Insurance companies refusing to pay.
It is typical that liability insurers don’t want to pay claims, but it used to be rare that insurance we paid for—health insurance, home or automobile property insurance—would deny claims. That trend has been on the rise of late—it happened twice to my family alone!
We have represented homeowner’s whose fire damage claims were refused; a lady whose car was stolen, and the insurer refused to cover it; and a client in a single car wreck whose health insurer refused to pay the medical bills.
In my situation, a doctor recommended medical equipment for my sleep apnea, but my insurer refused to cover it. After almost a year of waiting, the insurer finally agreed to reimburse me for the purchase. One of our clients was not so fortunate, as the insurer refused to pay for a test that the doctor ordered, and the patient died while waiting for a review. When it comes to health insurance claims, delays can be deadly.
In each of these situations, our firm had to file a lawsuit. Insurers know that the majority of claims they refuse will “disappear,” and that means big profits. In situations where one’s own insurance refuses to pay, called first party or vexatious refusal cases, the power balance shifts because the insurer is subject to penalties including paying the policy holder’s attorney fees if they lose. The S.E. Farris Law Firm will continue to fight for clients whose insurance companies refuse to pay claims.
Insurance companies wanting money back.
Missouri is one of the few remaining states that does not require injury victims who recover from a negligent party to repay their health insurers in most cases. Medicaid, Medicare, and some self-funded or federally-funded plans have always been the exception here, but private insurers are not entitled to reimbursement. This is only fair—if you pay for two life insurance policies, the insurers both have to pay, regardless of how many policies you bought. That is the benefit for which you paid a premium.
We have seen an uptick in health insurers that are NOT entitled to recover from an injury victim requesting repayment, called subrogation. This ploy is successful on victims who don’t have an experienced attorney as they don’t know their rights. Even insurers who are entitled to subrogation, like Medicaid and Medicare, will often reduce the amount they recover in the right instances, but a client without an experienced and dedicated attorney is unlikely to get any reduction.
Reducing payments to health insurers has always been part of our focus here and will continue to be.
Medical providers who “game” injury victims.
Missouri’s health care lien statute is designed to help injury victims without health insurance get medical treatment. It guarantees payment to the health care provider who treats an injury victim from settlement or judgment in their injury case.
This statute is a trade-off of sorts—while the health care provider is protected with a guaranteed payment, the amount of the medical bill is subject to reduction if the settlement or verdict is not substantial, as the injury victim will receive half of any settlement or judgment after attorney fees and litigation expenses, and the medical providers receive the remainder. Even with a statutory reduction, the doctor or hospital often gets more than would have been paid under health insurance!
Some local hospitals refuse to file a lien against an injury case, preferring to sue to collect from the injury victim after the claim is settled. This harms the injury victim as the unpaid balance shows up on credit reports. It is a risky proposition for the health care provider as the absence of a lien and guaranteed payment leaves them to pursue an injury victim who may be judgment proof.
Those health care providers face additional risk with our clients, as we typically will defend a client against a medical bill lawsuit without charging them an attorney fee.
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