Health Insurance Claim Denial Lawyer Berkeley, CA

You pay for health insurance so that you don’t have to sacrifice your financial stability to access the care you need after an injury or illness. When the insurance company says they won’t cover a procedure or medication you need to get better, it can be stressful and discouraging. The Law Office of Bennett M. Cohen will stand up for your best interests. Schedule a consultation with our Berkeley, CA health insurance claim denial lawyer to learn what your legal options are for appealing the insurer’s decision. Call now to get our team started on your case.

When To Seek Legal Guidance For An Insurance Denial

If your health insurance provider denied a claim that you believe should have been covered under your policy, contact our attorney immediately. There are several reasons why you might get a denial letter, but the most common include:

• Seeking care with an out-of-network institution or physician
• The procedure, medication, or evaluation is not medically necessary
• The claim is connected to a pre-existing condition
• You or your care provider filed the claim incorrectly or late

In situations where your claim is denied based on medical ineligibility, our lawyer will build a case to negotiate with your insurer. We may compile your medical records, seek third-party evaluations/second opinions, and leverage expert testimony to prove that you need the requested treatments. Sometimes, denials are simply an administrative error, and our lawyer can quickly revise your claim to meet your insurer’s qualifiers.

Insurance policies are filled with complicated language and confusing stipulations. Adjusters know that you have limited knowledge of the system and use that to take advantage of their customers. Our insurance lawyer knows these tactics and won’t back down until a fair outcome is achieved.

Legal Options After A Denial Letter

It can be disheartening to receive a health insurance denial letter, but it is important to know that isn’t the end of the road. It is your right to appeal the decision and fight for coverage. Our law firm takes on the responsibility of crafting your appeal letter and negotiating with your insurer. If they are unwilling to settle, our Berkeley health insurance claim denial lawyer is prepared to take your case to court and present our findings to a judge.

Unfortunately, some insurance companies participate in bad faith practices, which means they are intentionally dishonest or unfair when approving/denying claims. If our lawyer finds evidence of bad faith, such as purposeful lies, misleading language, or unreasonable delays, we may suggest pursuing litigation. Our team will represent you in this case and guide you through every step of the process so that you can secure proper compensation and prevent other people from experiencing similarly poor practices.

We Push Back Against Health Insurance Denials

At The Law Office of Bennett M. Cohen, we understand how essential access to healthcare is. Medical procedures and medication are expensive, and you need those critical services to be healthy. If you have received a denial letter regarding a health insurance claim, you don’t have to battle your insurer alone. Our Berkeley health insurance claim denial lawyer is passionate about upholding the rights of policyholders. Don’t leave your case to chance. Call now to put your claim in the hands of a seasoned professional who will fight for you. Get started with a free consultation.

Types Of Disability Claim Services We Offer

Disability benefits are supposed to provide financial support – but if a claim is denied, you should contact a Berkeley, CA health insurance claim denial lawyer as soon as possible. At The Law Office of Bennett M. Cohen, we use our over 30 years of legal experience to help clients get the benefits they deserve.

Insurance companies delay, deny, or undervalue valid disability claims. Whether it’s a claim under an employer plan or a private policy, we focus on getting clear answers and real progress. Read on to see how we can help, and contact us today.

Denied Long-Term Disability Claims

We work with clients who have received a denial letter for long-term disability benefits, even when medical records clearly support their condition. In many cases, we help appeal the decision and request a fair review backed by strong documentation.

Delays In Processing Claims

Waiting too long for a decision can put a serious strain on individuals and their families. As your Berkeley health insurance claim denial lawyer, we’ll push back on unreasonable delays and follow up with insurance providers when claimants are left without clear updates or timelines.

Partial Benefit Awards

Some insurers approve claims but only offer a portion of the benefits owed. We review policy terms and challenge decisions that underpay our clients, especially when their medical restrictions clearly meet the plan’s full benefit criteria.

Appeals After Denials

For those who’ve already submitted a claim and received a denial, we handle the appeal process. This includes collecting updated records, drafting appeal letters, and pointing out where the insurer failed to give the claim proper review.

Misclassification Of Conditions

Sometimes, insurers mislabel or downplay a person’s medical condition to avoid full coverage. For example, labeling a mental health condition as short-term when it qualifies for long-term benefits. We review the insurer’s reasoning and respond with facts drawn from medical evidence.

ERISA Plan Claims

If your disability insurance comes through your job, it’s likely governed by a federal law called ERISA. We help clients work through the specific procedures required under this law, including strict deadlines and detailed written appeals.

Independent Medical Examinations

Insurance companies often ask claimants to attend exams with their own doctors. When the results are used to deny or limit benefits, we challenge the conclusions if they don’t match the ongoing care and history provided by the claimant’s treating physicians.

Surveillance And Social Media Disputes

Some insurers deny claims based on video surveillance or online posts taken out of context. We address these tactics directly and help explain how a brief moment doesn’t reflect the full picture of someone’s condition.

Private Disability Policy Claims

We represent individuals with disability coverage purchased outside of their employer. These private plans are often subject to state laws and contract terms, and we work closely with clients to hold insurers accountable under those specific agreements.

At The Law Office of Bennett M. Cohen, we’ve represented plaintiffs against corporate giants such as Shell Oil and Metropolitan Life Insurance Company. Our team helps clients push back on delays, unfair denials, and partial benefit payments. If you’ve had trouble with a disability claim, reach out to discuss your situation with a Berkeley health insurance claim denial lawyer you can trust.