Gianelli & Morris

If your insurance claim is denied, the insurance company is required by law to provide a reasonable explanation of the basis relied on in the policy for denying the claim. Failure to do so is an “unfair and deceptive act,” also known as insurance bad faith. Learn how the failure to explain a claim denial is treated under California insurance law. https://lnkd.in/giNCDven

Here’s one of the most frustrating aspects of dealing with insurance companies: when they keep requesting the same documentation in different ways. Are they just being inefficient, or is this a bad-faith insurance tactic designed to delay your claim? Learn about repeated requests for documentation and why this is a prohibited practice under California insurance law. https://lnkd.in/gEjisbvd

The California Department of Managed Health Care asked Anthem for information related to three different customer complaints. Each time, Anthem responded that yes, it had received a grievance from the enrollee, yet it never sent over a copy of the grievance as requested. DMHC fined them $10,000 per violation, and Anthem agreed to pay, yet they continue to make the same mistakes. Learn about these recent fines and other problems with Anthem’s grievance system, labeled as “defective” by the DMHC. https://lnkd.in/gjRh5Wvk

In 2017 Anthem was hit with $6 million in administrative penalties for its “defective grievance system.” Later that year it was fined $5 million more. Have they cleaned up their act yet? In the first three months of 2024, they’ve been assessed over $100,000 for the same kinds of violations. Read about Anthem’s never-ending faults in providing an effective system to resolve policyholder complaints of delayed and denied insurance claims. https://lnkd.in/g62EaKei

Section 790.03 of the California Insurance Code defines a long list of unfair insurance practices, many of which can have severely negative impacts on health insurance policyholders and life insurance beneficiaries. Learn about unfair practices in the business of insurance and how we can help. https://lnkd.in/gAURV8EY

Unreasonable delays. Denying claims without a valid reason. Misrepresenting policy provisions. Failing to conduct a thorough investigation. When insurance companies engage in bad faith insurance tactics like these, they can be held liable for all the harm their actions cause, including liability for punitive damages in many instances. Learn about bad faith insurance tactics regarding California life and health insurance policies. https://lnkd.in/gvNcC4DE

When you purchase a health or life insurance policy, you expect the insurer to uphold its promise and pay out claims promptly and fairly. Unfortunately, this is not always the case. Learn about unfair claim settlement practices in California insurance law. https://lnkd.in/gAURV8EY

Life insurance meets critical needs for people just when they need it most. Sadly, insurance companies don’t always act responsibly in paying claims timely or fully. To make sure they do sections 10170 through 10180 of the California Insurance Code spell out their obligations. Learn about life insurance payments and proceeds under California law. https://lnkd.in/guAm4ja6

Waiting around for the insurance company to authorize medical treatment, including surgery or some other procedure, can be agonizing, especially if the matter is urgent. A new California law could improve that process and get decisions to patients and providers faster...if the bill passes. Learn about Assembly Bill 3260 in the California legislature. https://lnkd.in/gwYFJFDS

Do you have life insurance? You probably know what terms like “premium” and “beneficiary” mean, but what about “contestability period,” “irrevocable beneficiary,” and “nonforfeiture benefit”? Your policy is probably packed with terms you don’t know but should. Read our glossary of life insurance terms. https://lnkd.in/gFUT-_8r