COLORADO LIFE AND HEALTH INSURANCE DISPUTES

Unfortunately, sometimes issues like divorce or unemployment may complicate the processing of a claim for life insurance and the life insurance company may refuse to pay the life insurance benefits that are owed to you and your family. If a life insurance company wrongfully denies payment of life insurance benefits to you and your family, the experienced team at Bachus & Schanker, LLC in Colorado can help. Our Insurance Bad Faith attorneys will assist you in reaching a resolution.

The law surrounding the payment of life insurance benefits can become complicated quickly, depending on whether the life insurance was provided through an employee benefit plan or purchased as an individual policy. The attorneys at Bachus & Schanker, LLC have the knowledge and experience to sort through the complex issues and help you get the benefits you and your family are entitled to. Located in Denver, Colorado, our bad faith insurance attorneys can assist clients from across the state. To learn more, please use the links below:

HOW TO FILE A LIFE INSURANCE CLAIM

Below is a checklist of steps to follow when the need comes to file a claim:

1. See if you can find the actual insurance policy. If you can great, go to step 2. If you cannot find the actual policy, try to find the agent or company that your loved one may have used. If you still cannot find any agent or policy information, don’t stop there. You may still be able to find information on your loved one’s policy by contacting the Division of Insurance in the current state or any previous states your loved one may have lived in.
2. Call the agent or company on the policy. If you only know the company they should be able to find your loved one’s policy by their name and address.
3. Fill out any claim forms. If you have any concerns regarding any of the questions on the claim form, you should consider speaking with an attorney.
4. Send a certified copy of your loved one’s death certificate with the claim forms to the insurance company. A settlement should be issued within a couple of weeks.

HEALTH INSURANCE DISPUTES

Disputes with your health insurance carrier over unpaid health insurance claims, or denial of medical bills can be very stressful and if unresolved, can result in ruined credit and even bankruptcy.
At Bachus & Schanker, LLC in Colorado, the knowledgeable bad faith insurance attorneys can help you to obtain the health insurance benefits you are entitled to receive.
In order for the attorneys at Bachus & Schanker, LLC to enforce your rights to receive health care.coverage, the first step is to determine whether state or federal law governs the particular health care plan.

• State regulation. All individual health insurance policies will be governed by state law. So will health plans issued through state, city, or county employers. In addition, some employer or employee groups purchase health insurance coverage from an insurance company. Others may purchase group health coverage from a health maintenance organization (HMO). Both are called fully insured health benefit plans. Insurers of such plans are regulated by state insurance commissions.
• Federal regulation. Some employer or employee groups provide health insurance benefits to employees through what are called self-funded health welfare plans. This means your employer or employee group may set aside funds and employee premiums each month to pay health coverage claims submitted to the plan. If the plan is self-funded and offered by a private sector employer or bona fide union, the designated regulatory authority is the U.S. Department of Labor’s Pension and Welfare Benefits Administration. States are not permitted to regulate most valid self-funded plans authorized by Congress under terms of the Employee Retirement Income Security Act (ERISA). In most cases, this means: (1) state insurance regulators have no authority to investigate complaints that involve valid single-employer or union-sponsored self-funded ERISA plans; and (2) state laws requiring specific benefits in health care plans seldom apply to valid self-funded ERISA plans.

Most states, including Colorado, have laws that protect consumers against unlawful denial of valid insurance claims. These bad faith laws may allow for the recovery of attorneys’ fees and up to three times the amount of withheld benefits, among other remedies.

In order to determine whether state or federal law governs the insurance plan, it is also important to obtain a copy of your health insurance plan, usually known as the “Summary Plan Description (SPD).” This booklet describes your health insurance benefits and also lays out any appeals process if your claim is denied. Usually you must first satisfy any internal remedies of the plan, which are set out in the SPD, before filing a lawsuit. Please take careful notice of any deadlines and possible multiple layers of internal remedies which you must first go through before you can bring any external action against the health insurance company. Failure to follow these procedures could waive your right or ability to sue for any denied benefits.

If your health insurance company disputes your claim, contact Bachus & Schanker, LLC in Colorado to speak with the experienced health Insurance Bad Faith attorneys. Our team will get a copy of the SPD and make sure any internal remedies have been satisfied. We will walk you step-by-step through the process to make sure you get the benefits to which you and your family are entitled.

HOW TO MAKE A HEALTH INSURANCE CLAIM/DISPUTE DENIALS

THINGS TO DO BEFORE YOU FILE A CLAIM:

• Obtain a copy of your health insurance plan, also called the “Summary Plan Description” (SPD).
• Review the SPD carefully to be sure the service in question is covered.
• Follow any managed care rules, including pre-certification requirements and use of network providers.
• Give claim forms to the provider, with your policy number and other identifying information.

HOW TO SUBMIT A CLAIM PROPERLY:

• Find out if your provider submits the claim for you or if you need to do it.
• If you need to do it, review the information to be sure it is complete and correct.
• File it as soon as you get the bill from the provider.
• Send it to the right address.
• Keep a copy for your reference.

Allow reasonable time for company to process your claim. The health insurance company needs to inform you if it needs any additional information to complete the claim. Sometimes, it will request additional information directly from the providers or return the claim form to you to get more information. After the company has all the information it needs, it has a certain number of working days to process your claim. The company must send you an explanation of benefits that explains its decision.

IF YOUR CLAIM IS DENIED:

• Act promptly and quickly.
• The reason for denial should be stated on your explanation of benefits.
• If you disagree with the basis stated for denial, check your policy or SPD for the health insurance company’s appeal procedures and internal remedies procedures.
• The health insurance company should be able to answer procedural questions about appeals over the phone.
• Follow these procedures exactly.
• Your appeal should be in writing and may require information from your doctor.
• Consult with an attorney if you have any questions or need help with any of these procedures.