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Is this not insurance bad-faith denial in uppercase?

On Behalf of | Sep 25, 2018 | Denied Insurance Claims

First things first. Without being even arguably facetious, it might be reasonably suggested that one highly specialized business company named the Good Sam Club should change its name to something else.

Like Bad Sam.

We think readers of our pro-claimants’ Oklahoma insurance blog at Mansell, Engel & Cole would almost universally agree with that. The key facts of the following story stress why.

A member of the Good Sam group, an entity that caters to RV owners, was staying at remote facilities in the California mountains when she was suddenly stricken by a life-threatening kidney ailment. A local ER doctor determined that she needed immediate help at a better-equipped facility and ordered her departure via an air ambulance. The woman had duly paid for Good Sam’s TravelAssist package, which covers emergency evacuations. Her partner contacted Good Sam as soon as the helicopter landed.

The bombshell hit a few days later with a phone call from a company rep stating that Good Sam would not pay a dime for the evacuation. It told the recovered patient that she was fully responsible for the staggering sum of $71,000.

Good Sam’s rationale proceeded from contractual fine print that mandates prior approval from the company for evacuations, with no exceptions.

That was of course questioned, given the sheer illogic of a near-death party taking time out to deal with bureaucrats rather than striving to remain alive.

“You can’t seek prior consent if you’re incapable of doing so,” commented one patients’ advocate upon hearing the Good Sam story. That individual counseled the immediate filing of a lawsuit.

Fortunately, the tab was ultimately picked up by the woman’s primary insurer.

That of course does nothing to lessen the spotlight on bad faith that surrounds the tale or the element of “bizarre” attaching to it that is noted in a recent in-depth media report.

That article underscores the outlier nature of an insurer denying a claim because an insured had “neglected to obtain prior approval for treatment in the midst of a medical emergency.”