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Consumers Beware Of Insurance Denial Tactics

By Eddie Farah

If you’re one of the few who actually have health insurance coverage, consider yourself fortunate. However, if you have yet to file a claim for health insurance benefits, you may be in for some unpleasant surprises.

Insurers are now using a scheme to deny claims and actually cancel insured’s policies through “postclaims underwriting.”

“Postclaims underwriting” means that an insurance company refuses to pay your claim for a loss that should have been covered. The argument is that you were a bad risk, should never have been issued a policy, or you were not truthful when you filled out the forms.

When you (or a covered family member), makes a claim for health insurance benefits, the insurance company, at that time, begins an exhaustive investigation of your medical history in order to find any nugget of evidence that could qualify as a “pre-existing” medical condition. This review should have been done before the policy is written, not after of course, and not after you began paying premiums.

Once this “pre-existing” condition has been found, the insurance company then denies benefits under the current policy and can potentially cancel your policy altogether. That leaves the insured with a false sense of security until they are injured.

According to the June 2008 issue of Trial Magazine, California leads the country in stopping this type of harmful practice. A number of lawsuits filed against health insurers like Health Net and Blue Cross caught the public’s attention, which caused industry regulators to investigate and fine these health insurers. A class action suit was filed against Health Net for illegally canceling coverage for over 1,000 insureds and for delaying the claims of thousands of other insureds.

Understand your policy thoroughly before you begin paying for it and by all means, answer medical questions as fully and completely as possible, including information about family members who will be covered under the same policy.

Finally- read your policy and understand the cancellation provisions so you don’t get a much needed lesson after an accident. #

Originally posted at InjuryBoard by Eddie Farah

Full post as published by Jacksonville Personal Injury Lawyer on December 30, 2008 (boomark / email).