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Attorney to help with medical insurance benefits??

Newark, NJ |

My father visited the United States and we bought a Visitor's Medical Insurance for him. After a couple of months, he suddenly fell ill and was diagnosed with a serious kidney related problem called Wegener's. My father is aged 62 years and has no prior medical history. He has visited US a couple of times earlier and on both occasions we never used the insurance at all.

However the insurance company has denied all his claims citing the reason as pre-existing condition. This is particularly ridiculous as medically there is no known cause for the Wegener's disease. The claims denied are anticipated to be around 30K USD. Please let me know if there is any legal action possible.

Attorney Answers 6

  1. You would need to get a copy of the actual insurance policy, a copy of the denial letter, and copy of all relevant medical records, prior to the purchase of the policy, and since the purchase of the policy, up to and including the medical care and treatment for Wegener’s.

    The causation of Wegener’s is irrelevant, in some ways, for a determination of whether the Wegener’s was pre-existing or not. Your father either had it before he bought the insurance or he did not – and that will be the case regardless of the cause.

    If your father did not have the disease prior to the purchase of the policy, and the medical records bear that out, then you have a right to pursue a claim against the insurance company (sometime through an appeal process, sometimes arbitration, sometimes in Court) for failure to properly pay on the claim. You should contact an attorney to discuss.

    Each case is fact sensitive, so all answers should be viewed as general advice only, and should never replace a thorough and in depth consultation with an experienced attorney. Further, an answer should not be seen as establishing an attorney-client relationship.

  2. You should gather any and all prior medical records, a copy of the policy and denial letter (stating why the insurance company is denying the claim) and consult with an attorney as soon as possible. Time limitations will apply so contact the attorney as soon as you can. Best of luck.

    *This information should not be construed to be formal legal advice nor the formation of a lawyer/client relationship.

  3. Yes you could sue for breach of contract and perhaps it is also bad faith, what did they rely on to make that determination?

    Please only call me if your case is in California as I am only licensed here and laws of other states may vary. I approach trials and issues from a legal and common sense approach, This is how the majority of judges I have appeared before in 40 years also make decisions. I do not intend by my advice to enter an attorney client relationship and in most cases advise to obtain legal representation. Sometimes if you can not afford it a consultation or limited scope representation is available. As an experienced attorney I can tell you, judges can be impatient, hate emotional arguments and over exagerations or lies. A brief outline of the problems and desired solutions is always best and I often in limited scope representations advise clients on how to proceed at time of hearing or trial and my fees are considerably less when I do not appear in court as it takes much less of my time.

  4. Can't do this if 2014 due to Obamacare......

  5. I agree with Mr Lindner. If there was no prior medical history of this disease then you may have a claim against the insurance company for coverage and maybe also for bad faith. You should bring your father's medical records (current and prior) and also a copy of the policy to an attorney with experience handling insurance disputes, bad faith claims, and consumer fraud. The policy may provide a mandatory appeal process and strict timelines, so the sooner the better.

  6. If your father had no previous diagnosis of Wegener's disease, it is not a pre-existing condition. Simple as that. Based on what you have shared, you have a good case and should be able to recover the benefits. Follow Attorney Miller's advice, and get an attorney who has experience with medical and disability insurance claims to assist you right away. You don't want to lose the benefits because you missed a deadline.

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