Insurance Archive

MetLife: Can you Sink any Lower to Avoid Paying a Claim?

March 14th, 2011. By Hunter West

If there ever was a case for having a police force for insurance companies, it is this one. Jane Pierce could be the poster child for a clamp down on greedy, uptight insurers who will to a fault suspect the worst in people and grasp at any straw to avoid paying a claim.

Have you heard about this story?

Jane Pierce’s husband Todd died tragically in a car accident a few years ago. Yes, he had some health issues. Cancer. In his case, Todd developed skin cancer in his nasal cavity. But he fought the disease valiantly and was cancer-free within two years. There were more surgeries to follow, however—to rebuild his jaw and palate. Certainly not pleasant. But such is the jurisdiction of a fighter, and a devout Catholic who loved life and was not about to throw in the towel, even in the face of more than 40 surgeries…

Life was good, you see? Hard, but good. And Todd had driven to a family reunion one warm, July day in 2009. Enjoyed himself. They said he was the life of the party. There was certainly nothing untoward that caused any member of his family to be worried about him.

It was on the drive home that tragedy struck. Pierce pulled out to pass another vehicle on the highway and lost control of his truck. The vehicle, in which Todd was the lone occupant, rolled down Read the rest of this entry »

Tags: Accidental Death and Dismemberment, Bad Faith Insurance, Insurance, Jane Pierce, MetLife
Posted in Insurance | 3 Comments »

Allstate Insurance Inspires Song – You’re Not in Good Hands

October 8th, 2010. By AbiK

I love our readers at LawyersAndSettlements.com—there’s just no stopping the creativity and passion everyone exhibits when faced with a cause that’s near and dear to their hearts. The above video is from reader Layla Fanucci—it’s about Allstate Insurance.

Now, I don’t really know the full story here on what inspired Layla to go and pen this song—but clearly she’s less than charmed with Allstate. Suffice to say, it’s not the first time we’ve heard Allstate complaints or seen Allstate bad faith insurance lawsuits—and Allstate is certainly not the only insurance company that’s had a litany of bad faith insurance claims against it.

But the fact that she actually sat down, wrote lyrics about Allstate, recorded her song and then posted it pretty much sums up how much Allstate’s gotten under her skin.

If you’ve got a video—or know someone who does—about a legal issue that’s been on your mind, send it in! We’d love to see it, and may even post it to our site…

Tags: Allstate, Bad Faith Insurance, Layla Fanucci
Posted in Insurance | 8 Comments »

What’s the “Bad” in Bad Faith Insurance?

September 7th, 2010. By Kristine B

You’ve probably seen the commercials on tv: an actor—say Dennis Haysbert—walks around talking about how “his” insurance company (that would be Allstate) is his best friend…how it has his back in a bad situation…how it has bent over backwards to help him in his time of need…and, damn if he doesn’t sound so sincere! Or you’ve seen Flo–the Progressive Insurance girl–making it sound like no way no how would Progressive ever—EVER!—give you a lousy rate. No siree—Flo ensures us that buying insurance is as easy as ordering a Whopper with cheese, hold the pickles—thanks.

But, when it comes time to file an actual claim—when a real person needs real help from a real insurance company, all of a sudden it seems like there are a million reasons why the company won’t pay out a claim. Sometimes, that leads to claims of bad faith insurance—today’s Pleading Ignorance topic.

Before we get to that, though, the obligatory “not every denied claim is a legitimate claim” spiel. It’s true that insurance companies have to protect themselves from fraudsters and people out to make a quick buck off an accident. There are people who see an accident—real or faked—as a way to make easy money. This, of course, puts the honest people at a disadvantage. Why? Because they’re dealing with insurance companies that a) want to make as much profit as possible and b) have to unfortunately protect themselves from fraudsters who see the insurance companies as personal ATM’s.

The mix of profitability and self-protection can lead to claims of bad faith insurance.

So, what is bad faith insurance? You’ve probably heard of it before, because the companies that are accused of practicing it are often large insurance corporations—so it gets airtime in the news. Bad faith insurance occurs when an insurance company denies legitimate claims for illegitimate reasons.

Here’s the thing: When you buy an insurance policy to protect yourself or your family and you pay into it faithfully, with the full expectation that if you should ever need it, the policy will cover you, the insurance companies are required, by law, to pay out your legitimate claims.

Of course, it all looks good on paper—just like that insurance policy!—but when it comes down to it, some insurance companies use all sorts of tactics to avoid paying claims.

They might stall on the claim by forcing you to send in excessive amounts of paperwork—or they may claim to have found “mistakes” in the paperwork you’ve sent in. By stalling, they may push back the time your claim is received so that your claim is no longer valid. They might retroactively cancel your insurance policy—in effect waiting until you make a claim then deciding you shouldn’t have had the policy to begin with. They might find their own medical examiners who overrule your own doctor’s diagnosis. They might reclassify your illness or your claim and state that you should be able to work when you really cannot. Or they may classify a seemingly standard lab test as outpatient surgery requiring precertification that, of course, you did not get. The list of possibilities is endless.

Some insurance companies might target specific claims for denial; these claims might include anyone who claims Fibromyalgia or Chronic Fatigue Syndrome. People making those claims might automatically have their claims denied or may be required to send in additional paperwork to support their claim.

The bottom line is that “bad faith insurance” occurs any time that a legitmate claim that you’ve paid insurance premiums to be covered for is denied or delayed without sound reason. And, if you’ve found yourself in that position and have gone through the proper channels of contacting the insurance company and requesting that your claim be reprocessed or you’ve filed an appeal with the insurer to no avail, you may want to get some legal help.

Tags: Bad Faith Insurance, Denied Insurance, Insurance, Pleading Ignorance
Posted in Insurance, Pleading Ignorance | 2 Comments »

Flip Side of Bad Faith Insurance: Gravy Train Claims

June 17th, 2010. By Hunter West

Everybody likes to beat up on insurance companies for denying legitimate claims. And they should be taken to task for such behavior. Americans buy insurance policies in an effort to do the right thing, so as not to leave their families vulnerable in the event they are injured or incapacitated in some way. They pay their premiums faithfully, according to the tenets outlined in the policy. 

When they get hurt, it is their right by law and contract to receive what they have paid for. Shame on any insurer that attempts to pull the rug out from under honest, law-abiding policyholders. Unum, notably, has in the past been accused of grievous examples of bad faith practices—allegations that in some cases have borne out to become fact. 

But it goes the other way too, ya know. There are those who attempt to take the insurance companies to the cleaners. While a wary eye cast for the n’er-do-well should not result in ill treatment of legitimate claimants, you would be amazed at what some people will do to pull a fast one on the insurers, rather than the other way around. 

Take the case of Wanda Podgurski aka Wanda Lee Ann Plager of Manhattan Beach, California. According to an investigation carried out by the California Department of Insurance (CDI), Podgurski took out no fewer than six insurance policies with six different carriers. 

Long-term care polices were purchased from Prudential Group Insurance, Kanawha Insurance, Unum Life Insurance Co. and Metropolitan Insurance Co. 

She didn’t stop there. Podgurski also took out disability income policies with Balboa Insurance Read the rest of this entry »

Tags: Balboa, Kanawha, Metropolitan Insurance, Prudential, Reassure America Life Insurance, Unum
Posted in Emerging Issues, Insurance | 2 Comments »

Join me as I Submit my United Healthcare Out of Network Claim

May 26th, 2010. By AbiK

The much-anticipated Notice of Proposed Settlement for the United Healthcare (UHC) class action lawsuit about Out-of-Network (OON) charges being improperly reimbursed has finally landed in my mailbox—perhaps yours, too.

Chances are, if you’ve received the UHC OON settlement notice, you glazed over it and tossed it aside while simultaneously feeling some sort of nagging inside—that nagging you feel when you know you should do something but it’s just too much of a pain in the ass to do it. Windexing the windows falls into this category as well. The difference between the windows and the UHC settlement though is that at least you KNOW how to do the windows; just try to figure out how to submit a claim for this settlement.

So I’m going to go through the process with you—yes, I’m going to fill out the paperwork and post about it so I can feel your pain and hopefully help you make sense of it all along the way. And so our little journey begins…

My UHC Out of Network Settlement Experience: DAY 1

The UHC OON Proposed Settlement in hand, I rip it open to find a sea of text that immediately starts to confuse me. It’s not the lawsuit I’m confused about—we’ve followed the AMA v. UHC class action. It’s what the heck I need to do now. So I force myself to read the hideously dense serif text and here’s what I need to do:

1. Ask myself, was I a United Healthcare Subscriber…

at all between March 15, 1994 through November 18, 2009? Ok, yes, I was.

2. How long do I have to submit a Claim Form for this?

(i.e., how long can I procrastinate?) I have until October 5, 2010 to submit a UHC settlement Read the rest of this entry »

Tags: OON, out of network, Out of Pocket, UHC, United Healthcare
Posted in Drugs/Medical, Emerging Issues, Insurance, Settlement | 231 Comments »