Representing People With Denied Insurance Claims

Bad faith practices in health insurance

On Behalf of | Sep 1, 2022 | Insurance

When Oklahomans contract with a health insurance company, we expect them to be there for us when we need them. If we do not have our health, we do not have anything. But, what shocks many is that some health insurance companies act in bad faith or with unfair claims practices.

What does bad faith mean?

In insurance law, the term “bad faith practices” refers to cases in which a health insurance company (or any other type of insurance company) reneges on its obligation to pay when its customers have legitimate claims. In some cases, the insurance company unreasonably extends investigation periods in an effort to avoid paying the policyholder’s claim. A macabre practice is to stall health insurance claims so long that the policyholder dies.

Misrepresentation

Another bad faith insurance practice involves misrepresenting what is in the insurance contract to purposefully not pay a claim later. Some insurance companies also fail to disclose or misrepresent policy limitations and exclusions.

Reasonable discourse does not qualify

If you disagree with an adjuster’s opinion about the amount of the loss, that, by itself, does not qualify as bad faith. Similarly, a simple mistake, that is reasonably corrected later also does not qualify.However, if the adjuster does not provide and refuses to provide the reasonable basis for a  lower amount, then it can constitute bad faith.

Ignoring the client

Basing an insurance payout or an insurance finding on evidence that supports one conclusion, while totally excluding any evidence that supports an alternative or increased conclusion, can be evidence of bad faith. Even non-responsiveness can qualify.

Fighting back

If you think your insurance company is acting in bad faith, call them out. If the company does not correct the inaction, you may need to contact an attorney to fight back.