Bad Faith Insurance Claims: Tackling Denial of Health Benefits


Recent government discussions about health care reform have brought a number of issues to the surface regarding insurance practices in West Virginia and throughout the country. One of the biggest problems consumers have with insurance companies, regardless of political affiliation, is denial or gross underpayment of health insurance claims.

A lawyer can build a case against an insurance company for “bad faith” practices by proving that nothing in your policy stated that your claim could be denied for the reason given and that the company acted with recklessness disregard and/or malicious intention in your case. By definition, bad faith is the intentional or malicious denial to perform a contractually obligated duty and/or the fraudulent deception of another. Under the law, insurance companies (health care or otherwise) are required to pay claims properly and swiftly (good faith) and are prohibited from discounting, denying or unfairly denying payment of claims (bad faith).

You have the right to appeal any insurance claim you believe is in bad faith. A West Virginia attorney can help you prove your case so that you can recover all that is owed to you. Sometimes, if the case goes to trial, the judge may even order punitive damages above and beyond your policy limits in order to punish the company for their actions. In the future, policy limits may be eliminated through new health care legislation, but for now, many people are dealing with this issue and have valid grounds to pursue legal action against less-than-reputable insurance companies.