Groton Family Attorney

Insurance Claims

We handle claims against all kinds of insurance companies.
    - Insurance bad faith
    - Health insurance
    - Long term care
    - Disability
    - HMO claims

There are many different types of insurance: Liability, life, health, disability, long term care for example. Additionally, there are complicated relationships between insurance, non-insurance providers, and governmental entities. Some insurance is provided under employer sponsored plans, and is considered an employee benefit plan subject to ERISA (Employee Retirement Income Security Act). The insurance product is essentially a financial product. It is contract. It is sold individually or in groups. It is sold in the free market. It is regulated to some degree by the state government. It is a complicated financial product. Different rules apply depending on the type of insurance involved, and whether ERISA applies.

Here are some examples of types of insurance claims:

Bad faith claims. Insurance is a contract subject to general contract law principles. All parties to a contract must act in good faith. Additionally, acting in bad faith is also a tort. Therefore, if the insurance company acts in bad faith it will be subject to a bad faith claim.

Long term care. Be careful with long term care insurance. The issue surrounding long term care insurance focuses on whether the plans underpriced their products in order to gain a competitive advantage. Some companies used incorrect estimates of the number of claims so that their pricing was off, leading to price increases over time that were much larger than the consumer was told. In a report in November 2003 Consumer Reports issued its recommendations, and issued some guidelines for evaluating your need for the product.

Health insurance claims. Unfortunately, sometimes health insurance companies deny valid claims. Many times people simply give up fighting with their insurance company and pay the medical bills out of their own pocket. Some people are forced into bankruptcy. These claims are generally regulated by ERISA. These claims are very complicated, but can be successful. They require coordination and cooperation between the doctor that is owed monies, and the patient.

Another issue involving health insurance is the unfair practice of post insurance denial of insurability. This occurs when someone is approved for health insurance, but then after they begin to make claims the insurance company re-reviews their application finding a reason to deny coverage. This is an unfair business practice.

Lastly, health maintenance organizations (HMO) are a form of managed health care. Unfortunately, sometimes HMOs will chose to deny approval for valid necessary medical care simply to avoid paying the bill.

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