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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- Sue for breach of contract
- Can you sue for liability claims?
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 Jul 21, 2010 06:21 pm Post Subject:
.
.
This is my first look at this Thread so please...... cut me a little slack if I'm repeating something that has already been said.
With that said........
Quote:
June of 2010 I received a bill from two of my doctors requesting money. I knew that I was up to date with them both, so I called them to find out what the bills were for. They both stated that my insurance company (BCBS of Alabama) had requested their money back. One of these doctors office had previously requested a copy of the workers comp denial letter so they could try to "fight" with BCBS. Eventually, according to the doctors office, they couldn't fight anymore. They stated they had to give the money back because BCBS was refusing to pay other patients claims until they got their money back for my claims.
I can't believe that anywhere in the Nation that an insurer could Legally deny payment to 10's, 100's maybe Thousands of their insured's Claims just because they have one claim that they want refunded to them , which is totally unrelated to all the other claims ¿¿¿ ???
That's insane, plan and simple.
So, either the insurer is lying to the doctor in an attempt coerce the money from the Doctor and the Doctor is taking the bait and forwarding the lie to his patient
OR
The Doctor is lying and trying to double dip.
OR
The OP has errored in their interpretation of what the doctor is telling them.
OR
I don't have a clue of what I'm typing about.
Posted: Wed Jul 21, 2010 07:05 pm Post Subject:
Legal...not sure. I know where I used to work if a doctor or facility would not pay back a claim that was paid in error, it was hooked to their tax id number and payment would be stopped. My company seemed to follow all other laws and regulations, so I would think it is legal.....depending on the state.
Posted: Wed Jul 21, 2010 08:05 pm Post Subject:
Dasfuk,
I was referring to this part of the Quote
according to the doctors office, they couldn't fight anymore. They stated they had to give the money back because BCBS was refusing to pay other patients claims until they got their money back for my claims.
Also it would seem that if a doctor received payment for services provided to a patient it would be the doctors to keep. In other words, if the doctor pays the money back then the doctor preformed his services for FREE. And if the Patient pays the money back the patient would effectively be paying for the doctors services ... as they should.. Since its the insurer wanting the money it seem to me that the insurer made the mistake, so why should the Doctor be stuck for the money instead of the patient?
If the patient wrongfully received the money it would seem recovery would be from the insured patient not the doctor.
Posted: Wed Jul 21, 2010 08:17 pm Post Subject:
I would like to know why his insurance company is involved in the first place. He stated that he settled with his employer's carrier out of court for a sum that just covered his medical bills, although the claim was denied. Did he also file with his carrier or is Blue Cross his employers carrier? If BCBS is his carrier and they paid his bills, are they trying to get their money back for this claim? The OP's post doesn't make sense.
Posted: Thu Jul 22, 2010 06:58 am Post Subject:
I'm guessing since the OP wasn't real clear. OP filed workers comp claim. BCBS didn't find out that it was a work related injury and paid some claims that they normally would not have paid. They asked for their money back from the doctor and received it. The doctor now is asking his customer to pay the bill.
The OP said that he settled for a small amount to cover his portions of the medical bills (which I assume is copays, deductibles, coinsurance after BCBS paid). What now seems to be the problem is that the OP got a settlement (WC claimed denied?) and some how BCBS finally figured out that they were paying for a work claim injury ( It is possible that the OP filled out a paper for BCBS stating that it was a work place injury). The guy at BCBS and maybe his supervisor don't know what to do with this since there was a payment/settlement on the WC claim but not enough to cover bills.
FK
When I paid medical claims, there were times that claims got paid when they should not have or got paid incorrectly. We recovered the money from the doctor since the network contract was with that doctor and payment went to the doctor. When they would not send a refund, we would start to hold funds for that tax id number. Once we got the money back, the doctor would bill the insured. I know this since I would then get the call from the insured and would have to explain that originally a mistake was made and a claim was paid wrong or should have been denied.
Posted: Thu Jul 22, 2010 12:08 pm Post Subject:
If this truly was a Workers' Comp event, then the medical claims would (should) have been paid by the employer's carrier (which would never be Blue Cross/Blue Shield). If BCBS became involved in paying claims, then the OP was going to their private doctor outside the Workers' Comp arena, which may be possible, but the claims would still be paid by the Workers' Comp carrier.
As Dasfuk surmises, if BCBS was paying for care/treatment that rightfully is a Workers' Comp case, they should be subrogating directly with the WC carrier, not the doctor and not the OP.
So that's why something here still is not right.
Posted: Thu Jul 22, 2010 05:02 pm Post Subject: Can I sue insurance comapany
My daughter was in auto accident. The other driver swerved to miss deer in the road and hit my daughters car AND the deer. Thank goodness there was a witness that waited for police and told officer what happened. Offical police report says "car #1 swerved to miss deer and hit car # 2(my daughter) and deer. Blood and fur on car number 1". Witness statement says same thing. Car #1 insurance company initially told me to go get quote to have our car fixed. They called back yesterday and said they are denying claim because their client was not at fault. said their client never left her lane. They are ignoring police report and Witness. Can I sue them for bad faith?
Posted: Thu Jul 22, 2010 05:59 pm Post Subject:
They called back yesterday and said they are denying claim because their client was not at fault. said their client never left her lane.
I would agree with that, if that is what happened. The other driver wasn't negligent in causing damage to your daughter's care regardless if she left her lane or not, even though the general rule is to always stay in your lane. The deer is contributory to the accident in that had the deer not been in the road.
They are ignoring police report and Witness.
The report involving an animal collision has little to do with a drivers negligence, no matter whose opinion or statement is on the report.
Can I sue them for bad faith?
It's not bad faith and you could not sue the insurer anyway. You can however sue the other driver, but I doubt you get very far with that. Your best course of action would be to file with your carrier and let them fight it out with hers.
Posted: Thu Jul 22, 2010 06:06 pm Post Subject:
You can however sue the other driver, but I doubt you get very far with that.
If the damage is within the small claims court filing limit, it might be worth the $50-$75 to file and serve. You never know how the judge is going to rule. If you lost there, then you could turn it over to the insurance company.
But the small claims process is time consuming, and if you need your car fixed now, it's not going to work. You could always sue later, but if your insurance company has paid for the damage repairs, the only claim you have is for the deductible, anything over than amount has to be subrogated to the insurer.
Posted: Mon Jul 26, 2010 07:21 pm Post Subject: CAR INSURANCE
My car was stolen on June 3. I had a tracking device installed on it when i bought the car, and it was valid for one year ,when i called back the company to renew my contract they told me that there was no more service. Either they shut down or went bankrupt. My insurance gave me a discount because of this system, i was paying 88% of my premium. Now the insurance says that they called me but i never received their call nor did i receive a registered letter in the mail, saying that i had to change or fix the problem with the tracking device. Now that my car got stolen their telling me that that only owe me 88% of the total value. Nowhere in the contract does it say that if the company shuts down they only owe me what i was paying them in my premium. Their telling me that its my fault that i didn't call them but what I don't understand is that their subcontracting these tracking devices to other companies , and if they shut down its my problem .What should i do???????????
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