Mansell, Engel & Cole

Oklahoma City Insurance Law Blog

What factors commonly trigger insurance claim denials?

We wouldn’t reasonably expect at Mansell, Engel & Cole that our readers across Oklahoma could comprehensively cite all the applicable responses relevant to the above-posed headline query in today’s blog post.

We feel confident in assuming, though, that most followers of our insurance law blog could easily compile lengthy lists.

A look at post-disaster insurance claim responses

Tornadoes, lightning strikes, fires, high winds, ravaging hail, heavy rain, flooding, earthquakes … and more.

A recent national article citing the “perils” linked with natural disasters notes their broad-based and often catastrophic nature. Every one of the calamities listed above can destroy a home or business in an instant.

Recurrent question: What losses will insurance protect against?

We spotlighted the instantly scary word “temblor” in a recent Mansell, Engel & Cole blog post. We noted in our August 23 entry that temblors -- those earthquake-defining ground shakes that are never forgotten once experienced – are “top tier events that always command attention and dominate the news.”

They are also relatively common occurrences across Oklahoma, with the potential in any given instance to wreak devastation and nearly incalculable losses.

Yes, Oklahomans know a thing or two about earthquakes

"I Feel the Earth Move" is a classic Carole King-penned pop song of a generation ago.

Some Oklahoma residents might have flashed back on it recently when, a couple of Sundays back, earthquake temblors announced their always-scary presence in their locale of the state.

Filing an insurance claim for hail damage to your home

You pay for homeowners' insurance, and you rightfully expect that your insurance company will pay for any damage done to your home. This is how insurance companies and policies should work, but that is not always the case. In fact, many Oklahoma homeowners actually find that it is quite complicated to get what they need, even from a valid claim.

There are many reasons why you may need to file a claim, and one of the most common is damage to the roof and other areas caused by hail. Oklahoma sees many storms each year, and many of them can cause damage to your home. It can be helpful to know the signs of damage, what they can mean for your house and how you can fight back in case the insurance company acts unfairly.

A nemesis for some insureds: pharmacy benefits managers

It’s just “one more layer of bureaucracy,” says a disgruntled doctor.

That physician’s discontent – arguably, even rage – points straight toward a single participant in the health care system. Namely, that is the pharmacy benefits manager. So-called PBMs were largely nonexistent in the medical industry a few short years ago, but are now playing an increasingly key role as health insurance company adjuncts.

What is driving policyholder complaints against one large insurer?

“Unfortunately, far too many patients today receive care that’s not evidence-based.”

So says a principal with a company that runs interference for national health insurer Blue Cross Blue Shield. Dr. Eric Gratias and his company eviCore are recipients of outsourced work sent their way by BCBS. The entity plays a central role as a for-profit company in ruling upon care providers’ prior-authorization requests made on behalf of patients. Blue Cross authorization approvals and denials are based on eviCore’s recommendations.

Being proactive, resolute in the wake of an insurer’s denial

When a big dog gets up close and barks, many people freeze. Some panic and run.

That’s not a good idea where an insurance denial is concerned. Although the inclination of many policyholders receiving a denial letter from an insurer that has an unmistakable “this is nonnegotiable” tone to it is to just give up, those claimants are well advised to think again.

What do you need to file a claim for bad faith insurance?

When you pay for insurance coverage, you expect that the insurance company will provide the coverage as agreed in your contract. However, insurance companies are more interested in their bottom lines than your well-being, and sometimes, they may refuse to pay for a claim. In some cases, this is grounds to take legal action against the insurance provider.

Insurance companies have more experience, more legal power and more resources than you do. This can make it very difficult to settle a claim or get what you deserve after making a claim. Sometimes, a denied or delayed claim is the result of a provider acting unreasonably. This is called bad faith insurance, and while frustrating, there are ways you can take action and fight for what you need from your insurance company.

How should policyholders approach prior authorization demands?

Among perhaps a handful of candidates marking insurance-linked subject matter that drives doctors in Oklahoma and nationally to veritable distraction, so-called “prior authorization” likely tops the list.

If you’re a policyholder, you likely know what that is. And if you’re an insured who has personally dealt with prior authorization, it has undoubtedly frustrated you, too.

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