by ty_ger88 » Fri Sep 14, 2007 02:20 pm
Many a times you may be unhappy with your insurance company for not paying you your dues or for delaying your payments or for any other reason. Your insurance company does not always have the upper hand. There are laws to protect you if you have a dishonest insurer.
When can you sue your insurance company?
You can sue your insurance company on grounds of:
If your insurer tries to trick you by not paying up a legitimate claim you can put up a civil suit against the company for having acted in bad faith. A company shows bad faith when it unreasonably denies a legitimate claim. This may mean that:
You can sue your insurance company for the full amount of benefits that has been denied to you as well as for any economic loss or emotional distress that you may have had to suffer as a result of the refusal. If your insurance company has been dishonest you may also get punitive damages. This is a means to make the insurance company behave more responsibly in future correspondences.
It is good to keep all paper works organized so that you can find them as soon as you need them. You may think of an old receipt as unimportant but it might hold great importance when you have a case standing against your insurer for bad faith or breach of contract.
- Bad faith and
- Breach of contract
If your insurer tries to trick you by not paying up a legitimate claim you can put up a civil suit against the company for having acted in bad faith. A company shows bad faith when it unreasonably denies a legitimate claim. This may mean that:
- The company has failed to carry out proper investigations
- Undue delay in processing a claim
- Disregarding the rights of the policyholder
- Inadequate compensation provided against claim filed
You can sue your insurance company for the full amount of benefits that has been denied to you as well as for any economic loss or emotional distress that you may have had to suffer as a result of the refusal. If your insurance company has been dishonest you may also get punitive damages. This is a means to make the insurance company behave more responsibly in future correspondences.
It is good to keep all paper works organized so that you can find them as soon as you need them. You may think of an old receipt as unimportant but it might hold great importance when you have a case standing against your insurer for bad faith or breach of contract.
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I'm confused, please help. Here's my story and question. I'll try to make it short. My car was hit about a month ago. I was not in the car. It was parked on the side street. The driver of the truck that hit me left a note with all of his information. Now, it has been almost a month, and his insurance is not doing much. At first, they promised to have the damage estimated, but then nothing was sent to the car shop where my car located. I ended up going through my own insurance company. The problem is before I went with my insurance company, I had rented a car and had discussed this with the other insurance company. They said they would reimburse me all the fees. Now, they're not answering my calls. They keep on telling me that the agent is busy and will get back to me. It has been 4 days since I faxed in my car rental bill. What can I do? Can I sue them? Would you tell me how to sue an insurance company? The bill was paid for by my credit card, and I don't want to owe interests on it. Please help. Thanks.
Posted: Wed Sep 05, 2012 10:09 pm Post Subject: Suing our priscription insurance CO.
Our Priscription Insurance Co has been allowing us to receive certian drugs, now all of a sudden they are denying them, can we sue them for this? My wife needs this medication, the Doctor has prescribed it and even sent letters to the insurance co, but they still deny them.
She is starting to get sick because she is not receiving this medication.
Posted: Sat Sep 29, 2012 12:39 pm Post Subject:
Can you sue tow companies for the same accident?
Posted: Sat Sep 29, 2012 02:39 pm Post Subject:
You can only sue the person responsible for your loss. If you believe two persons were responsible (or liable) for your loss you can sue two persons.
When it comes to suing insurance companies, you can only sue them for breach of contract and related claims. If two insurance companies breached contracts covering different aspects the same loss, it is possible to sue two companies.
Posted: Wed Oct 10, 2012 04:36 pm Post Subject: MY FATHERS INSURANCE
My father has been laying in the hospital after having a stroke, after sugery and now he is still laying there basically untreated due to the delays in the insurance company. He could of been i theropy 2 weeks ago, but the insurance co. only grants 1 day or denies it. What can I do? He has blue cross and medicare, we have been told if he only had medicare, he would already have been treated, because they do not need auths. Blue Cross has been jerking us around for over a month now, and my father is laying there getting weaker and weaker everyday we have to wait on the insurance company. What can I do?
Posted: Thu Oct 11, 2012 12:06 pm Post Subject:
When you say your father has "Blue Cross and Medicare" are you talking about a Medicare Advantage plan or Medicare Supplement insurance? There is not enough information given to know what the actual situation is.
And, unfortunately, the issue may not be with the insurance company or Medicare, but with the physician treating your father. What is your father's diagnosis/prognosis? The physician has to order physical or occupational therapy -- it does not happen automatically. Has he done this? Or does he think it is too soon to begin such treatment? Have you even discussed any of this with the physician? [Having worked for more than a year on the stroke unit of a major rehabilitation hospital (1971-1972), I know that PT and OT is not always something that needs to happen in the first few weeks following a stroke. The patient must be stable and strong enough to benefit. You may just be too emotionally attached to the situation to realize this.]
You have to understand that what you want or what you think is needed, and when, is immaterial.
Medicare will never pay for anything unless it is medically-necessary. If the physician has determined that your father will not benefit from physical or occupational therapy, Medicare won't pay for it, even if you think it would be of value, and a Medicare Advantage plan doesn't have to pay for it if Medicare doesn't.
Medicare also provides only limited "long term care" benefits. They will not pay for any non-acute care setting other than "Skilled Nursing" in a licensed, Medicare-approved facility. If your father will not make a medical recovery (which is highly unlikely following a severe stroke), Medicare will not pay for any confinement in a SNF. If they do approve such care, they only pay 100% of the expense for the first 20 days. After that, there is a daily co-insurance amount of about $150 paid by your father, and Medicare would pay any excess beyond that, but only for days 21-100 (80 days). After 100 days in a SNF, Medicare pays nothing.
But if the issue does lie with the insurance company, then filing a complaint with the state Dept of Insurance where this is taking place might help. Your state may also have a Dept of Aging that could be involved. In some states, HMO plans of insurance -- including Medicare Advantage -- are regulated by another state agency. In CA, for example, we have the Dept of Managed Health Care which would be the proper place to file a complaint.
At the very least, your state will have a Health Insurance Counseling and Advocacy Program ("HICAP" in many states, but other names are used in some). That program is available at no cost to Medicare beneficiaries and their families. You can make an appointment to meet with one of their representatives and discuss the matter with them in greater detail. If there has been an abuse on the part of an insurance company, they can refer the matter to the proper authority.
Posted: Sun Oct 21, 2012 11:45 pm Post Subject: Bad Faith Claim
My car was stolen from my home. My insurance company is saying that because I did not list my husband (fiancé at the time of application) as living in my household at the time I filled out my insurance application that I misrepresented information. However, he had his own insurance, own car, and did not drive my car, so that's why I didn't list him. Also, I listed him in my previous policy with them and I canceled it b/c they listed him as a driver and I resubmitted it and they accepted it, which is the current policy I am referring to. Aren't they supposed to verify previous policies before accepting a new policy? If so, then how can they now say that I misrepresented information when they had access to the information? I feel that this is a bad faith claim and they did not want to pay off my car that was totaled. I look forward to any guidance. Thanks.
Posted: Wed Oct 24, 2012 09:14 pm Post Subject: lib-nal ins. comp
my son passaway on 2/25 /11 they paid me for his death.i also had accident'el ins. on him.his death was .accident death.the death certificate say's acc. death.the medical examiner say's acc. death.the sheriff's office say's acc.death.the university of florida pathology laboratories say's acc. death.cause of death.misuse/abuse of prescription medications and illicit drug.the definitions of acc.death. acc. death means the death of the insured; can i sue for the acc. death benefit's
Posted: Wed Oct 24, 2012 10:45 pm Post Subject:
My car was stolen from my home. My insurance company is saying that because I did not list my husband (fiancé at the time of application) as living in my household at the time I filled out my insurance application that I misrepresented information.
Are they claiming that your husband stole the car? Makes no sense.
A misrepresentation must be material to the risk, and an unnamed driver in the household is not exactly the basis for rescinding a contract following the theft of an insured auto. It is true that you are supposed to identify all licensed drivers living in the household (because they have access to your vehicle with or without your permission). Same is generally true when they ask you about children over the age of 12 or 13 -- they're big enough to drive (unlawfully) and will soon be of legal driving age.
You do make a good point that you previously gave them notice of your husband's presence in your household, which very likely defeats their claim of "misrepresentation" because they could have asked you specifically to exclude him when you resubmitted your application for insurance. It could possibly be considered a concealment (whether intentional or not, it could give the insurance company grounds to rescind -- but, again, the concealment has to be material to the risk).
You have two instant choices: 1) File a formal complaint with your state's Dept of Insurance, or 2) Find an attorney willing to sue the insurance company for breach of contract (which will cost you 30% - 40% of any eventual settlement, and that may be too severe a consequence).
Start with the Dept of Insurance and see what happens. That's a free service. If they can't help, then you can start the path to litigation by interviewing attorneys. That, too, may cost you money for "consultations". Many will consult for up to one hour at no cost. Suing an insurance company is far too complex to attempt it on your own.
Posted: Wed Oct 24, 2012 10:57 pm Post Subject:
cause of death.misuse/abuse of prescription medications and illicit drug
Despite the fact that all the authorities have labeled your child's death as an accident, that is not necessarily good enough for the insurance company -- or a court of law.
You have to read the insurance contract in question and see what "definition" of accident they have chosen to use. There are two.
Accidental injury (or "result" or simply Accidental Death) is only concerned with the outcome, not the cause -- was the death due to an intentionally caused act of the decedent, or was the death not due to accident? In some states, suicide is considered an accidental death.
Accidental means is more problematic. When those two words are used, the insurance company can avoid the claim when the decedent was involved in the accident that led to their death. The act of ingesting illicit drugs or non-prescribed medications can be listed as an excluded cause of death.
If you cannot figure out what part of the contract discusses this, you can email me a copy and I will figure it out for you.
This is a PERFECT example of the difference between genuine LIFE INSURANCE and accidental death benefits. The life insurance policy paid its benefit because DEAD IS DEAD, and the cause is immaterial. The accident policy hasn't paid because it may not be the "right kind" of accident. For this reason, the companies that sell accidental death benefits are hugely profitable because they don't pay many claims. Most deaths are not caused or due to accidents.
I am sorry for your loss. Parents are not supposed to bury their children.
Posted: Thu Oct 25, 2012 07:51 pm Post Subject:
My father was sold insurance unit linked plans with and without life cover respectively. He wasnt mentally fit and was suffering from bipolarity then. Can i sue my insurance company and claim refund.? They also have a lock in period of 3years and we have paid only two premiums out of three compulsory premiums.
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