HEALTH AND MEDICAL INSURANCE
One buys health and medical insurance to protect themselves and their families from the financial hardships that may result by accidents and illness. Whether before or after Affordable Care Act (ACA), often referred to as Obamacare or federal health reform, there are two (2) avenues of obtaining health insurance, one in which you purchase the health insurance directly from the insurer – Individual Health Insurance – and the other is where health insurance is obtained by and through your Employer – Group Health Insurance.
The rights one has against his or health insurer differ drastically depending upon whether you purchase your health insurance or you obtain the health insurance by or through your employer.
INDIVIDUAL HEALTH INSURANCE
You can directly contest your insurance company’s claims decisions and have the important right to bring a legal action seeking benefits under your health insurance policy, plus you can seek legal remedies against your health insurer generally not available to one who has Group Health Insurance. Importantly, your health insurer providing you Individual Health Insurance owes you a duty of GOOD FAITH AND FAIR DEALING. Your health insurer must treat you fairly and consider your interest at least equal to its own. If your health insurance company violates its duty of GOOD FAITH AND FAIR DEALING, you have the right to seek rights, benefits including damages for emotional distress and penalties including possible punitive damages that are generally not available to persons insured under Group Health Insurance. However, there are exceptions in which Group Health Insurance provided by and through an employer that is state (Nevada), county (Clark County or Washoe County), or City (Reno or Las Vegas) or a church then you have the same rights to being a legal action as those persons with Individual Health Insurance.
GROUP HEALTH INSURANCE
Group health insurance generally means your legal rights against the insurance company and/or employer who self-insures its employees’ health coverage are governed by a federal law called the Employment Retirement Income Securities Act (“ERISA”). The courts have determined that under ERISA, your legal rights against the insurer or self-insured employer are restricted and you are required to appeal your claims denial to the insurer or self-insured employer. One must follow the strict appeal rules set forth in your insurance policy or insurance plan and it is highly recommended that everyone obtains legal advice during the appeal process because usually only the appeal record can and will be considered by the court. Since the appeal is required before one can bring a legal action for the failure to provide health coverage, it is extremely important and in fact “critical” that one obtains an attorney during the initial appeal process. If the appeal record is inadequate then not only may it be difficult to find an attorney to take your legal matter, but it is unlikely that a lawsuit would result in getting your claim paid. Your legal rights are restricted such that even a successful lawsuit would only result in your receiving your denied benefits, with interest thereon and possibly reimbursement of attorney fees and costs.
ACT QUICKLY CONCERNING ANY CLAIM DENIAL OR FAILURE TO PAY YOUR CLAIM PROMPTLY. CALL LEVERTY & ASSOCIATES LAW CHTD. (775-322- 6636)
If your health insurer denied your claim, 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 Health Insurance Attorneys, Leverty & Associates Law Chtd. at (775) 322-6636 for a Free Consultation. Our goal is to help you understand your rights when dealing with your health insurance company. Leverty & Associates Law Chtd. has helped many persons whose health insurance claim has either been improperly denied or improperly terminated.