Mansell, Engel & Cole

The troubling reality of denied claims for paying policyholders

It happens all the time.

It is quite common, in fact, for an individual in Oklahoma or another state who dutifully complies with health care policy requirements to be flatly denied coverage by an insurance company.

Can that ever be right?

Obviously, it would be hard to find anyone outside the insurance industry who would state that it is.

Insurance denial for covered policyholders is clearly a huge national problem. One respected patients' rights group states than nearly one-quarter of patients with a chronic illness have been denied coverage by their insurers.

Moreover, a survey indicates that more than 30 percent of chronically ill patients in the United States have skipped treatment because of coverage denial. Close to one-third of those individuals say that their health declined because of that.

A recent article discussing coverage denials stresses that, clearly, refused treatment renders those patients "more susceptible to negative health effects."

Some denials are concededly based on good-faith reasons provided by insurers (a treatment might be largely untested, for example), but many aren’t.

The bottom line: a policyholder who feels that he or she is being wrongly denied coverage for an illness should seek input from a proven patients' rights attorney who routinely challenges bad-faith insurers in denial cases.

Insurance companies command a superior position in many company-policyholder matters. They should never be allowed to exploit that in an unethical or illegal manner.

Questions or concerns regarding insurance denial can be directed to an insurance law attorney who advocates diligently on behalf of policyholders.

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