Bad-Faith Healthcare and Homeowner Damage Insurance Claim Denials, And Avoiding Payouts for Unsupported Claims
Surprisingly—throughout the New York metropolitan areas of Manhattan, Brooklyn, Queens, and upstate New York—many named in insurance policies are denied payment for their genuine health ailments or property losses.
The result is that this leads to the carrier stowing hundreds of thousands if not, millions of dollars that rightfully belongs to the insured who has already paid the premium payments.
Although each claim is different, bad faith claims stand apart from claim denials based on technical grounds.
Distilling the background and subcategories at play for carrier claim denials of insured submitted insurance claims, can shine light on a grey area of New York insurance law that remains today in the U.S. Being better informed of the rights and duties of an insurance company and insured each has can provide more assurance and comfort in knowing how to navigate the insurance claims denial appeals process.
It is worthwhile to learn more about the various kinds of insurance law coverage disputes that arise in big cities such as New York City, Brooklyn, Queens and upstate New York under insurance law by reading below.
What Forms the Bulk of Insurance Lawsuits Brought in New York City, Brooklyn, Queens and Upstate New York?
According to New York Department of Insurance, the problem of insurance disputes is fairly common enough for government agencies to investigate into deceptive insurance practices and bad-faith claim denials.
Upon bad-faith insurance denial there is a process firmly in place to get the insurance company to reverse its initial denial. For this reason, New York Department of Insurance requires that the insured who was denied first:
- Tell the company he or she intends to appeal, unless there is a medical emergency involved; then to
- File a complaint with the New York Department of Insurance.
- Ask for an insurance review, if necessary.
According to the bulletin of L’Abbate, Balkan, Colvaita & Contini, LLP, it is required for an insurance company to do business in New York to do the following:
- Conduct a proper investigation and/or evaluation and acknowledgment of the insured’s communication promptly when it is reasonable to do so.
- Timely negotiate a Settlement or timely negotiate.
- Do foresee a Verdict in Excess of the Policy Limits.
- Do inform the Insured of Settlement Negotiations.
- Do Attempt to Obtain Contribution to Settlement From the Insured.
- Act Reasonably On Account of Carrier’s Belief in Non-Coverage.
- Comparatively Evaluate Financial Risks.
- Do Take Into Account the Insured’s Conduct.
On the other hand, New York carriers are concerned about their right under the doctrine of “duty to defend and indemnify.” According to L’Abbate, Balkan, Colvaita & Contini, LLP review, typically when an individual or company is sued having insurance, there is no recognized “right” of the party sued to be automatically defended by the carrier. Instead, the right exists only to have the insurance company defend or pay for expenses to defend when a lawsuit is filed.
According to the international firm Hunton Andrews Kurth, frequently misunderstood concepts are the two duties “to defend” and “to indemnify.” Each duty has its own meaning that has serious implications in your insurance claims denial action. With a skilled New York insurance claim lawyer specializing in these kinds of insurance disputes, your odds of a just outcome are increased.
This may mean access to healthcare, recovery of property damages, costs of improvements to real estate, or reimbursement expenses incurred in defending against potentially frivolous claims.
Factors Making a Solid Case, or Exposing a Spurious Property or Healthcare for Claims in New Jersey, New York, New York
Under New York Civil Code Section 2601, an insured, also known as a first-party, who believes that he or she is the victim of bad-faith insurance claims denial relating to health care or property insurance, can file a claim with the state of New York’s Department of Financial Services.
Generally, the New York’s Department of Financial Services is responsible for protecting consumers against abuse by insurance companies and scams targeting vulnerable populations and the elderly.
Such programs affect the following areas of concern insurance law:
- rates, forms, and rules affecting the type of insurance (personal coverages such as auto, residential property, title, and credit insurance), or
- forms and rules for life insurance, car insurance, and health insurance.
On the side of the company or person accused of wrongfully denying a claim, or the first-party (the insured) needing indemnification, a skilled New York insurance claims attorney would be a reliable resource to use to be advised on these topics at the time of denial of payment or reimbursement.
By analyzing all pertinent legal issues and employing all available legal strategies created by the New York State Senate, Supreme Court of New York, The New York Court of Appeals and federal appellate courts, the injured or denied claimant could have a better footing on the protections available for consumers victims of personal injuries, scams or deceptive and fraudulent practices committed by large insurance companies.
Helpful Insurance Law Arguments for Resolving New York Insurance Law Insurance Coverage Disputes In Health Insurance Law
A controversial subject in insurance law recently in the US today has been the effect of the coronavirus on businesses that carry commercial insurance. According to the New York City-based law firm Wingate, Russotti, Shapiro, Moses & Halperin, LLP, there are innovative ways to have the carrier reimburse the business to avoid having to dissolve or declare bankruptcy.
Typically, government programs are a safety net for small businesses to rely upon. However, the concept of “interruption insurance” is another option you may consider pursuing so long as an effective legal argument can be made on your behalf to demonstrate that it applies.
Examples of such interruption include:
- loss of income and other damages suffered as a result of a disaster.
- A natural disaster, commonly understood.
- Disaster other than natural disasters such as “forced shut-downs” due to a non-natural disaster.
There are strong incentives to attempt to pursue these claim with the right New York insurance claims lawyer with extensive experience in these kinds of cases to recover the following:
- Fixed costs
- Overhead insurance coverage
- Temporary costs
- commission and training,
- other general “business-related expenses,”
- and/or lost streams of revenue.
Legal Advice: Why Do Policyholders Need to Hire a New York Insurance Claims Lawyer?
As many bar association-affiliated lawyers in New York State have valuable legal advice and legal services to offer at high prices, there are some concerns likely how much access to an insurance lawyer is worth as a personal advocate for a policyholder.
Based health and life insurance law nuances in New York, evaluating an insured’s policies, their meaning and predicting how the terms may be interpreted in your particular situation—are undoubtedly priceless in terms of notwithstanding the incredibly high average rate of New York lawyers and law practices, which can charge between reportedly $122 to $485 per hour, per Clio.com’s 2021 statistics.
Without the insured having a valued and trusted in-house or outside counsel as its disposal, you risk needless exposure to risk and increased liability. The ramifications are that many companies will face similar situations of having to close down affecting the local and national economy in ways that cannot be completely ascertained.
Why Should I Hire a Skilled New York Insurance Law Office for My ERISA Healthcare Claim Denial?
Given the fast-changing world of health care and business structures with personal injury, accident or wrongful death occurring at high rates involving devastating effects on homeowners and businesspeople alike, it is important to have a skilled New York lawyer who can distinguish him or herself from others in the field.
Whereas many New York law firms may be generally knowledgeable about how to represent a business entity, a particularly skilled and incredibly talented New York claims insurance attorney will be intimately familiar with the most recent decisions in employment law, ready and willing to use whatever tools in his or her arsenal to prosecute or defend the case.
Many top-rated law firms specialize in these cases, including Manhattan-based insurance law firm Hagelin Spencer, LLC, the Great Neck-based Greenblatt Agulnick Kremin, PLLC, Brooklyn-based JT Law Firm, among others in the surrounding areas, offer an initial free consultation to help strategize your best course of action during a time of stress and uncertainty about the future.
For such a New York law firm competent in insurance law, a specialist will ask you, the client, questions to maximize the value of your case or minimize liability in exploring your legal options—whether you are a relatively inexperienced small business owner, a large Manhattan corporation with real estate, or greater assets to protect, or a patient denied necessary treatment by a doctor or hospital.
Such legal representation often necessitates employing novel legal arguments and arguments for fundamentally changing the law to benefit you, the client at arbitration or at trial.
As a client whether for the organization or another party to an insurance coverage dispute, it is also imperative to share any business malpractice or personal insurance company policy maintained and investigate other potential actors responsible for the wrongful act causing personal injuries.
Also important is it that your attorney test the strength and validity of any insurance claim made.
Forming an Attorney-Client Relationship: Call a Bronx or Staten Island Insurance Claims Lawyer Today to Discuss Your Case and Odds of Victory for the Company!
Having the right insurance claims attorney on your side can navigate the vast and ever-changing landscape of New York employment law and ever evolving case precedent. The attorney-client relationship forms upon consultation when you consider hiring the attorney in Nassau, New York, New York, Westchester or other surrounding areas.
Once formed, this relationship helps prepare the client to bring a winning case to receive compensation where there is clearly established liability and avoid liability for healthcare and disability insurance claims that have no support in fact or law and lack supporting evidence.
Whether you are looking for a New York City, Brooklyn, upstate or nearby insurance claims lawyer, Lawsuit.org will help you pinpoint one in the right practice area by offering a free consultation to obtain the just results that an insured or carrier needs.