Everybody has problems at one time or another with insurance companies, whether it be complete denial of coverage, or a disagreement over a specific charge. Insurance companies are not in the business of protecting society from its ills - they're in the business of making money. More likely than not, an insurance company will lean more toward not paying out a claim, than paying one, because it protects its bottom line. Without a doubt, if there is an ambiguity in an insurance contract based on a particular fact situation, the insurance company will deny coverage.
Here is an example of a case The Neighbors Law Firm recently settled:
A woman presented to her family practitioner with a lump in her breast. Her doctor felt the lump and told her it was nothing to worry about. He recommended she perform a self-check breast exam and follow-up as needed. Being prudent, the woman took out a "cancer" insurance policy that would pay her a lump-sum payment should she be diagnosed with cancer. In the policy application, she was asked if she had been advised to have a test to determine malignancy. She answered "no," because in her mind a self-check "as needed" recommendation from her doctor was not advice to have a test for malignancy.
As fate would have it, forty days after taking out the policy, the woman went back to her doctor, who recommended at this point that a biopsy be performed. Unfortunately, the results came back as breast cancer. She made a claim against the insurance company for the lump-sum payment under the policy. As you would have guessed, the insurance company flatly denied coverage, asserting she had misrepresented the recommendation for a test for malignancy in her application.
The Neighbors Law Firm was contacted. Her doctor was interviewed, who said that when he originally examined the woman, she would have had no reason to believe that a self-check "as needed" recommendation would have been considered a recommendation for a test for malignancy. In his mind, a test for malignancy would have been a biopsy or a scan. He said he would testify to the same, if needed. Moreover, one of The Neighbors Law Firm's consultants reviewed the case and rendered an opinion to the same effect. A demand was made on the insurance company, and it settled the case quickly and quietly.
Patrick believes that insurance companies make it a practice to summarily deny questionable claims, with the hope that a given percentage of claimants will simply go away and not return. This is probably true, as many people don't know how to open the right avenues to get a fair hearing on their claim. Simply having an attorney make a case for your claim carries a great deal of weight.
Have you had an insurance claim denied that you believed was legitimate, whether it be life, health, auto, disability, property, home, or otherwise? If so, you should contact The Neighbors Law Firm immediately by calling (919) 550-6055 or by clicking the link below.
The Neighbors Law Firm, P.C.
301 Trestlewood Lane, Clayton, North Carolina, 27520
(919) 550-6055, Fax: (919) 550-6055