Bad Faith Insurance Claim Investigation
Bad faith insurance claim investigation involves the legal examination of a policyholder's denied insurance claim to determine if the insurer acted in bad faith by unreasonably denying coverage. Bad faith is defined as an insurance company's failure to uphold their fiduciary duties set forth in the contract existing between the insurer and the insured. When bad faith is suspected on the part of an insurer, an insurance claim investigation may take place in order to determine whether an actionable offense has been committed.
All insurers have a duty to act in accordance with good faith and fair dealing principles. This means that the interests of the insured are to be given priority over the interests of the company. Insurers must find a way to honor a policyholder's claim rather than looking for ways to deny it. They must also comply with all applicable state and federal laws (including the ERISA, COBRA, and HIPAA). Failure to adhere to these guidelines may result in insurance claim investigation, litigation, and penalties imposed on the insurer.
Insurance companies are notorious for coming up with a myriad of excuses intended to justify the denial of policy benefits. Some will claim that proper documentation was not received in a timely manner, that a certain benefit is not covered, that addition information must be provided, and much more. Professional insurance claim investigation conducted by a legal expert can analyze the reason provided for the denial of a claim to determine whether or not the insurance company acted in bad faith.
To avoid becoming the victim of bad faith insurance practices, it is helpful for consumers to familiarize themselves with the specific provisions set forth in their insurance policy. In cases where insurance is provided by an employer, individual employees may not have received a copy of the policy in its entirety. Employers do, however, have the right to access this information upon request. Analyzing the terms of an insurance policy is often the first step in the bad faith insurance claim investigation process.
In many cases, insurance claim investigation must first be handled through the insurance company's appeals and grievances department. This essentially means that another member of the insurance company will conduct an insurance claim investigation to determine whether or not to uphold the original denial of claims or to pay benefits to the policyholder. Once the company's internal regulation department has conducted an insurance claim investigation, the insured may then have the option of seeking legal remedy for the bad faith.
If you suspect that you may be the victim of a bad faith insurance dealing, it may be in your best interest to contact a legal professional as soon as possible. A qualified and experienced attorney knows the laws applicable to your case and can conduct an insurance claim investigation to determine how to best protect your legal rights and options.
For more information on bad faith insurance claim investigation, please contact us to speak to a reputable attorney in your area.
