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Austin Insurance Law Blog

Do not take an insurance provider's ethics for granted

Most of the insurance companies you are likely to encounter in the Texas marketplace aim for a high standard of professional ethics. They would assess the risks of carrying your policy, charge a fair premium and pay up in the event something unfortunate occurs. However, you should be aware that this is not always the case.

At the office of Jon Michael Smith, our team knows that any some insurers have a different way of doing business. We have seen some companies that deny claims to delay payment, others that have internal errors leading to unjust rejections and even a handful that are downright misleading in their policy documentation and sales processes. Our job is to review each potential clients' case to see which if any of these situations applies.

How a recorded statement can affect your insurance claim

Texas state laws require every individual who owns and operates a motor vehicle to carry insurance. When you get in an accident, you expect your insurance company will take care of the damage and your medical bills.

Insurance company adjusters obtain something called a recorded statement after filing a claim, and your answers affect how the insurance company proceeds. What is a recorded statement?

Top insurance claim errors to avoid

Whether you need to submit a claim on a homeowner's, disability, life or another type of insurance policy, the process can be complex. As a result, many people make one or more mistakes, leading to a denial or delay of the claim.

Even a denial does not always mean the end of the road; rather than giving up, you may be able to file an effective appeal. However, you can increase your chances of getting your claim approved sooner by avoiding some common errors.

Denied insurance claim: You need an experienced attorney

From health to auto insurance, you rely on these coverages when you need them most. Unfortunately, insurance companies frequently deny such claims for a litany of reasons. When it comes to health insurance claims, denials can result from minor transcription errors to using a provider out of your network. 

It is possible to appeal a decision, but it can be an incredibly complicated process. That is why you always want to retain the services of an experienced insurance attorney to assist you through this. 

Common reasons for life insurance claim denials

When you purchase a life insurance policy in Texas, chances are, you do so expecting that it will help your loved ones regain their financial footing after your passing. Similarly, if you are the beneficiary of a particular life insurance policy, you probably expect that you will have a certain amount of money available to you following the loss of your loved one. Attorney Jon Michael Smith recognizes that many life insurance providers deny claims for similar reasons, and we have helped many people facing life insurance claim denials pursue solutions that meet their needs.

According to Nerdwallet, there are numerous reasons your life insurance company may deny your claim, and some are more avoidable than others. It is essential, for example, that the policyholder pay all premiums in a timely manner, because failing to do so can lead to a lapse in coverage. The policyholder must also be truthful when completing the life insurance policy application in the first place, taking care to answer questions about smoking habits, medical history and similar matters honestly. This can prove particularly important if the policyholder dies within two years of purchasing the policy.

When is COBRA a good idea?

There is good healthcare available in Texas, but it is unlikely you would be able to easily handle the cost on your own. Your employer's group health care plan provides a crucial safety net: If you or your family members were to get injured or fall ill, the financial burden of dealing with medical bills on your own could be enough to completely change your way of life. 

There are many reasons that you might lose your group health coverage. Regardless of whether you remained on good terms with your employer, you could potentially retain your insurance policy temporarily via the Consolidated Omnibus Budget Reconciliation Act.

Filing an appeal after a denied ERISA claim

As a resident of Texas who has a long-term disability insurance policy through your place of employment, chances are, the tenets of the Employee Retirement Income Security Act of 1974 apply to your policy. Therefore, if you file a claim and receive a denial in response to it, you may be able to find a more favorable solution by filing an ERISA appeal. Attorney Jon Michael Smith has considerable experience helping employees file ERISA claim appeals, and he has helped many people facing similar circumstances pursue solutions that meet their needs.

According to the U.S. Department of Labor, your insurer may initially deny your claim for any number of reasons. The company may, for example, deny your claim because it says you were not eligible for benefits in the first place. It may, too, do so because you failed to submit enough information or documentation about your condition, or because you utilized services not covered by your current plan.

Insurance adjusters are not your friends

While there are many advantages to owning a home in Texas, there are also many significant issues that can arise in the wake of a catastrophic event. If your home becomes damaged or destroyed due to fire, plumbing leaks or severe weather, your insurance company will send an adjuster to assess the damage and determine the eligibility of your claim. You may assume that the insurance adjuster is working with your best interests at heart, but unfortunately, we at the law office of Jon Michael Smith have observed that the opposite is more often the case.

According to The Law Dictionary, the job of an insurance adjuster is to minimize the amount of money the insurance company has to pay out to you for damages to your home. In other words, they work for the insurance company, not for you, and though they may appear pleasant enough when interacting with you, they are not your friends. 

What does it mean to be an underinsured driver?

Being struck on a Texas road by a driver who does not possess insurance can be a true burden for the driver who was wronged, as the other motorist’s lack of coverage can make receiving compensation harder. But what does it mean if a driver is underinsured? While a driver that has been struck by an underinsured driver can still receive compensation, it will not be up to the level the injured party would receive if the other driver had adequate insurance.

Esurance explains that some motorists, while they do carry car insurance, may possess liability limits that are too low to fulfill the medical or repair bills of an injured party. When an underinsured driver hits your vehicle, you can expect the other driver’s insurance policy to pay out to the policy’s limit and no more. You would end up with only a partial payment for your damages and injuries.

Understanding your health plan’s internal appeals process

As a Texas resident with a health insurance policy, you have the right to question your insurer’s decisions if the company denies you coverage or decides to terminate your relationship. The first step in the process involves requesting what is known as an “internal review.” Attorney Jon Michael Smith is well-versed in the methods health insurers often use to deny claims, and he has helped many clients facing similar circumstances pursue appeals and other solutions to meet their needs.

According to HealthCare.gov, your health insurer may deny your claim for any number of different reasons, but you are within your rights to question, and if necessary, appeal, your health insurance company’s decision to deny you coverage. Your insurer may, for example, deny your claim if you had what it considered to be a “preexisting condition,” meaning you had the issue before your insurer started covering you. It may do the same if it considers certain treatments not medically necessary or experimental in nature, among other reasons.

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