Los Angeles, CAAnyone who has dealt with wrongly denied disability claims or issues of bad faith insurance knows how frustrating the insurance system can be. They know the frustration of being told their insurance claim has been denied, of trying to find out why it was denied and of appealing the denial. The good news, however, is that a surprising number of people are successful on appealing their denial - an indication that too many people are denied right away and that the appeals system helps correct the problem.
A report by Capital Public Radio, based on information from the California Department of Managed Health Care, when patients appeal their denied health care services through a third party, they win their appeal approximately 50 percent of the time. This is because there are a variety of problems that could result in an appeal being wrongly denied.
Although many patients would argue that their claims are unfairly denied to increase profits - an argument that may have validity - according to the report, there are other problems that can arise. These include information being incorrectly entered into the computer system or human errors when reviewing a file.
National information about denials varies among the insurers, a 2011 report from the Government Accountability Office (GOA) found. Although the average denial rates for the first three months of 2010 were 19 percent, 25 percent of insurers had denial rates of higher than 40 percent. That means that of all policyholders filing a claim with those particular companies, more than 40 percent had their claim denied.
The GAO report noted that denials occurred for a variety of reasons, including billing errors, incomplete information and duplicate claims. Much like the Capital Public Radio report, the GAO report noted that the success rate tended to be between 39 and 59 percent. The GAO report included appeals that were filed with insurers.
The GAO report noted that not only did appeals frequently result in a reversal of the denial, but that in some cases complaints resulted in financial recoveries for policyholders who had their claims wrongfully denied.
So although having an insurance claim wrongfully denied is frustrating, policyholders can be successful either appealing their situation to the insurance company or filing an appeal with a third party. In some cases, lawsuits have also resulted in reversals of coverage and financial recoveries for policyholders.
If you or a loved one have suffered losses in this case, please click the link below and your complaint will be sent to a financial lawyer who may evaluate your Denied Disability Insurance claim at no cost or obligation.