Denied Insurance Claims

Many Insurance Companies Are Set Up To Deny Claims If At All Possible

In the real world, insurance companies carefully craft denials of claims to provide the appearance of validity and to discourage the insured from making a fair and justifiable challenge. However, when you put the insurer’s denial under the microscope, the denial often cannot be sustained.

When properly challenged, the insurer’s highly selective “review” of the medical and vocational evidence can be readily exposed. The medical and vocational “experts” whom, you are told in the insurer’s denial letter, support the denial are often revealed to be mere pawns of the insurer with whom they enjoy a longstanding and highly lucrative business relationship.

Many Insurance Companies Manufacture Pretexts To Deny Claims

Under California law, your insurance company must thoroughly investigate any basis that may support payment of your claim and cannot disregard evidence that supports your claim. However, insurance companies create pretexts to deny claims including, most commonly:

1. you have “no objective signs” or “no abnormality on exam” — even where your purported lack of objective signs or abnormality is irrelevant to why you are unable to work;

2. you are able to engage in “sedentary work” — even where your ability to sit has nothing whatsoever to do with why you are disabled from your job;

3. you fail to meet the “definition of disability” in the policy — even though the definition of disability in the policy, in fact, is illegal under California law;

4. your own treating doctor has stated that you are able to work — where, however, your treating doctor was never informed of the correct definition of disability under California law and obviously an incorrect definition in mind;

5. your own treating doctor does not support your inability to work — where, in fact, your doctor made an ambiguous statement about your working capacity that should and can easily be clarified — but your insurer elects not to do so and resolves the ambiguity in its favor.

When it comes to medical insurance, insurers commonly misconstrue key terms of the insurance policy such as “medical necessity” or “emergency care” to generate or buttress their denial of benefits. Medical insurers commonly assert inapplicable exclusions to deny your claim.

Bennett M. Cohen stands up for people whose insurance claim has been denied in bad faith. He will fight aggressively and effectively for you to recover the benefits you deserve.

What Are My Options If My Claim Has Been Denied?

If your insurance company has denied your claim or underpaid your claim, it is important that you seek counsel from an experienced insurance attorney. Once you know your rights under the law, you will be empowered to make the right decisions to obtain redress against the insurer.

At the Law Offices of Bennett M. Cohen, we represent individuals throughout California who have had their claims denied or benefits underpaid. Cohen has decades of experience successfully advocating for individuals whose benefits were unfairly denied due to the bad faith of insurers.

Contact Our Law Firm

We offer free initial consultations for new clients and are happy to schedule meetings at a time that is convenient for you. Located in San Francisco, we handle cases throughout the Bay Area and the surrounding regions of California. Call 415-864-3246, send us an email or use the inquiry box online. Our office is dedicated to providing timely and clear communication with our clients. When you contact the law office of Bennett M. Cohen, you will receive straightforward responses and practical answers to your insurance questions.