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Denied an Insurance Claim?

Cancer and Specified Disease Insurance

Cancer and Specified Disease Insurance provides benefits, usually directly payable to you, if you get the identified disease the policy specifically covers. A good example of this type of coverage is the coverage offered by AFLAC. There are many different types of these policies and the benefits vary considerably between insurers and even various insurance company policies. For example, some specified disease policies pay a certain amount to you while you are confined in a hospital; some policies pay a schedule of benefits to you – so much for surgery, chemotherapy, etc.; other policies pay a lump sum amount on the first diagnosis; while other policies pay monthly amounts while you suffer from the disease. These policies are usually not a replacement or substitute for health insurance nor are these policies supplement health insurance, as these policies do not pay a hospital or doctor but are pay you.

Cancer and Specified Disease Insurance Is Provided Either as (1) an Individual Policy or (2) as A Group Policy.

Individual insurance is generally insurance you buy on your own. If you purchase your cancer and/or specified disease insurance on your own but by or through your employer it still may be governed by ERISA and limit your legal rights and benefits.

Group insurance is insurance you generally buy through your employer or insurance that is paid for by your employer as part of your employee benefits. It is important to know whether you have a group insurance policy or purchased cancer and/or specified disease insurance through your employer because it can be governed by ERISA and dramatically limit your legal rights and benefits.

Your Rights If You Have Individual Cancer And/or Specified Disease Insurance Policy or you Obtained Your Disability Policy by or Through a State, County or City or Church Employer.

Generally, if you have individual cancer and/or specified disease insurance policy or you obtained your group disability insurance policy by or through any governmental entity (state, county, city), except the federal government, then you have certain rights when dealing with your insurance company:

  • Your insurance company must promptly pay your claim.

  • Your insurance company cannot deny or refuse to pay your claim unless it first investigates and evaluates your claim.

  • When investigating and evaluating your claim, your insurance company must

  • look for reasons to pay the claim.

  • If it denies your claim, your insurance company must give you the factual and legal basis for denying the claim.

Employee Retirement Income Securities Act (ERISA)

If you have a group cancer and/or specified disease insurance policy purchased through or provided to you by your employer and you are not employed by a state or local government, you still have the right to expect your insurance company to treat you fairly and in good faith. Generally, however, if you obtained your cancer and/or specified disease insurance through your employer, it is most likely that your remedies will be governed by an ERISA.

If your Cancer or Specified Disease Insurance Company denied your claim or terminated your benefits, it is important you immediately seek an attorney to assist you so that you do everything correctly to protect your appeal and legal rights. Contact your Reno Nevada Cancer and Specified Disease Insurance Attorneys, Leverty & Associates Law Chtd. at (775) 624-5276 for a Free Consultation. Our goal is to help you understand your rights when dealing with your Cancer or Specified Disease Insurance Company. Leverty & Associates Law Chtd. has helped many persons whose cancer and the specified disease insurance claim has either been improperly denied or improperly terminated.