Bad Faith Insurance Like a Bad Reality TV Show

Jefferson County, TXHow is this for a reality TV show? 'Bad Faith Insurance: How Far Will They Go to Deny a Legitimate Bad Faith Insurance Claim?' Okay, the title is a bit long, but you get the idea. An insurance bad faith attorney is a busy boy these days, thanks in part to all those insurance companies acting in bad faith, denying legitimate claims from people who are hurting.

It should be noted that not all insurance companies operate with bad faith. There are some good ones out there, who deliver the goods as promised. And as a policyholder, if you play fair with them, they'll play fair with you. After all, as a policyholder you have paid your premiums faithfully. They've collected, and have had your money to use at their own discretion all these years.

It is YOUR premium money that has helped the insurance company to grow, and prosper—and to fund a claims kitty used for everyone else. So now it's your turn…

Gloria Landry thought it was her turn, too. However, it seems Blue Cross Blue Shield of Texas took an opposing view.

Here's the story: Gloria and Rod Landry, a couple from Jefferson County, applied for a medical insurance policy through Blue Cross Blue Shield of Texas on May 7th of last year. Their policy was duly issued on June 1st of 2007.

Two weeks later Gloria was in to see her doctor. She complained to Dr. Robert Y. Faseler on June 14th of that year, of abdominal pain and rectal bleeding. Dr. Faseler immediately ordered a colonoscopy on Mrs. Landry, which ultimately resulted in a diagnosis of colon cancer.

Such news would prove devastating to anyone. So imagine their surprise when Blue Cross Blue Shield rescinded their policy on September 4th of that year "based upon 'supporting medical documentation' that was obtained by her medical doctor stating that 'further testing recommended but not completed prior to the application date would have resulted in the application being denied.'"

Huh?

Dr. Faseler wasted little time in contacting Blue Cross Blue Shield. According to the Landry's lawsuit, filed in October of this year, Faseler issued a letter to the insurer on September 20, 2007 "stating that on Ms. Landry's initial visit on July 18, 2006, ' the bleeding was resolved with treatment,' and therefore no further testing was needed."

Gloria Landry states further that in no way did she, or could she have misrepresented her condition on her application for insurance, given that the diagnosis of colon cancer didn't come until after her testing for colon cancer on June 14, a full two weeks after her approval and several more weeks after her initial application.

What's more, the Landrys claim that Blue Cross Blue Shield misrepresented the terms of the insurance policy and benefits, and in so doing acted in bad faith. It is alleged that Blue Cross Blue Shield issued false statements, indicating that it would cover the type of claim Gloria filed, only to renege on that commitment.

The bad faith insurance provider, it is alleged, also failed to even notify them of their claim denial in the reasonable period of time required, thereby delaying payment longer than Texas code allowed. The bad faith insurance lawsuit also suggests that Blue Cross Blue Shield failed to provide a reasonable explanation relating to the cancellation of Landry's policy.

"Blue Cross Blue Shield and (adjuster Peter) Fischer acted unfairly and in bad faith in dealing with Plaintiffs," the suit states. "Blue Cross Blue Shield and Fischer took advantage of Plaintiffs' lack of knowledge, ability, experience, or capacity to a grossly unfair degree."

The Landrys are seeking a variety of damages including actual damages, which include the loss of benefits that should have been paid, and mental anguish. The plaintiffs are seeking three times their actual damages, 18 percent per annum of the amount of damages, plus attorney's fees, together with three times their economic damages, which include benefits wrongly held or denied.

With help from their insurance bad faith attorney, the plaintiffs are seeking the amount of Gloria's claim and the benefit of her bargain, plus exemplary damages, prejudgment interest, attorney's fees, court costs and other relief the court deems just.

Ultimately what is just, is doing what you say you would do. Bad faith insurance is akin to flipping the bird to a policyholder who just happened, via serendipity, to apply for and be approved for insurance just prior to a diagnosis. So the policyholder hasn't built up a premium mountain. Too bad, critics would say. Plenty have, and insurers have taken premiums for years from policyholders who have never triggered a claim. And are those premiums refunded, if the insurance is never used? Not on your life. And yet, here we read about another bad faith insurance claim.

There will likely be more. And any insurance bad faith attorney worth her salt will be working overtime, just to keep up with the injustice.