Austin Insurance Law Blog

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.

Employers typically present group healthcare plans as important employee benefits during the hiring and contract negotiation processes. Unfortunately, Texas insurers are not always enthusiastic about paying up — even when the people make claims for benefits that are well within the scope of the policies.

For those who come up against resistance while filing a claim, it is often important to realize that an important federal law protects the rights of employees. This often helps relieve some of the stress that comes from going against large, powerful institutions, such as insurance providers and employers.

Protecting your family financially is an important consideration. That is why, at the legal practice of Jon Michael Smith, our team does everything possible to hold Texas insurers to their promises. However, our ability to secure benefits or damages is limited by the scope of internal insurance company negotiations and courtroom proceedings. Choosing the right insurance policy could go a long way towards securing your family's future.

You might also want to look beyond insurance. Our life insurance dispute clients often suffer from an immediate lack of funds due to delayed or denied claims. While it may seem redundant, you might avoid this issue by keeping an emergency savings account to tide family members over until they resolve their insurance issue.

Life insurance is an important precaution that can be of immense help to beneficiaries at a difficult time in their lives. The last thing you want to hear when you are in the position of having to make a claim is that the insurer is delaying or even flat-out denying your claim.

One common situation when insurers conduct a close investigation into a policy's documentation is when the death occurs within Texas' contestability period. The law allows insurers to investigate and contest claims that beneficiaries submit within two years after the policy takes effect.