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Austin Insurance Law Blog

Examples of bad faith insurance tactics

If you live in Texas and experience a car accident, develop a medical condition or otherwise have cause to file a claim with your insurance company, you may be counting on the entity to provide you with what you need to move forward. Regrettably, however, insurance companies sometimes prioritize profits over those they insure, which can leave you wondering how you will begin to rebuild without their assistance. Attorney Jon Michael Smith built a career upon going to bat against unethical insurance companies, and he has helped many victims of bad faith insurance seek appropriate recourse.

Per FindLaw, “bad faith insurance” essentially refers to unethical, unfair or dishonest practices on the part of an insurance company. Bad faith insurance tactics are not industry-specific, meaning they can arise from auto insurers, health insurers, homeowner’s insurers and so on. Bad faith insurance tactics can take on many different forms, though some are more common than others.

How can you fight an auto insurance claim denial?

If you, like many others across Texas, have ever filed an auto insurance claim after a car accident only to receive a denial in response, you probably understand all too well just how infuriating this can be. Expecting to receive a certain amount of money after your accident and then hearing that you will instead receive nothing at all can leave you scrambling to figure out how to make up the difference. You might be remiss, however, to simply accept your insurer’s claim denial without a fight, and there are certain steps you may be able to take to help fight your denial.

Per The Street, you may be especially wise to fight back against your insurer if the accident in question was not your fault, and you receive a claim denial despite fully understanding the terms of your policy. After all, insurance companies are businesses, and at the end of the day, they are out to make a profit – but you do want to make sure that they do not make that profit at your expense. So, what can you do to help argue your side?

3 things you should know about ERISA

If you have filed a claim with your health insurance only to have it denied, you know just how frustrating it is to face this situation. There is a myriad of reasons this might occur, but the result may leave you feeling as though you have hit a dead end. Many people do not realize that the Employee Retirement Income Security Act covers certain health care-related claims. 

ERISA, also known as the Employee Retirement Income Security Act, is a law passed in the 1970s that dictates administration of employee pensions and insurance. It exists to protect employees who receive such benefits through private companies facilitated by employers. If this applies to you, you should know the following three facts about ERISA.

Tips for avoiding a heath insurance claim denial

If you are a Texas resident who has ever had the unfortunate experience of having your health insurance claim denied, you may know full well just how anxiety-inducing this can be. An unexpected claim denial can leave you facing massive medical bills, leaving you in the hole without knowing how you are going to pull yourself out. Attorney Jon Michael Smith understands how upsetting it can be to have your insurance company deny your claim, and he has helped many clients facing similar circumstances pursue appropriate recourse.

Per Nerdwallet, insurance companies issue many health insurance claim denials for similar reasons, so recognizing factors that commonly lead to claim denials can help you avoid one in the first place. You may hear, for example, that you received a claim denial because you visited an out-of-network medical provider. Typically, insurance companies work with certain providers who have an existing understanding and agreement about billing practices, so check with any medical provider before signing on to make sure it falls within “your network.”

What COBRA and ERISA mean for employees

Anyone who has received health insurance benefits from an employer in Texas has probably benefited — indirectly, at least — from the Employee Retirement Income Security Act of 1974. Some have also taken advantage of a prominent amendment to this federal law: the Consolidated Omnibus Budget Reconciliation Act.

The United States Department of Labor describes COBRA as a way for former employees to continue using their employer's healthcare plans. The details, including who qualifies for coverage under COBRA and when, are highly conditional on the insured person's situation. 

The importance of disability insurance riders

An insurance rider is like a valuable feature added on to an automobile. While all automobiles can carry you from one location to another, you would not settle for just any vehicle from the lot. Instead, you would shop for the Texas automobile that matches whatever standards you are looking for. Similarly, not all long-term disability insurance is alike. One important feature to look for is the riders that the insurer offers along with the policy.

According to the Fox Business website, a rider is an add-on that can be attached to an insurance policy. A rider offers a particular benefit that can be made available to the policyholder in the event of a sudden life changing event. Some riders grant policyholders lump sums in the event they contract critical illnesses, like a stroke or a kidney disorder. These sums can help pay for the cost of treatment. Also, a policyholder who has contracted a terminal disease may have a rider that pays the holder a portion of the policy before the holder dies.

The facts about independent medical examinations

One way insurance companies may try to turn you down for an injury claim is to say that whatever injuries you have sustained are either exaggerated, misdiagnosed, or do not exist. Showing the results of medical exams from your Texas doctor that prove you have indeed been hurt can show you are deserving of benefits. But then an insurer throws another hurdle your way, claiming that you used a doctor that is too biased in your favor. They want an independent medical examination conducted instead before they will proceed with your claim.

There are several things anyone should understand about independent medical examinations. First, they are not always needed. According to Findlaw, if you are in a car accident and are only filing a claim for damages to your car, you do not need to undergo an independent medical examination since you are not filing for physical injuries. An independent exam is also not required if your injuries have already healed up.

What is uninsured motorist coverage and must I carry it?

Getting struck by a motorist who does not carry the proper insurance can add more frustration and anger on top of the damage your automobile has sustained. After all, the law requires motorists to carry insurance in the event of an accident, so it feels wrong that the at-fault motorist does not possess insurance to cover your damages. However, Texas drivers do have an available safeguard against uninsured motorists in the form of uninsured motorist coverage.

According to Nerdwallet, uninsured motorist coverage is an additional policy that some insurers offer that covers drivers in the event they are struck by another motorist who does not possess auto insurance. This coverage also may be used if a motorist is the victim of a hit-and-run. If the other party drives away without leaving behind insurance information, uninsured motorist coverage can still cover the damages of the motorist.

What is long-term disability insurance?

Regardless of your age, there is a chance that you could become disabled either through an accident or due to a medical condition. To help plan for your future and ensure you can still take care of your obligations in Texas should you become disabled, you have the option of getting long-term disability insurance. 

According to Insure.com, long-term disability insurance is designed to offer you an income when you cannot work. You can often this insurance as part of your benefits package at work, but you also can buy it privately.

Tactics insurance companies use to delay or deny claims

When you become ill or injured, or your property sustains damage, you look to your insurance provider to cover the cost of care or repair. After all, the whole point of having an insurance policy is to prepare for the time when an accident happens and you need that money back to pay for expenses.

However, insurers see things differently because they are primarily businesses. Their goal is to keep their pockets full. Even the best of companies with high ratings of customer service and satisfaction do not shell out all the money for every claim, or they would go out of business.

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Jon Michael Smith Attorney

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Austin, TX 78731

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