Insurance Claim RejectedI’m starting to notice a new, frustrating trend developing when it comes to the many, many ways that insurance companies try to get out of paying claims: denying or delaying medical payment coverage.

The biggest culprit is USAA, which used to be one of my favorite insurance companies due to the ethical way they handled claims, but they are rapidly dropping to the bottom of the list.

If you have included medical payment coverage on your insurance and you get into an accident, you obviously want to use it for your medical expenses. That’s why you have been paying for it all this time!

Well, I’m noticing two upsetting trends:

  1. Insurance companies are running claims by “medical professionals” (using the term loosely) to see if the expenses are legitimate, and
  2. They are even disputing claims that they should pay automatically within one year of an accident.

They sit at computers all day, paid to do this by insurance companies (where do you think their loyalties lie?), and they get to decide if a claim is too high and even if the treatment was related to the accident.

“Medical Professionals”

Increasingly, insurance companies are denying medical payment coverage based on the opinions of “medical professionals” that they have hired to review cases. This fires me up because people PAY for this coverage to help with medical expenses! They file claims for treatments that their doctors have ordered. And yet the insurance companies are going out of their way to dispute their clients’ claims by running each claim by their own cadre of nurses and doctors.

These nurses and doctors are probably not even licensed to practice in the state where the claim was made. They sit at computers all day, paid to do this by insurance companies (where do you think their loyalties lie?), and they get to decide if a claim is too high and even if the treatment was related to the accident. They never, ever lay eyes on the patient… only the claims and accident reports.

If this is happening to you, hire a lawyer and get your money.

Timing of Claims

When you purchase medical payment coverage as part of your insurance, the contract usually stipulates a maximum amount that you’re purchasing and it states that you must use the funds within one year of the accident.

Wouldn’t ya know? Now insurance companies are delaying and then denying claims that were made within that one-year window. The whole point of medical payment coverage is to pay for these things so that it’s not coming out of your pocket, possibly affecting your credit. By law, this payment has to be used before health insurance, so we are seeing clients completely stuck with bills because their medical payment coverage isn’t coming through and they can’t use their health insurance.

If this is happening to you, hire a lawyer and get your money.

What We Do

At the O’Sullivan Law Firm, we are proactive with medical payment coverage. We take steps up-front by sending letters to our clients’ insurance companies, reminding them of their contractual duty to pay. If they deny a claim, we demand that they provide any reports that they relied on from outside medical professionals.

We instantly and regularly remind companies of Colorado laws regarding bad faith and let them know that we have no qualms about suing them.

I recommend that, if you are having trouble with medical payment coverage and you don’t have a lawyer, you’ve got to get a lawyer. Fast. As soon as you encounter resistance, slow payment or a denial, get a lawyer on your side.