What Are the Most Common Signs of Insurance Bad Faith?

When you sign up for insurance coverage, you expect to get reimbursed for medical care you need. Unfortunately, some insurance companies focus on sustaining the bottom line rather than providing customers with compensation for their medical expenses. Review these most common signs of insurance bad faith.

Denial or Delay of Payment

The most common cause of insurance bad faith is when an insurance entity refuses to pay or unreasonably delays the payment of a medical bill without a thorough explanation. Your insurance provider has a legal obligation to reimburse you for any medical expenses according to the terms outlined in your contract. As an example, imagine that you broke your leg in a skiing accident. If they don’t cover the cost of your x-rays and casts without providing a reasonable explanation for doing so, then they are “acting in bad faith.” The same applies if your provider unnecessarily delays the reimbursement process.

Failing to Conduct an Investigation

If a company disregards the facts or fails to look into a medical matter properly, they can be found in bad faith. Sometimes theses errors are innocuous — a simple coding error could lead to a claim denial. However, these issues usually can be sorted out with a phone call.

What separates human error from a true act of bad faith is usually willful negligence. For example, say a claims adjuster filed a worker’s compensation claim as a “non-confining illness” after reviewing medical records. Adjusters don’t have the medical expertise to make these decisions; they need to confer with the filer’s physicians or order an independent exam.

Offering Insufficient Settlements

Often, a company will try to settle a claim for less than what it’s worth. It’s not uncommon for insurance entities to low-ball on their offers because they will take advantage of any opportunity to cut costs and save money. However, if they repeatedly refuse to budge on the initial offer, you may have a case for bad faith. It’s helpful to have an experienced West Virginia bad faith insurance attorney in your corner if you suspect your insurance provider is taking advantage.

Refusing to Provide Documentation

If you’re denied a claim, your insurance company is duty-bound to give you a reason why. You have the right to request any documentation the adjuster used to make his or her decision. Similarly, the company has to give any requested documents to your medical provider. If they repeatedly refuse to provide this evidence, it’s often a sign they’re acting in bad faith.

Proving Bad Faith

Insurance companies are required by law to execute duties in a timely and fair fashion. This seems like common sense, but sometimes they try to exploit policyholders in order to avoid a full payout. Unfortunately, bad faith can be difficult to prove on your own. Some signs of bad faith are obvious, but it still takes a seasoned professional to hold guilty parties responsible.

Whether you’re recovering from a car accident or undergoing serious medical treatment, you should never have to worry about how to pay your medical bills. Your main concern should be tending to your health. Let the West Virginia personal injury lawyers at Tiano O’Dell, PLLC help you fight the insurance company.

Our firm’s founders have been named among the Top 100 Trial Lawyers by the American Trial Lawyers Association because of their exemplary record. If you feel your insurance company is giving you the runaround, call our office or contact us online for a free case evaluation. We’ll let you know, risk-free, if your case is worth pursuing.