Watch out for these unfair and dishonest insurer tactics when filing a claim
In Montana, if your insurance company unjustly denies your personal injury or auto accident claim, you may have the right to bring an insurance bad faith civil suit against them. Montana law holds insurance companies responsible when they deny a claim that should have been paid as that denial.
However, simply because your claim was denied doesn’t mean that the insurer acted unfairly. You may not agree with an insurer’s decision, but only certain unfair and unjust actions may be considered acting in “bad faith.” Sometimes, determining whether or not an insurer acted in bad faith is difficult to do, which is why you may need to consult with an experienced Montana attorney who specializes in such cases.
In the meantime, here are 5 examples of common unjust insurance practices to help you better understand whether an insurance company may be held accountable for your denied claim.
Improper denial of a claim
There are several reasons an insurance company may offer as to why a claim was denied. It’s important to understand your policy in order to be sure the denial is proper. Your insurance company may tell you that the coverage is not included in the policy or that the treatment is “experimental.”
In some cases, they may claim that the medication or treatment is not necessary. There have also been instances where an insurance company has searched for pre-existing conditions after the claim is filed and then denied the claim based on the supposed pre-existing condition.
Improper denial of a specific benefit
In some cases, the entire personal injury claim may not be denied but certain treatments or benefits, such as payment of wages, may be denied. The insurance company may claim that you are not eligible for lost wages or that you don’t need a certain treatment, even though your doctor has determined the treatment is necessary. These denials often occur after car accidents, especially when the fault is unknown.
Utilization of a “hired gun” medical examiner
“Independent” medical exams are often used by insurance companies under the false belief that anyone claiming to be injured is making a fraudulent claim. You will be asked to submit to an independent medical examination that usually lasts less than 20 minutes.
In most cases, the examiner simply reads records provided to them by the insurance company. Because they are paid by the insurance company, their diagnosis may be far different than the one your doctor gave you. The doctor may claim you are “faking” your injury, allowing the insurance company to deny claims for medical treatments, medications, lost wages, rehabilitation and more.
Misinterpreting or misapplying the law
An insurance company may delay or deny a claim stating that they have no legal responsibility to pay when this is actually false. They may use a portion of the policy that applies to another type of claim to deny yours or may simply read the Montana law incorrectly and state that they don’t have a legal basis to pay the claim.
Not informing you of a legal entitlement to benefits
Once you have provided proof of loss in some way, the insurance company must immediately confirm or deny the claim. If they do not respond quickly or acknowledge the claim, they may be in breach of your contract. The company must also provide you with information on what you are entitled to claim under your policy.
Treating you differently because you hired a lawyer
You are entitled to hire an attorney for any type of insurance issue, and your insurance company may not treat you differently because you have done so. If your insurance company advises you not to hire an attorney or threatens non-payment if you do so, they may be liable in a civil suit.
They also cannot treat you or your attorney as an adversary, denying claims simply because you sought the advice of an attorney.
Montana bad faith insurance law
Under Montana’s Insurance Bad Faith Law, insurance companies must attempt to settle legitimate claims when liability is reasonably clear. However, they will often deny claims (even when they know they are valid) simply to hold onto your money, investing it and collecting interest, as long as possible.
If an insurance company does this to you, a civil lawsuit may be filed against the company. Damages you may receive in a bad-faith lawsuit include:
- Emotional distress
- Interest calculated from the date on which the claim should have been paid
- Punitive damages
In Montana, punitive damages are limited to $10 million or 3 percent of the insurance company’s worth, whichever is lower.
You pay your insurance premiums with the understanding that your insurance company will be there when you need them. When they act in bad faith, critical treatments may be delayed, your financial future placed in jeopardy and you may find it harder to focus on healing from injuries.
If you are dealing with an insurance company that is not paying claims under the requirements of your policy, contact the Murphy Law Office today. You can arrange for a free, no-obligation consultation by calling or filling out the easy online form to talk to one of our insurance litigation experts and find out what rights you have under the law.