When can insurance companies be held liable for denying a claim?
Chicago, IL Personal Injury Attorney Mark P. Loftus talks about when insurance companies can be held liable for denying a claim.
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They can be liable when they don’t have a good faith basis for the denial, and one case which jumps to mind immediately is a represented the wife of a really nice young guy. He and his wife, before they got married, filed for life insurance – purchased life insurance. And not long after their marriage – and he was a young guy. He was probably only in his 20s. Not long after his marriage, he was diagnosed with a really rare and incredibly aggressive form of cancer. And it killed him within a matter of months.
And his wife came to me and said, “I’ve applied for the life insurance benefits, and they’ve denied ‘em on the basis of fraud.” And the insurance company – I filed suit and the insurance company took the position that this individual had been to the doctor a year or two prior to getting sick with a routine stomach ailment that was treated and he felt better and it was no big deal.
And they decided that that routine stomach ache somehow translated to some sort of precursor to this incredibly aggressive cancer. It was obviously kind of a shot in the dark. So, I filed suit. Ended up taking the deposition of a number of claims, handlers, and underwriters. And learned that in the claims process, people who had absolutely no medical training and very little supervision where making these decisions as to whether or not these claims would be covered.
And those decisions were being embraced wholeheartedly by their supervisors. And these claims where being denied. And thankfully, once it became apparent that decisions that should have been made by medical personnel were being made by low-level claims personnel without the appropriate training, the case resolved shortly thereafter.