris today for a free consultation and let an experienced California insurance law attorney fight for your rights.