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Let an Experienced Miami Insurance Claim Lawyer Help Oftentimes, people acquire health insurance coverage thinking that they can rest easy knowing that they won’t have to worry about their insurer “paying out” in the event of serious illness or injury.  This is unfortunately not the case in reality, however — insurers are incentivized to avoid acknowledging coverage in borderline cases, and they may write in ambiguous terms and provisions to give themselves the opportunity to […]

Experienced Miami Health Insurance Lawyer   In the healthcare context, the insured are often surprised by the denial of their claims, and perhaps not unreasonably — when signing up for coverage, prospective policyholders are often sold an “ideal” of comprehensive coverage.  In essence, they are made to feel safe and secure.  The truth is substantially more complicated. Insurance companies will use any available justification to deny a claim.  This is particularly exacerbated in healthcare situations […]

Miami Health Insurance Lawyer Though healthcare insurance denials are common, many policyholders are shocked when they are denied benefits for having received a medical device at the behest of their treating physician.  In truth, healthcare insurers are built to deny as many claims as they can reasonably justify.  They profit and thrive on the expectation that you will not challenge their decision and that they will “get away” with not having to pay out the […]

Health insurance policyholders who are suffering from catastrophic or even life-threatening injuries, illness, and other medical conditions may find that their insurance carrier is not necessarily amenable to extending coverage to experimental treatments.  Though the outcome of an experimental treatment may not be certain, and though there may be concerns about efficacy, safety, and long-term health, there are many patients who are left with no other recourse. If your insurer has denied coverage for an […]

Miami Health Insurance Lawyer More than ever, Floridians suffering from injuries and illness — whether chronic or acute in nature — are seeking out alternative medical treatments (i.e., homeopathic remedies, massage therapy, traditional medicine, etc.) to resolve their health problems in a way that they feel comfortable with.  This trend is unsurprising.  In recent years, many have expressed their anxieties about the ubiquity of heavy pharmaceutical and surgical treatment in situations that might be more […]

In 1974, the Employee Retirement Income Security Act (ERISA) was enacted, thus creating new standards governing private employee benefit plans — such as employer-sponsored disability, health, and welfare insurance, among other plans.  In Florida and elsewhere, ERISA does not require that employers purchase private insurance coverage for their employees, but it does impose a stricter set of rules on such plans so that employee-policyholders are protected from the potential abuses of plan administrators and others. […]

In Florida, and elsewhere, health insurance policyholders are entitled to appeal adverse determinations by their insurer — such as a denial of coverage — and thereby request that the insurer conduct a full review of their original decision. The appeals process is the first of several steps in challenging the determination made by your health insurer.  After you have exhausted the internal appeals process, you can move forward with an external, third-party review of the […]

Insurers — whether in the health insurance context, or some other context — will look for any possible justification to support their denial of a policyholder’s substantial claims, however legitimate those claims may be.  Recent scandals plaguing health insurers have shaken the industry to its core and revealed that many health insurers do not enforce their guidelines or properly supervise their assessors, which can lead to systemic wrongdoing. If you have a legitimate health insurance […]

In Florida — and in other jurisdictions throughout the country — many health insurance claims are denied on the basis of the insurer evaluating the treatment that their policyholder received as “medically unnecessary” or “medically inappropriate” given the circumstances of the injury or condition.  Despite the fact that most insurers view the claims filed by their policyholders as little more than a nuisance, the gritty reality is that a denial can be life-changing.  Denial of […]

Whether you are injured in an accident in which there is an at-fault third-party and are attempting to recover damages through the third-party’s liability insurance, or whether you’re making a first-party claim with your own health insurer, the presence of a pre-existing condition could complicate recovery somewhat. Injury Must Be Distinct or Aggravated In Florida, you may recover for injuries that are either distinct from a pre-existing injury, or that have simply aggravated a pre-existing […]