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Insurance Disputes

What is insurance? The commonly understand meaning is that you give your money to a big giant company and when you have an emergency, the insurance company gives you back your money, plus enough additional money to cover the emergency. Sounds like a good deal . . . right?

It’s only a good deal if the insurance company complies with its side of the bargain. Unfortunately, many insurance companies take your money, invest it, and think of a million reasons not to give it back to you when you need it most.

That is why there are strict regulations and laws to protect you from unfair insurance practices.

Disputes with insurance companies are some of the most frustrating experiences an individual can have. Usually, the insurance dispute arises at the worst possible time, when you have just suffered a tragedy.

Insurance companies have millions of dollars and high powered attorneys to fight any insurance claim they choose to fight. Only an equally smart and aggressive attorney who knows how to fight back can protect you.

The best way to get what you are entitled to from an insurance company is by producing tangible evidence that supports your claim. You would think that the insurance company would be on your side during a tragedy. But, typically, the insurance company becomes the adversary and you end up fighting the equivalent of a miniature trial to get what you are entitled to. Several examples are below:

(1) Why Doctor’s Hate Insurance Companies More Than Lawyers

A cottage industry has arisen where doctors have hired their own staff people or their own lawyers to do nothing but process their insurance claims. Every doctor and chiropractor I have ever known has had a dispute with an insurance company over payments owed to them for work they did on a person who was insured. All over the country, more and more doctors are suing insurance companies for wrongfully delaying or denying insurance payments. Sometimes doctors must wait months or years to get paid for work they have performed on insured patients. Recently, a federal court lawsuit was filed in Florida by several large medical associations against several insurance companies for routinely and unfairly delaying and denying insurance claims. The lawsuit was based on federal racketeering laws. If you are a doctor who is in a dispute with an insurance company, contact us. We may be able to help.

(2) Bad Foundation Insurance Dispute.

If you ever have a bad foundation caused by leaky plumping, the insurance company is likely to pay an expensive engineer a lot of money to generate a report that concludes that the foundation damage was not caused by the leaky plumbing, but by something else. The reason for this is that most insurance policies only cover foundation damage if it is caused by leaky plumbing. Therefore, they have an incentive to eliminate leaky plumbing as a cause. Expert reports such as these can cost the insurance company as much as $5,000.00. But this is much cheaper than actually paying your claim. Insurance companies know that you are not likely to shell out $5,000.00 of your own money to hire your own engineer to refute the insurance company’s engineer’s report. What most people don’t know is that insurance companies tend to use the same engineers over and over because they always give them the results they want. It is a symbiotic relationship. As long as these engineers keep giving the insurance companies the conclusions they like, they will keep getting hired. Often these reports are not as objective and scientific as you would like to think. Don’t be fooled. If you had the money, you could hire your own engineer, in many cases, to give the opposite conclusion. Then you would have the leverage to negotiate a settlement. I recently settled a case in just this way.

(3) Emergency Helicopter Insurance Dispute

Recently, my brother was seriously injured in a cycling accident in a major fundraiser bike ride from Houston to Austin, Texas. In the accident, he broke two ribs and was having trouble breathing. Any medical student knows that whenever you have broken ribs, there is always a possibility of a punctured lung. A doctor who was also cycling with the group that day came upon the accident and instructed the EMS technicians to airlift him out. As a result, he was airlifted to a hospital in Houston.

Wouldn’t you know it, a few weeks later, my brother received a letter from the hospital saying the insurance company was refusing to pay for the $10,000 helicopter ride, and that he was expected to pay the bill. My brother was shell-shocked. The reason the insurance company came up with for denying the claim was that the helicopter ride was “not medically necessary” (one of their favorite expressions). No one knew who the doctor was who happened to be cycling by the accident that day. So, it was impossible to get him to write a letter saying it was medically necessary.

Normally, I would have sent the insurance company a nasty letter demanding that they pay the claim. But to prove what the average person can do on his own, I simply instructed my brother to get a letter from another doctor explaining why it was medically necessary to be airlifted out of there. My brother got a doctor friend to write a letter for him. Then my brother wrote his own letter to the insurance company appealing the company’s decision, attaching the doctor’s letter as an exhibit. The insurance company capitulated and paid the claim.

If you are in a dispute with an insurance company, you have rights. Contact us.