Charlottesville Health Insurance Claims Attorney
Assisting Virginians with Health Insurance Disputes
Insurance gives us peace of mind that there are contingencies should the unexpected occur. Smart, proactive insurance policies can provide lifelines to individuals and families in crisis, especially in scenarios where injuries are long-lasting or keep someone from returning to work. Bills do not stop coming just because you have been injured or required medical care, and insurance claim awards help bridge that gap.
Unfortunately, sometimes insurance companies will look for any reason to avoid paying out even the most open-and-shut, obvious claims. This can lead to a frustrating process where you go back and forth through a labyrinthine corporate bureaucracy in search of the compensation to which you are entitled. Companies sometimes have literal departments whose jobs are to try and poke holes in your claim or otherwise keep you from obtaining the benefits you are owed.
This breach in an agreement is frustrating on its own, but if you are pursuing an insurance claim, you are likely doing so in conjunction with a serious injury or illness, augmenting the problem. That is where our Charlottesville health insurance claims lawyer can help. Our legal team at Norton Health Law has substantial experience in numerous aspects of healthcare law, with our founding attorney having both legally represented corporate healthcare entities and served as a nurse in Virginia hospitals. We have encountered all sorts of healthcare insurance claims scenarios and consequently have a vast knowledge base to leverage in pursuit of a favorable result for your dispute.
Health Insurance Claim Disputes
It is no secret that cost is one of the biggest obstacles to quality healthcare in the United States. Premiums for health insurance can often balloon to a sizable portion of an individual’s monthly budget. When you are paying that much, that often, it is fair to expect your insurance company does their part when you go to the doctor, get routine treatment, or receive emergency care.
Sadly, health insurance companies often will do everything possible to avoid paying what is owed, even if your care is explicitly covered in the language of your insurance policy. This can lead to erroneous denials of claims, which means you could be on the hook for the high costs of healthcare. Fortunately, the state of Virginia has laws in place that help define how contracts, including insurance policies, must be legally interpreted.
Virginia law offers the following rules that can help you in a dispute against your insurance company:
- Plain meaning – a contract, including that of an insurance policy, will be parsed under the most obvious definitions and intentions of its language; this helps avoid trickery attempted through words or terms with double meanings or overly ambiguous verbiage
- Burden of proving exclusion – if an insurance company’s justification for denying your claim is that your care falls under an exclusion explicitly noted in your policy contract, the onus is on the company to prove why your case counts as an exclusion; unclear interpretations are slanted in favor of the insured
- Interpreting against the drafter – should your contract contain ambiguous language that can be read more than one way, with one benefiting you and the other benefiting the insurance company, the reading beneficial to you will be the one legally accepted
- Reasonability rule – your insurance company must act “reasonably” in its investigation of your claim and decisions involving it
Despite these rules, all of which heavily favor the insured over the insurer, many insurance companies will still attempt to wrongfully deny claims. This can represent a heavy burden on you if you are attempting to continue to access lifesaving care or are now facing enormous medical debts as a result of an insurance company’s refusal to pay what is owed.
Our Charlottesville health insurance claims lawyer at NHL is prepared to assist you in your fight against a wrongfully denied claim. We are empathetic to the urgency and suffocating uncertainty that can surround a claim in flux, and we will exercise every legal tool available in compelling insurance companies to honor your agreement.
Our legal team’s experience with numerous areas of the healthcare industry means we understand the importance of timely medical care and are committed to ensuring our clients are taken care of.